Cacciari Licia P, Pássaro Anice C, Amorim Amanda C, Geuder Manfred, Sacco Isabel C N
Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil.
novel GmbH, novel.de, Munich, Germany.
J Biomech. 2017 Jun 14;58:139-146. doi: 10.1016/j.jbiomech.2017.04.035. Epub 2017 May 15.
We developed an intravaginal instrumented probe (covered with a 10×10 matrix of capacitive sensors) for assessing the three-dimensional (3D) spatiotemporal pressure profile of the vaginal canal. The pressure profile was compared to the pelvic floor (PF) digital assessment, and the reliability of the instrument and repeatability of the protocol was tested. We also tested its ability to characterize and differentiate two tasks: PF maximum contraction and Valsalva maneuver (maximum intra-abdominal effort with downward movement of the PF). Peak pressures were calculated for the total matrix, for three major sub-regions, and for 5 planes and 10 rings throughout the vaginal canal. Intraclass correlation coefficients indicated excellent inter- and intra-rater reliability and intra-trial repeatability for the total and medial areas, with moderate reliability for the cranial and caudal areas. There was a moderate correlation between peak pressure and PF digital palpation [Spearman's coefficient r=0.55 (p<0.001)]. Spatiotemporal profiles were completely different between tasks (2-way ANOVAs for repeated measures) with notably higher pressures (above 30kPa) for the maximum contraction task compared to Valsalva (below 15kPa). At maximum contraction, higher pressures occurred in the mid-antero-posterior zone, with earlier peak pressure onsets and more variable along the vaginal depth (from rings 3 to 10-caudal). During Valsalva, the highest pressures were observed in rings 4-6, with peak pressure onsets more synchronized between rings. With this protocol and novel instrument, we obtained a high-resolution and highly reliable innovative 3D pressure distribution map of the PF capable of distinguishing vaginal sub-regions, planes, rings and tasks.
我们研发了一种用于评估阴道三维（3D）时空压力分布的阴道内仪器化探头（覆盖有10×10的电容式传感器矩阵）。将压力分布与盆底（PF）数字评估进行比较，并测试了该仪器的可靠性和方案的可重复性。我们还测试了其对两项任务进行特征描述和区分的能力：PF最大收缩和瓦尔萨尔瓦动作（PF向下移动时的最大腹内用力）。计算了整个矩阵、三个主要子区域以及贯穿阴道管的5个平面和10个环的峰值压力。组内相关系数表明，对于整个区域和内侧区域，评分者间和评分者内的可靠性以及试验内的可重复性都非常好，而对于头侧和尾侧区域，可靠性为中等。峰值压力与PF数字触诊之间存在中等程度的相关性[斯皮尔曼系数r = 0.55（p < 0.001）]。任务之间的时空分布完全不同（重复测量的双向方差分析），与瓦尔萨尔瓦动作（低于15kPa）相比，最大收缩任务的压力明显更高（高于30kPa）。在最大收缩时，中前后区域出现更高的压力，峰值压力起始更早，并且沿阴道深度（从第3环到第10环 - 尾侧）变化更大。在瓦尔萨尔瓦动作期间，在第4 - 6环观察到最高压力，各环之间的峰值压力起始更同步。通过该方案和新型仪器，我们获得了高分辨率且高度可靠的创新性PF三维压力分布图，能够区分阴道子区域、平面、环和任务。
