盆底肌力联合盆底超声评估分娩方式对产后早期盆底功能的影响

目的 探讨不同分娩方式对产后早期盆底解剖结构和功能的影响。方法 收集2015年4月~2016年7月在中山大学附属第三医院岭南医院分娩,并在产后6~12周复查的产妇共469例,按照分娩方式分为会阴侧切组187例、会阴裂伤组195例和选择性剖宫产组87例。应用盆底肌电生理仪和3D会阴超声两种评价方式评估三组产妇产后产后盆底Ⅰ类Ⅱ类肌纤维肌力异常率、膀胱颈位置、膀胱移动度、Valsalva动作后肛提肌裂孔面积、膀胱后角的开放率及尿道内口漏斗形成率差异。结果 产后盆底Ⅰ类和Ⅱ类肌纤维肌力的异常率分别为85.92%,84.86%,其中裂伤组的异常率89.74%,88.21%,高于剖宫产组的78.16%,74.71%,差异有统计学意义（P＜0.05）。其余组间比较,差异无统计学意义（P＞0.05）;三组间静息状态下膀胱颈的位置比较,差异无统计学意义（P＞0.05）;裂伤组及侧切组的膀胱移动度及Valsalva动作后肛提肌裂孔面积大于剖宫产组,差异有统计学意义（P＜0.05）,而侧切组与裂伤组比较,差异无统计学意义（P＞0.05）;侧切组及裂伤组的膀胱后角的开放率及尿道内口漏斗形成率高于剖宫产组,差异有统计学意义（P＜0.05）,侧切组与裂伤组比较,差异无统计学意义（P＞0.05）。结论 选择性剖宫产对盆底功能有一定的保护作用。阴道分娩的女性产后盆底组织结构变化较选择性剖宫产的更明显,会阴侧切对产后早期盆底的结构及功能影响无明显差异。     

盆底超声及盆底肌力评估分析分娩对女性肛门括约肌复合体的影响*

目的：探讨盆底超声及盆底肌力评估分析分娩对女性肛门括约肌复合体（ASC）的影响。方法：选取2018 年1 月～ 2019 年1 月于本院妇科门诊进行产后复查的患者,包括阴道分娩产妇（ 阴道分娩组）和剖宫产产妇（ 剖 宫产组）,2 组均进行妇科检查、盆底超声及盆底肌力评估,比较2 组肛门内括约肌（ IAS）近端平面、中部平面、 远端平面及肛门外括约肌（ EAS）远端平面3、6、9、12 点钟方向的厚度,耻骨直肠肌（ PRM）中部平面4、8 点钟方向的厚度,盆底肌力评估指标。结果：与剖宫产组IAS 近端6 点、12 点,IAS 中部12 点厚度测量值比较, 阴道分娩组显著降低;与剖宫产组EAS远端12 点厚度测量值比较,阴道分娩组显著降低;与剖宫产组Ⅱ类肌最 大收缩力和Ⅰ类肌持续收缩力比较,阴道分娩组显著降低,差异具有统计学意义。结论：盆底超声能够对顺产及 剖宫产产妇的ASC进行有效评估,与剖宫产产妇比较,顺产产妇产后IAS、EAS均发生较大改变,且顺产产妇产 后盆底Ⅱ类肌最大收缩力及Ⅰ类肌持续收缩力均降低。     

阴道分娩对盆底肌功能的影响及产后康复治疗的临床应用研究

目的：研究阴道分娩对盆底肌功能的影响及产后康复治疗的临床应用。方法选择我院妇产科2012年10月~2013年10月实施阴道分娩并行围产期检查的妇女100例,使用盆底功能筛查仪对产后6w的产妇盆底肌力进行评估,根据评估结果决定是否需进行盆底肌肉训练,对于接受训练的产妇,在产后3个月再次进行盆底肌力的测量,观察盆底肌力的变化情况。结果产后6w进行盆底肌力检测发现所有产妇均需进行盆底肌肉康复训练,3个月盆底肌力与产后6w相比明显增高,差异具有统计学意义(P<0.05)。结论阴道分娩会严重破坏盆底肌功能,在短期内不存在完全自主恢复的可能,通过产后盆底肌肉康复训练可以有效促进盆底肌功能的恢复,提高产妇生活质量。     

穴位敷贴+电针联合盆底肌肉康复训练对产后盆腔器官脱垂患者盆底肌力及性生活质量的影响

目的:旨在讨论穴位敷贴+电针联合盆底肌肉康复训练对产后盆腔器官脱垂(Pelvic Organ Prolapse,POP)患者盆底肌力及性生活质量的影响.方法:选取我院收治的产后POP患者150例,随机分为观察组与对照组各75例.对照组给予盆底肌肉常规康复训练,观察组在此基础上加用穴位敷贴和电针进行康复训练.比较治疗3个...     

基于超声弹性成像的女性盆底肌肉定量评估方法

女性盆底功能障碍性疾病是中老年女性的常见疾病,现已成为威胁女性健康的5种常见慢性疾病之一。盆底支撑结构中,盆底肌肉群的支撑作用至关重要,因此盆底肌肉评估对于女性盆底功能障碍性疾病的诊疗具有重要的临床价值。提出一种无创客观的肌肉运动分析方法,基于经会阴超声检测手段,同步获取50例具有不同脱垂程度女性主动收缩肌肉时的超声视频数据及阴道内压数据,应用二维弹性成像算法追踪盆底肌位移场,提取特征点的位移曲线,对比分析能有效完成指定动作的37例不同脱垂程度患者的位移结果,发现提取接近耻骨处特征点的切向位移参数(M_Pu)与临床脱垂测量参数(L_BP)具有相关性(r=-0.93),同时通过在指定的肌肉慢缩运动中的肌力维持时间均值和最大厚度均值对盆底肌的持续控制能力进行评估,结果与被试临床脱垂分级表现具有显著相关性。结果表明,这种方法可实现对盆底肌肉自身生物力学特性的客观定量评估,为临床脱垂诊断提供重要的参考价值。     

女性盆底肌力检测及临床分析

背景：了解女性盆底功能障碍性疾病在新疆多民族聚集区的发病相关因素、探寻能相对准确反映盆底功能的量化检查方法,对此病的三级预防起到不可或缺的作用。 目的：探讨女性盆底肌力的相关因素,并分析盆底肌力测定与女性盆底功能障碍性疾病临床症状、体征的相关性及临床意义。 方法：通过问卷调查、体格检查、盆底肌力检测收集2010年4至11月于新疆医科大学第一附属医院妇科住院女性患者资料共210例。采用秩和检验对分组变量进行分析,对有统计学意义的资料再进行Spearman秩相关分析。 结果与结论：年龄、体质量指数、不同分娩次数、绝经、慢性便秘持续时间与盆底肌力呈负相关性;压力性尿失禁症状、盆腔器官脱垂体征与盆底肌力均存在负相关性。提示：控制体质量,减少慢性便秘的发生;做好围绝经期激素替代治疗;从产科因素控制孕产妇盆底组织受损程度,引起患者对自身盆底肌力的重视,利于盆底功能障碍性疾病提早预防及治疗。     

女性压力性尿失禁患者盆底肌形态改变的磁共振成像评价

目的 磁共振成像(MRI)技术探讨女性压力性尿失禁(SUI)患者盆底肌形态的改变.方法 自2006年1月至2008年6月间,21例SUI患者(尿失禁组)以及10例正常控尿成年女性(对照组)入组研究.所有对象均分别在平静状态以及屏气用力状态下行盆腔MRI扫描.分析尿失禁组和对照组两种状态下耻骨直肠肌厚度以及肛提肌裂隙面积的变化情况与SUI之间的关系.结果 无论在平静或屏气用力状态下,尿失禁组左、右侧耻骨直肠肌厚度均较对照组薄(均P<0.05).尿失禁组肛提肌裂隙多呈横径增宽的纵向椭圆形,平静状态下裂隙面积较对照组大[(1893.44±218.44)mm2比(1661.86±206.62)mm2,P<0.05].尿失禁组阴道呈"H"形占33.3%(7/21),提示存在阴道侧壁损伤占66.7%(14/21);对照组阴道呈"H"形占80.0%(8/10).尿失禁组阴道侧壁损伤明显高于对照组(P<0.05).结论 女性压力性尿失禁患者左、右侧耻骨直肠肌厚度变薄,肛提肌裂隙明显增大.MRI在评价女性SUI患者的肛提肌形态改变的检测中结果可信,能为临床治疗提供明确信息.     

不同分娩方式对产后盆底超声指标及盆底肌力的影响

目的:探讨不同分娩方式对产后盆底超声指标及盆底肌力的影响。方法:纳入2018年1月至2019年1月我院产科选择性剖宫产的40例产妇和经阴道分娩的40例产妇分别作为观察组和对照组。两组产妇产后7～8周均接受盆底超声以及盆底肌力检查,比较两组产妇产后盆底超声指标及盆底肌力相关指标检测结果差异。结果:观察组产妇产后静息状态和Valsalva状态下膀胱尿道后角、尿道倾斜角均低于对照组(P0.05),宫颈外口位置、膀胱颈位置均高于对照组(P0.05);观察组产妇产后前静息平均值、后静息平均值、快肌最大值、慢肌平均值、混合肌平均值均高于对照组(P0.05)。结论:剖宫产对盆底结构、功能以及盆底肌力影响更小,发生盆底功能障碍性疾病的风险更低。     

肌桥内肌纤维相对长度及截面积的差异对缺损神经再生的影响

目的 :探求较理想的肌桥。方法 :对取材于犬的不同部位的肌桥内肌纤维相对长度和截面积进行镜下观测及桥接缺损神经的实验观察。结果 :缝匠肌的肌条内肌纤维与肌条长轴平行并且多与肌条等长 ;指浅屈肌肌纤维走向与肌条长轴夹角较大而且不与肌条等长。不同肌条的肌纤维截面积有很大差异 ,其中肌纤维走向与肌条长轴夹角较大的肌纤维的截面积也较大。由相对长度较大的肌纤维为主要构成的肌桥缝接缺损神经的再生效果较好。结论 :肌桥内肌纤维的相对长度的差异对缺损神经再生有较大影响     

Smooth muscle of the male pelvic floor: An anatomic study

Knowledge of the anatomy of the male pelvic floor is important to avoid damaging the pelvic floor muscles during surgery. We set out to explore the structure and innervation of the smooth muscle (SM) of the whole pelvic floor using male fetuses. We removed en-bloc the entire pelvis of three male fetuses. The specimens were serially sectioned before being stained with Masson's trichrome and hematoxylin and eosin, and immunostained for SMs, and somatic, adrenergic, sensory and nitrergic nerve fibers. Slides were digitized for three-dimensional reconstruction. We individualized a middle compartment that contains SM cells. This compartment is in close relation with the levator ani muscle (LAM), rectum, and urethra. We describe a posterior part of the middle compartment posterior to the rectal wall and an anterior part anterior to the rectal wall. The anterior part is split into (1) a centro-levator area of SM cells localized between the right and left LAM, (2) an endo-levator area that upholsters the internal aspect of the LAM, and (3) an infra-levator area below the LAM. All these areas are innervated by autonomic nerves coming from the inferior hypogastric plexus. The core and the infra-levator area receive the cavernous nerve and nerves supplying the urethra. We thus demonstrate that these muscular structures are smooth and under autonomic influence. These findings are relevant for the pelvic surgeon, and especially the urologist, during radical prostatectomy, abdominoperineal resection and intersphincteric resection. Clin. Anat., 2019. © 2019 Wiley Periodicals, Inc.     

Twisted orientation of the muscle bundles in the levator ani functional parts in women: Implications for pelvic floor support mechanism

This study presents a comprehensive investigation of the anatomical features of the levator ani muscle. The levator ani is a critical component of the pelvic floor; however, its intricate anatomy and functionality are poorly understood. Understanding the precise anatomy of the levator ani is crucial for the accurate diagnosis and effective treatment of pelvic floor disorders. Previous studies have been limited by the lack of comprehensive three-dimensional analyses; to overcome this limitation, we analysed the levator ani muscle using a novel 3D digitised muscle-mapping approach based on layer-by-layer dissection. From this examination, we determined that the levator ani consists of overlapping muscle bundles with varying orientations, particularly in the anteroinferior portion. Our findings revealed distinct muscle bundles directly attached to the rectum (LA-re) and twisted muscle slings surrounding the anterior (LA-a) and posterior (LA-p) aspects of the rectum, which are considered functional parts of the levator ani. These results suggest that these specific muscle bundles of the levator ani are primarily responsible for functional performance. The levator ani plays a crucial role in rectal elevation, lifting the centre of the perineum and narrowing the levator hiatus. The comprehensive anatomical information provided by our study will enhance diagnosis accuracy and facilitate the development of targeted treatment strategies for pelvic floor disorders in clinical practice.     

Topography and landmarks for the nerve supply to the levator ani and its relevance to pelvic floor pathologies

The aim of this study was to explore the anatomical variations of the nerve to the levator ani (LA) and to relate these findings to LA dysfunction. One hundred fixed human female cadavers were dissected using transabdominal, gluteal, and perineal approaches, resulting in two hundred dissections of the sacral plexus. The pudendal nerve and the sacral nerve roots were traced from their origin at the sacral foramina to their termination. All nerves contributing to the innervation of the LA were considered to be the nerve to the LA. Based on the spinal nerve components, the nerve to the LA was classified into the following categories: 50% (n = 100) originated from S4 and S5 (type I); 19% (n = 38) originated from S5 (type II); 16% (n = 32) originated from S4 (type III); 11% (n = 22) originated from S3 and S4 (type IV); 4% (n = 8) originated from S3, S4, and S5 (type V). Two patterns of nerve termination were observed. In 42% of specimens, the nerve to the LA penetrated the coccygeus muscle and assumed an external position along the inferior surface of the LA muscle. In the remaining 58% of specimens, the nerve crossed the superior surface of the coccygeus muscle and continued along the superior surface of the iliococcygeus muscle. Damage to the nerve to LA has been associated with various pathologies. In order to minimize injuries during surgical procedures, a thorough understanding of the course and variations of the nerve to the LA is extremely important. Clin. Anat. 29:516–523, 2016. © 2015 Wiley Periodicals, Inc.     

经会阴三维超声联合实时剪切波弹性成像评价产后女性盆底功能的研究

目的探讨经会阴三维超声联合实时剪切波弹性成像(SWE)评价初产后女性盆底功能的价值。方法选择50例产后6~8周首次经阴道分娩产妇作为产后组,年龄22~33岁,平均年龄28.02岁。同时选择41例健康未育女性作为对照组,年龄20~34岁,平均年龄26.73岁。应用经会阴三维超声和SWE分别测量静息期和缩肛期肛提肌裂孔的前后径、左右径、面积、周长、肛提肌厚度,以及耻骨直肠肌的弹性模量值(即杨氏模量值),并进行两组间比较。结果产后组静息期和缩肛期肛提肌裂孔前后径、左右径、面积、周长均较对照组大,而肛提肌厚度和耻骨直肠肌的杨氏模量值均较对照组减小,差异有统计学意义(P<0.05)。产后组静息期和缩肛期肛提肌裂孔面积与耻骨直肠肌弹性均无显著相关性[静息期(左侧:r=-0.0589,P=0.684;右侧:r=-0.200,P=0.164);缩肛期(左侧:r=-0.275,P=0.053;右侧:r=-0.208,P=0.148)]。结论经会阴三维超声联合实时SWE可以更好地客观、准确评价产后女性盆底功能。     

左额窦扩大为额眶上壁窦一例

盆底功能障碍性疾病是一种多发于中老年女性的疾病,对患者的生活质量有明显影响。盆底支持结构异常 是该疾病发生的主要因素。盆底肌在盆底支持结构中占主要作用,协同盆底筋膜共同构成一个紧密的盆底封闭结 构。了解盆底复杂的解剖结构对临床治疗盆底功能障碍性疾病尤为关键。对盆底的解剖结构研究已发展出多个理 论与学说,但尚未达成一个明确统一观点,本文主要针对盆底肌解剖、功能的研究现状及研究方向进行综述。     

多维健康教育模式在孕产妇妊娠及产后盆底肌锻炼中的运用

目的:建立妊娠及产后盆底肌锻炼多维度健康教育模型,并探讨其在临床的运用价值.方法:以2016年1至5月在郑州大学第一附属医院产科门诊规范产检的146名孕妇为研究对象,按照患者门诊号顺序进行随机分组,其中对照组采取传统的健康教育模式,观察组采用多维健康教育模式,比较两组患者干预后盆底康复锻炼健康知识水平、康复锻炼的依从性、分娩方式、盆底肌力变化情况及产后盆底功能障碍疾病的发生情况.结果:观察组盆底肌锻炼相关健康知识水平和依从性均明显高于对照组,两组分娩方式无明显差异;产后3个月观察组盆底Ⅰ类和Ⅱ类纤维肌力明显高于对照组,且观察组产后尿失禁发生率和盆腔脏器脱垂程度明显低于对照组.结论:在妊娠期及产后开展多维度的健康宣教,可提升孕产妇盆底肌锻炼相关健康知识水平和盆底康复锻炼的依从性;有效降低盆底功能障碍性疾病的发生率,在临床值得进一步推广.     

In vivo visualization of the levator ani muscle subdivisions using MR fiber tractography with diffusion tensor imaging

Understanding the levator ani complex architecture is of major clinical relevance. The aim of this study was to determine the feasibility of magnetic resonance (MR) fiber tractography with diffusion tensor imaging (DTI) as a tool for the three-dimensional (3D) representation of normal subdivisions of the levator ani. Ten young nulliparous female volunteers underwent DTI at 1.5 T MR imaging. Diffusion-weighted axial sequence of the pelvic floor was performed with additional T2-weighted multiplanar sequences for anatomical reference. Fiber tractography for visualization of each Terminologia Anatomica-listed major levator ani subdivision was performed. Numeric muscular fibers extracted after tractography were judged as accurate when localized within the boundaries of the muscle, and inaccurate when projecting out of the boundaries of the muscle. From the fiber tracking of each subdivision the number of numeric fibers (inaccurate and accurate) and a score (from 3 to 0) of the adequacy of the 3D representation were calculated. All but two volunteers completed the protocol. The mean number of accurate fibers was 17 ± 2 for the pubovisceralis, 14 ± 6 for the puborectalis and 1 ± 1 for the iliococcygeus. The quality of the 3D representation was judged as good (score = 2) for the pubovisceralis and puborectalis, and inaccurate (score = 0) for the iliococcygeus. Our study is the first step to a 3D visualization of the three major levator ani subdivisions, which could help to better understand their in vivo functional anatomy.     

Interactive three-dimensional teaching models of the female and male pelvic floor

Controversies regarding structure and function of the pelvic floor persist because of its poor accessibility and complex anatomical architecture. Most data are based on dissection. This “surgical” approach requires profound prior knowledge, because applying the scalpel precludes a “second look.” The “sectional” approach does not entail these limitations, but requires segmentation of structures and three-dimensional reconstruction. This approach has produced several “Visible Human Projects.” We dealt with limited spatial resolution and difficult-to-segment structures by proceeding from clear-cut to more fuzzy boundaries and comparing segmentation between investigators. We observed that the bicipital levator ani muscle consisted of pubovisceral and puborectal portions; that the pubovisceral muscle formed, together with rectococcygeal and rectoperineal muscles, a rectal diaphragm; that the external anal sphincter consisted of its subcutaneous portion and the puborectal muscle only; that the striated urethral sphincter had three parts, of which the middle (urethral compressor) was best developed in females and the circular lower (“membranous”) best in males; that the rectourethral muscle, an anterior extension of the rectal longitudinal smooth muscle, developed a fibrous node in its center (perineal body); that the perineal body was much better developed in females than males, so that the rectourethral subdivision into posterior rectoperineal and anterior deep perineal muscles was more obvious in females; that the superficial transverse perineal muscle attached to the fibrous septa of the ischioanal fat; and that the uterosacral ligaments and mesorectal fascia colocalized. To facilitate comprehension of the modified topography we provide interactive 3D-PDFs that are freely available for teaching purposes. Clin. Anat. 33:275–285, 2020. © 2019 Wiley Periodicals, Inc.