Dietz H P, Shek C
Nepean Clinical School, Nepean Hospital, University of Sydney, Penrith, New South Wales 2750, Australia.
Int Urogynecol J Pelvic Floor Dysfunct. 2008 Aug;19(8):1097-101. doi: 10.1007/s00192-008-0575-1. Epub 2008 Feb 13.
Levator ani muscle trauma is a common consequence of vaginal childbirth and detectable on digital vaginal palpation. To ascertain validity and reproducibility of this test, we saw 110 women for an interview, prolapse staging, digital vaginal palpation by two blinded examiners and four-dimensional translabial ultrasound. The mean age was 55.5 years (range 17-85) and the median parity was 2 (range 0-8). Three patients could not be assessed, leaving 107 datasets representing 214 assessments of a right or left puborectalis muscle. Levator defects were found in 21 women (20%) with nine bilateral defects. There was agreement between assessors in 173/214 (81%), k=0.411, signifying moderate agreement. Agreement with an independent blinded review of tomographic ultrasound data was k=0.495. Even after substantial training, the agreement between assessors using digital palpation for the diagnosis of levator trauma remains only moderate. There seems to be a substantial learning curve. Palpatory detection of major levator trauma is less repeatable than identification by ultrasound.
肛提肌损伤是阴道分娩的常见后果，可通过阴道指诊检测到。为确定该检查的有效性和可重复性，我们对110名女性进行了访谈、脱垂分期、由两名盲法检查者进行阴道指诊以及四维经阴唇超声检查。平均年龄为55.5岁（范围17 - 85岁），中位产次为2次（范围0 - 8次）。三名患者无法进行评估，剩下107个数据集，代表对左右耻骨直肠肌进行的214次评估。在21名女性（20%）中发现了肛提肌缺陷，其中9例为双侧缺陷。评估者之间的一致性为173/214（81%），k = 0.411，表明一致性中等。与断层超声数据的独立盲法复查的一致性为k = 0.495。即使经过大量培训，使用指诊诊断肛提肌损伤的评估者之间的一致性仍然仅为中等。似乎存在一个显著的学习曲线。通过触诊检测主要的肛提肌损伤的可重复性低于超声识别。
