Musculoskeletal Research Center, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Women's Research Institute, Pittsburgh, PA, USA.
BJOG. 2013 Jan;120(2):224-232. doi: 10.1111/1471-0528.12077.
To define the impact of prolapse mesh on the biomechanical properties of the vagina by comparing the prototype Gynemesh PS (Ethicon) to two new-generation lower stiffness meshes, SmartMesh (Coloplast) and UltraPro (Ethicon).
A study employing a nonhuman primate model.
University of Pittsburgh, PA, USA.
Forty-five parous rhesus macaques.
Meshes were implanted via sacrocolpopexy after hysterectomy and compared with sham. Because its stiffness is highly directional, UltraPro was implanted in two directions: UltraPro Perpendicular (less stiff) and UltraPro Parallel (more stiff), with the indicated direction referring to the position of the blue orientation lines relative to the longitudinal axis of the vagina. The mesh-vaginal complex (MVC) was excised in toto after 3 months.
Active mechanical properties were quantified as the contractile force generated in the presence of 120 mmol/l KCl. Passive mechanical properties (a tissue's ability to resist an applied force) were measured using a multiaxial protocol.
Vaginal contractility decreased by 80% following implantation with the Gynemesh PS (P = 0.001), 48% after SmartMesh (P = 0.001), 68% after UltraPro Parallel (P = 0.001) and was highly variable after UltraPro Perpendicular (P = 0.16). The tissue contribution to the passive mechanical behaviour of the MVC was drastically reduced for Gynemesh PS (P = 0.003), but not for SmartMesh (P = 0.9) or UltraPro independent of the direction of implantation (P = 0.68 and P = 0.66, respectively).
Deterioration of the mechanical properties of the vagina was highest following implantation with the stiffest mesh, Gynemesh PS. Such a decrease associated with implantation of a device of increased stiffness is consistent with findings from other systems employing prostheses for support.
通过比较原型 Gynemesh PS（Ethicon）与两种新一代低刚性网片（Coloplast 的 SmartMesh 和 Ethicon 的 UltraPro），来确定脱垂网片对阴道生物力学特性的影响。
采用非人类灵长类动物模型的研究。
美国宾夕法尼亚州匹兹堡大学。
45 只经产恒河猴。
子宫切除术后经骶骨阴道固定术（ sacrocolpopexy）植入网片，并与假手术进行比较。由于 UltraPro 的刚度具有很强的方向性，因此将其以两种方向植入：UltraPro 垂直（较软）和 UltraPro 平行（较硬），所指方向是指蓝色定向线相对于阴道纵轴的位置。3 个月后，整块切除网片-阴道复合组织（mesh-vaginal complex，MVC）。
主动机械性能通过在 120mmol/L KCl 存在的情况下产生的收缩力来量化。使用多轴方案测量被动机械性能（组织抵抗外力的能力）。
Gynemesh PS 植入后阴道收缩力下降 80%（P=0.001），SmartMesh 植入后下降 48%（P=0.001），UltraPro 平行植入后下降 68%（P=0.001），UltraPro 垂直植入后变化很大（P=0.16）。Gynemesh PS （P=0.003）使 MVC 的组织对被动机械行为的贡献明显减少，但 SmartMesh （P=0.9）或植入方向对 UltraPro 没有影响（分别为 P=0.68 和 P=0.66）。
植入最硬的网片 Gynemesh PS 后，阴道机械性能恶化最严重。这种与植入器械刚度增加相关的下降与其他采用假体支撑的系统的发现一致。
