Health Local Unit ASL Rome 3, Via Portuense, 292, Rome, Italy.
Italian Association for Postural Global Reeducation, AIRPG, Ivrea, Italy.
Tech Coloproctol. 2020 May;24(5):463-469. doi: 10.1007/s10151-020-02179-9. Epub 2020 Mar 13.
There is little evidence about possible effects of pelvic anatomical characteristics on proctological complications. The aim of our study was to investigate the potential correlation between sagittal pelvic position and rectal prolapse.
A study was conducted on a proctology patients and patients without any specific history of proctological disorders who were divided into two groups according to the presence or the absence of rectal prolapse. In all cases, the pelvic angle was measured with a pelvic goniometer and categorized as posterior (< 10°), neutral (10°-15°), and anterior (> 15°). To minimize effects of potential confounders in the analysis, 3:1 nearest neighbor propensity score matching (PSM) method was implemented using age, sex, and diagnose of rectal disorders as confounding variables.
Among the 143 screened patients, posterior tilt was more frequent in the 19 patients with rectal prolapse than in those without prolapse (42 vs. 18%; p = 0.027). This result was also confirmed in the post-PSM analysis (42 vs. 14%; p = 0.036) using 35 propensity score (PS)-matched controls compared with the rectal prolapse group. Posterior tilt was associated with an increased risk of prolapse in both the unmatched population (odds ratio = 3.37; p = 0.020) and PS-matched subset (odds ratio = 4.36; p = 0.028).
A posterior pelvic angle was more frequently associated with the diagnosis of rectal prolapse. In both the entire population and in the PS-matched subset, posterior tilt was a significant risk factor for rectal prolapse. The easy-to-do investigation of the pelvic angle can provide several benefits in terms of rectal prolapse prevention and more precise management of post-surgical prolapse recurrence.
关于骨盆解剖特征对肛肠并发症可能产生的影响，目前证据有限。本研究旨在探究矢状位骨盆位置与直肠脱垂之间是否存在相关性。
本研究纳入了肛肠疾病患者和无肛肠疾病特定病史的患者，根据是否存在直肠脱垂将其分为两组。所有患者均使用骨盆量角器测量骨盆角，将骨盆角分为后倾（<10°）、中立（10°-15°）和前倾（>15°）。为了最大限度地减少分析中潜在混杂因素的影响，我们采用年龄、性别和直肠疾病诊断作为混杂变量，采用 3:1 最近邻倾向评分匹配（PSM）方法进行分析。
在筛选出的 143 名患者中，19 例直肠脱垂患者的骨盆后倾更为常见（42%比 18%；p=0.027）。在经过 PSM 分析后（42%比 14%；p=0.036），这种结果仍然成立，使用了 35 名倾向评分（PS）匹配的对照组与直肠脱垂组进行比较。在未匹配人群中（比值比=3.37；p=0.020）和 PS 匹配亚组中（比值比=4.36；p=0.028），骨盆后倾与直肠脱垂的发生风险增加相关。
骨盆后倾与直肠脱垂的诊断更为相关。在整个人群和 PS 匹配亚组中，骨盆后倾是直肠脱垂的显著危险因素。对骨盆角度进行简单的检查，可以在预防直肠脱垂和更精确地管理术后脱垂复发方面带来诸多益处。
