Barone William R, Knight Katrina M, Moalli Pamela A, Abramowitch Steven D
Musculoskeletal Research Center, Department of Bioengineering, University of Pittsburgh, 405 Center for Bioengineering, 300 Technology Drive, Pittsburgh, PA 15219 e-mail: .
Musculoskeletal Research Center, Department of Bioengineering, University of Pittsburgh, , 300 Technology Drive, Pittsburgh, PA 15219 e-mail: .
J Biomech Eng. 2019 Feb 1;141(2):0210011-8. doi: 10.1115/1.4041743.
Synthetic mesh for pelvic organ prolapse (POP) repair is associated with high complication rates. While current devices incorporate large pores (>1 mm), recent studies have shown that uniaxial loading of mesh reduces pore size, raising the risk for complications. However, it is difficult to translate uniaxial results to transvaginal meshes, as in vivo loading is multidirectional. Thus, the aim of this study was to (1) experimentally characterize deformation of pore diameters in a transvaginal mesh in response to clinically relevant multidirectional loading and (2) develop a computational model to simulate mesh behavior in response to in vivo loading conditions. Tension (2.5 N) was applied to each of mesh arm to simulate surgical implantation. Two loading conditions were assessed where the angle of the applied tension was altered and image analysis was used to quantify changes in pore dimensions. A computational model was developed and used to simulate pore behavior in response to these same loading conditions and the results were compared to experimental findings. For both conditions, between 26.4% and 56.6% of all pores were found to have diameters <1 mm. Significant reductions in pore diameter were noted in the inferior arms and between the two superior arms. The computational model identified the same regions, though the model generally underestimated pore deformation. This study demonstrates that multiaxial loading applied clinically has the potential to locally reduce porosity in transvaginal mesh, increasing the risk for complications. Computational simulations show potential of predicting this behavior for more complex loading conditions.
用于盆腔器官脱垂（POP）修复的合成网片与高并发症发生率相关。虽然目前的器械具有大孔隙（>1毫米），但最近的研究表明，网片的单轴加载会减小孔隙尺寸，增加并发症风险。然而，由于体内加载是多方向的，很难将单轴结果转化到经阴道网片上。因此，本研究的目的是：（1）通过实验表征经阴道网片在临床相关多方向加载下孔径的变形情况；（2）开发一个计算模型来模拟网片在体内加载条件下的行为。对每个网片臂施加2.5牛的张力以模拟手术植入。评估了两种加载条件，改变施加张力的角度，并使用图像分析来量化孔隙尺寸的变化。开发了一个计算模型并用于模拟在相同加载条件下的孔隙行为，并将结果与实验结果进行比较。在两种条件下，发现所有孔隙中有26.4%至56.6%的孔径<1毫米。在下臂和两个上臂之间观察到孔径有显著减小。计算模型识别出了相同的区域，不过该模型通常低估了孔隙变形。本研究表明，临床上施加的多轴加载有可能局部降低经阴道网片的孔隙率，增加并发症风险。计算模拟显示了预测更复杂加载条件下这种行为的潜力。
