Stafford Ryan E, Aljuraifani Rafeef, Hug François, Hodges Paul W
Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia.
Laboratory 'Movement, Interactions, Performance', Faculty of Sport Sciences, University of Nantes, Nantes, France.
BJU Int. 2017 Apr;119(4):619-625. doi: 10.1111/bju.13688. Epub 2016 Nov 11.
To investigate whether increases in stiffness can be detected in the anatomical region associated with the striated urethral sphincter (SUS) during voluntary activation using shear-wave elastography (SWE); to identify the location and area of the stiffness increase relative to the point of greatest dorsal displacement of the mid urethra (i.e. SUS); and to determine the relationship between muscle stiffness and contraction intensity.
In all, 10 healthy men participated. A linear ultrasound (US) transducer was placed mid-sagittal on the perineum adjacent to a pair of electromyography electrodes that recorded non-specific pelvic floor muscle activity. Stiffness in the area expected to contain the SUS was estimated via US SWE at rest and during voluntary pelvic floor muscles contractions to 5%, 10% and 15% maximum. Still image frames were exported for each repetition and analysed with software that detected increases in stiffness above 150% of the resting stiffness.
Pelvic floor muscle contraction elicited an increase in stiffness above threshold within the region expected to contain the SUS for all participants and contraction intensities. The mean (SD) ventral-dorsal distance between the centre of the stiffness area and region of maximal motion of the mid-urethra (caused by SUS contraction) was 5.6 (1.8), 6.2 (0.8), and 5.8 (0.7) mm for 5%, 10% and 15% maximal voluntary contraction, respectively. Greater pelvic floor muscle contraction intensity resulted in a concomitant increase in stiffness, which differed between contraction intensities (5% vs 10%, P < 0.001; 5% vs 15%, P < 0.001; 10% vs 15%, P = 0.003).
Voluntary contraction of the pelvic floor muscles in men is associated with an area of stiffness increase measured with SWE, which concurs with the expected location of the SUS. The increase in stiffness occurred in association with an increase in perineal surface electromyography activity, providing evidence that stiffness amplitude relates to general pelvic floor muscle contraction intensity. Future applications of SWE may include investigations of patient populations in which dysfunction of the SUS is thought to play an important role, or investigation of the effect of rehabilitation programmes that target this muscle.
研究在自愿激活过程中，使用剪切波弹性成像（SWE）能否在与横纹尿道括约肌（SUS）相关的解剖区域检测到硬度增加；确定相对于尿道中段最大背侧移位点（即SUS），硬度增加的位置和区域面积；并确定肌肉硬度与收缩强度之间的关系。
共有10名健康男性参与。将线性超声（US）换能器置于会阴的矢状中线上，靠近一对记录非特异性盆底肌肉活动的肌电图电极。通过US SWE在静息状态以及盆底肌肉自愿收缩至最大收缩力的5%、10%和15%时，估计预期包含SUS区域的硬度。每次重复时导出静态图像帧，并使用能检测出硬度增加超过静息硬度150%的软件进行分析。
对于所有参与者和收缩强度，盆底肌肉收缩均在预期包含SUS的区域内引起超过阈值的硬度增加。在最大自主收缩力的5%、10%和15%时，硬度增加区域中心与尿道中段最大运动区域（由SUS收缩引起）之间的平均（标准差）腹背距离分别为± 5.6 (1.8)、6.2 (0.8)和5.8 (0.7)毫米。更大的盆底肌肉收缩强度导致硬度随之增加，不同收缩强度之间存在差异（5%与10%，P < 0.001；5%与15%，P < 0.001；10%与15%，P = 0.003）。
男性盆底肌肉的自愿收缩与SWE测量的硬度增加区域相关，这与SUS的预期位置一致。硬度增加与会阴表面肌电图活动增加相关，这表明硬度幅度与一般盆底肌肉收缩强度有关。SWE的未来应用可能包括对认为SUS功能障碍起重要作用的患者群体进行研究，或对针对该肌肉的康复计划效果进行研究。
