Rejano-Campo M, Desvergée A, Pizzoferrato A C
Service de médecine physique et de réadaptation, CHU de Caen, CHU de Caen Normandie, 14000 Caen, France.
Service de médecine physique et de réadaptation, CHU de Caen, CHU de Caen Normandie, 14000 Caen, France.
Prog Urol. 2018 Mar;28(4):193-208. doi: 10.1016/j.purol.2017.12.007. Epub 2018 Jan 5.
Pelvic girdle pain (PGP) is characterized by the presence of pain in the posterior pelvic area, distally and laterally to the fifth lumbar vertebra, and/or at the pubic symphysis. PGP is a very common pain condition in women, especially during pregnancy and postpartum. After delivery, pain prevalence decreases to 7 % in the first three months. The current literature describes an association between pelvic girdle pain and different perineal characteristics and symptoms.
A better understanding of perineal structures influence on PGP could assist towards the management of this condition. The aim of this review is to describe the peer-reviewed literature about perineal function in patients with PGP.
A bibliographic search on PubMed was conducted. The key words used were: pelvic girdle pain, pregnacy-related low back pain, lumbopelvic pain, posterior pelvic pain, peripartum pelvic pain, pelvic girdle relaxation, pelvic joint instability, peripartum pelvic pain, sacroiliac joint pain, sacroiliac joint dysfunction, sacroiliac-joint related pelvic pain and pelvic floor. Two hundred and twenty-one (221) articles were identified. Out of them, a total of nine articles were selected. The level of evidence was determined using Oxford's scale.
Patients with PGP showed increased activity of the pelvic floor muscles (P=0.05) (LE3), decreased urogenital hiatus area (PGP 12.4 cm±2.7, control 13.7 cm±2.8, P=0.015) (LE3), shorter endurance time (PGP 17.8 s; control 54.0 s, P=0.00) (LE3), significantly later onset time during affected side leg elevation (PGP 25ms, control -129ms, P=0.01) (LE3), levator ani and obturator internus tenderness (PGP 25/26; control 5/25, P<0.001) (LE3) and a higher prevalence of vesico-sphincteric disorders compared to asymptomatic subjects (LE3).
This review confirms that subjects suffering PGP present particular perineal characteristics regarding morphology and biomechanics. It would be interesting to develop clinical research concerning pelvic floor release effect in PGP.
骨盆带疼痛（PGP）的特征是在骨盆后部区域、第五腰椎远端和外侧以及/或者耻骨联合处出现疼痛。PGP是女性中非常常见的疼痛病症，尤其是在孕期和产后。分娩后，前三个月疼痛患病率降至7%。当前文献描述了骨盆带疼痛与不同会阴特征及症状之间的关联。
更好地理解会阴结构对PGP的影响有助于对该病症的管理。本综述的目的是描述关于PGP患者会阴功能的经同行评审的文献。
在PubMed上进行了文献检索。使用的关键词为：骨盆带疼痛、妊娠相关的下背痛、腰骶部疼痛、骨盆后部疼痛、围产期骨盆疼痛、骨盆带松弛、骨盆关节不稳定、围产期骨盆疼痛、骶髂关节疼痛、骶髂关节功能障碍、骶髂关节相关的骨盆疼痛以及盆底。共识别出221篇文章。其中，总共选择了9篇文章。使用牛津量表确定证据水平。
PGP患者表现出盆底肌肉活动增加（P = 0.05）（证据水平3）、泌尿生殖裂孔面积减小（PGP为12.4 cm±2.7，对照组为13.7 cm±2.8，P = 0.015）（证据水平3）、耐力时间缩短（PGP为17.8秒；对照组为54.0秒，P = 0.00）（证据水平3）、患侧腿部抬高时发病时间明显更晚（PGP为25毫秒，对照组为 -129毫秒，P = 0.01）（证据水平3）、肛提肌和闭孔内肌压痛（PGP为25/26；对照组为5/25，P < 0.001）（证据水平3），并且与无症状受试者相比，膀胱括约肌功能障碍的患病率更高（证据水平3）。
本综述证实，患有PGP的受试者在形态学和生物力学方面存在特定的会阴特征。开展关于PGP中盆底松解效果的临床研究将会很有意思。
