Department of Urogynaecology, St. Mary's Hospital, London, United Kingdom.
Institute of Women's Health, University College London, London, United Kingdom.
Neurourol Urodyn. 2019 Jan;38(1):123-129. doi: 10.1002/nau.23847. Epub 2018 Oct 30.
The sonographic appearance of a levator muscle "avulsion" representing the literal detachment of the pubovisceral muscle (PVM) enthesis has been contested. The nature of the levator ani "avulsion" is still not fully understood. It is known, that the tensile strength of a tendon is dependent on collagen with increased synthesis of collagen occurring in tissue with increased mechanical load levels. This study aims to perform a quantitative histological evaluation of the PVM enthesis with or without the imaging finding of levator ani "avulsion" to determine if there is a difference in the proportion of muscle and collagen.
Three-dimensional translabial ultrasound for PVM "avulsion" was performed on cadavers using a GE Voluson I with a 5-9 MHz electronic probe. Cadavers were meticulously dissected to identify the presence or absence of an anatomical avulsion. The PVM enthesis was excised for further histopathological processing and treated with three different colorations. Quantitative analysis using ImageJ software was conducted to compare tissue composition in samples with or without sonographic "avulsion." All stages were performed by two separate investigators blinded to each other's results. The results were analyzed using SPSS v24, IBM.
Twenty-three PVM enthesis with histological staining were procured. Ultrasonographic "avulsions" were seen in 5/23 PVM enthesis. No anatomical avulsions were seen. There was no difference in the overall muscle or collagen content (Kruskal-Wallis, P = 0.864). The mean organized skeletal muscle content was 23% in the sonographic "avulsion" group versus 62% in the no "avulsion" group (Kruskall-Walis, P = 0.02). "Avulsions" were associated with a disorganized appearance at histology.
The tissue composition relating to the proportion of muscle and collagen was not significantly different in specimens with or without sonographic "avulsions." However, morphological differences were observed in the organization of the muscle fibres, which requires further evaluation.
代表耻骨直肠肌（PVM）附着点的肛提肌“撕脱”的超声表现一直存在争议。肛提肌“撕脱”的性质尚不完全清楚。众所周知，肌腱的拉伸强度取决于胶原蛋白，而在机械负荷水平增加的组织中，胶原蛋白的合成增加。本研究旨在对存在或不存在肛提肌“撕脱”影像学表现的 PVM 附着点进行定量组织学评估，以确定肌肉和胶原蛋白的比例是否存在差异。
使用 GE Voluson I 型和 5-9MHz 电子探头对尸体进行三维经阴道超声检查以评估 PVM“撕脱”。仔细解剖尸体以确定是否存在解剖学撕脱。切除 PVM 附着点进行进一步的组织病理学处理，并进行三种不同的染色。使用 ImageJ 软件进行定量分析，比较有或无超声“撕脱”的样本中的组织成分。所有阶段均由两名独立的研究人员进行，彼此之间不了解结果。结果使用 SPSS v24、IBM 进行分析。
共获得 23 个带有组织学染色的 PVM 附着点。在 5/23 个 PVM 附着点中可见超声“撕脱”。未见解剖学撕脱。总体肌肉或胶原蛋白含量无差异（Kruskal-Wallis，P=0.864）。在超声“撕脱”组，有组织的骨骼肌含量平均为 23%，而在无“撕脱”组，有组织的骨骼肌含量为 62%（Kruskal-Wallis，P=0.02）。组织学上，“撕脱”与组织结构紊乱有关。
在有或无超声“撕脱”的标本中，与肌肉和胶原蛋白比例相关的组织成分无显著差异。然而，在肌肉纤维的组织方面观察到形态学差异，这需要进一步评估。
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