Female Pelvic Medicine and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA.
Society for Gynecologic Surgeons Pelvic Anatomy Group- Imaging, East Dundee, IL, USA.
Int Urogynecol J. 2021 Apr;32(4):1007-1013. doi: 10.1007/s00192-020-04546-4. Epub 2020 Sep 30.
Intraabdominal pressure acts on the pelvic floor through an aperture surrounded by bony and muscular structures of the pelvis. A small pilot study showed the area of the anterior portion of this plane is larger in pelvic organ prolapse. We hypothesize that there is a relationship between prolapse and anterior (APA) and posterior (PPA) pelvic cross-sectional area in a larger, more diverse population.
MRIs from 30 prolapse subjects and 66 controls were analyzed in this case-control study. The measurement plane was tilted to approximate the level of the levator ani attachments. Three evaluators made measurements. Patient demographic characteristics were compared using Wilcoxon rank-sum and Fisher's exact tests. A multivariable logistic regression model identified factors independently associated with prolapse.
Controls were 3.7 years younger and had lower parity, but groups were similar in terms of race, height, and BMI. Cases had a larger APA (p < 0.0001), interspinous diameter (ISD) (p = 0.001), anterior-posterior (AP) diameter (p = 0.01), and smaller total obturator internus muscle (OIM) area (p = 0.002). There was no difference in the size of the PPA(p = 0.12). Bivariate logistic regression showed age (p = 0.007), parity (p = 0.009), ISD (p = 0.002), AP diameter (p = 0.02), APA (p < 0.0001), and OIM size (p = 0.01) were significantly associated with prolapse; however, PPA was not (p = 0.12). After adjusting for age, parity, and major levator defect, prolapse was significantly associated with increased anterior pelvic area (p = 0.001).
We confirm that a larger APA and decreasing OIM area are associated with prolapse. The PPA was not significantly associated with prolapse.
通过由骨盆的骨性和肌肉结构围绕的孔，腹腔内压作用于盆底。一项小型初步研究表明，在盆腔器官脱垂中，该平面前部的面积更大。我们假设，在更大、更多样化的人群中，脱垂与前（APA）和后（PPA）骨盆横截面积之间存在关系。
本病例对照研究分析了 30 例脱垂患者和 66 例对照者的 MRI。测量平面倾斜以近似肛提肌附着处的水平。三名评估者进行了测量。使用 Wilcoxon 秩和检验和 Fisher 确切检验比较患者的人口统计学特征。多变量逻辑回归模型确定了与脱垂独立相关的因素。
对照组年龄小 3.7 岁，产次少，但两组在种族、身高和 BMI 方面相似。病例组的 APA（p<0.0001）、棘突间径（ISD）（p=0.001）、前后径（APD）（p=0.01）较大，而总闭孔内肌（OIM）面积较小（p=0.002）。PPA 大小无差异（p=0.12）。双变量逻辑回归显示，年龄（p=0.007）、产次（p=0.009）、ISD（p=0.002）、APD（p=0.02）、APA（p<0.0001）和 OIM 大小（p=0.01）与脱垂显著相关；然而，PPA 则不然（p=0.12）。在校正年龄、产次和主要肛提肌缺陷后，脱垂与增大的前盆腔面积显著相关（p=0.001）。
我们证实，较大的 APA 和减少的 OIM 面积与脱垂相关。PPA 与脱垂无显著相关性。
