Cayrac Mélanie, Letouzey Vincent, Ouzaid Idir, Costa Pierre, Delmas Vincent, de Tayrac Renaud
Obstetrics and Gynaecology Department, Caremeau University Hospital, Place du Pr Robert Debré, 30029 Nîmes cédex 9, France.
Int Urogynecol J. 2012 Mar;23(3):335-40. doi: 10.1007/s00192-011-1554-5. Epub 2011 Sep 2.
The objective of this paper is to study the reproducibility and anatomical risks of anterior sacrospinous ligament (SSL) fixation associated with paravaginal repair using the Pinnacle device (Boston Scientific).
Simplified bilateral anterior SSL fixation associated with paravaginal fixation through the arcus tendineus fascia pelvis (ATFP) was performed on five fresh cadavers using the Pinnacle device. Cadaver dissection was then performed by open pelvic surgery.
Eight SSL and ten ATFP were available for analysis. SSL fixations were optimal in four cases, too superficial in three cases, and too high in one case. Mean distance between SSL fixation and ischial spine was 18.6 mm (range 10 to 30 mm). Mean distance between SSL fixation and pudendal nerve was 6.5 mm (range 0 to 15 mm). ATFP fixations were optimal in five cases, good in four cases, and too superficial in one case. In one case (10%), the middle arm of the prosthesis was in contact with the ureter and traction on that arm resulted in ureteral kinking.
Anterior SSL fixation associated with paravaginal repair using the Pinnacle™ device was not reproducible every time in this cadaver study. These results confirm the need for specific training before starting anterior SSL fixations.
本文的目的是研究使用Pinnacle装置（波士顿科学公司）进行阴道旁修补术时，骶棘前韧带（SSL）固定的可重复性及解剖学风险。
使用Pinnacle装置，在五具新鲜尸体上进行了简化的双侧骶棘前韧带固定，并通过盆筋膜腱弓（ATFP）进行阴道旁固定。然后通过开放式盆腔手术进行尸体解剖。
有8条骶棘前韧带和10处盆筋膜腱弓可供分析。骶棘前韧带固定在4例中效果最佳，3例过浅，1例过高。骶棘前韧带固定点与坐骨棘之间的平均距离为18.6毫米（范围为10至30毫米）。骶棘前韧带固定点与阴部神经之间的平均距离为6.5毫米（范围为0至15毫米）。盆筋膜腱弓固定在5例中效果最佳，4例良好，1例过浅。在1例（10%）中，假体的中间臂与输尿管接触，牵拉该臂导致输尿管扭结。
在这项尸体研究中，使用Pinnacle™装置进行阴道旁修补术时，骶棘前韧带固定并非每次都能重复。这些结果证实了在开始骶棘前韧带固定之前进行特定培训的必要性。
