未育女性盆膈裂孔和耻骨内脏肌生物力学的三维超声评估

目的应用经会阴三维超声动态观察未育女性盆膈裂孔，探讨其评估耻骨内脏肌生物力学的可行性。方法使用经会阴三维超声观察60例未育正常女性，分别在静息状态、Valsalva状态及缩肛状态下测量分析盆膈裂孔三维超声生物力学参数。结果60例未育女性的盆底结构均得以清晰显示。在静息状态至Valsalva状态的转变过程中，盆膈裂孔左右径、前后径、面积及周长均增大（P〈0．05），耻骨内脏肌角度增大，耻骨内脏肌拉伸、变薄（P〈0．05），应变值为（19．95±8．32）％；而在静息状态至缩肛状态的转变过程中，盆底内部结构变得更加紧凑致密，盆膈裂孔左右径、前后径、面积及周长均明显缩小（P〈0．05），耻骨内脏肌角度增大，耻骨内脏肌缩短、变厚（P〈0．05），应变值为（-19．01±6．43）％。结论经会阴三维超声能动态观察女性盆膈裂孔变化，并可评估耻骨内脏肌的延展性、收缩性等生物力学指标。

Evaluation of levator hiatus and pubovisceral biomechanics in nulliparas by three-dimensional ultrasound

Objective To dynamically observe levator hiatu by perineal three-dimensional ultrasound in normal nulliparas and to explore its feasibility in assessing the biomechanics of puboviscera. Methods Perineal three-dimensinal ultrasound was performed in 60 normal nulliparas in the condition of resting, Valsalva maneuver and anal sphincter contraction. The indices for biometric parameters of the puhovisceral muscle and levator biatus were determined in the three-dimensinal reconstruction planes. Results The pelvic floor structure of 60 subjects was clearly displayed by three-dimensinal ultrasound. During the period from the rest to Valsalva state, the hiatus＇ area, circumference, anteroposterior diameter and left -right diameter increased （P 〈 0.05 ）, the angle of the pubovisceral muscle increased（P 〈 0.05 ）, the thickness of the puboviseeral muscle decreased （P 〈 0.05 ） and the strain of pubovisceral muscle was （19.95~8.32）%. But during the period from rest to contracting state,the hiatus＇ area, circumference, anteroposterior diameter and left-right diameter decreased （P 〈 0.05 ） , the angle of the pubovisceral muscle increased （P 〈 0.05）,the thickness of the puhoviseeral muscle increased （P 〈 0.05）,the strain of pubovisceral muscle was （ - 19.01 ±6.43 ）%.Conclusion The perineum three-dimensional uhrasound can dynamically observe the change of levator hiatu and can estimate the hiomechanics parametersof pubovisceral muscle like traetility and myotility.