Department of Obstetrics and Gynecology, Taipei Medical University Hospital, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Department of Physical Medicine and Rehabilitation, School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan.
Sci Rep. 2021 May 4;11(1):9483. doi: 10.1038/s41598-021-89041-6.
Myofascial pelvic pain (MFPP) of pelvic floor muscles is a common cause of chronic pelvic pain (CPP). The pathological mechanisms and treatments of MFPP are complex and still unclear until now. The levator ani muscle (LAM) is the major pelvic floor muscle. The purpose of this study was to examine the fascia and attachment of LAM through the electromyogram (EMG) and cadaver dissection. Electrophysiological stimulation of the obturator fascia above the arcus tendinous levator ani (ATLA) could trigger contraction and electrophysiological changes in LAM insertion. The LAM of embalmed adult cadavers was examined especially in the area above the ATLA. Some skeletal muscle fibers were found above the ATLA within the obturator fascia and were confirmed by Masson's trichrome section staining. Our electromyography (EMG) and anatomical data implied that the attachment of LAM aponeurosis extended beyond ATLA to the inferior border of the superior ramus of the pubic bone. The new discovered attachment of LAM could provide a reference position for clinical diagnosis and treatment of MFPP or CPP.
盆底肌肉的肌筋膜盆腔疼痛 (MFPP) 是慢性盆腔疼痛 (CPP) 的常见原因。MFPP 的病理机制和治疗方法很复杂，到目前为止还不清楚。肛提肌 (LAM) 是主要的盆底肌肉。本研究的目的是通过肌电图 (EMG) 和尸体解剖检查，研究 LAM 的筋膜和附着。在肛提肌肌腱弓 (ATLA) 上方的闭孔筋膜上进行电生理刺激，可引发 LAM 插入处的收缩和电生理变化。对经过防腐处理的成人尸体的 LAM 进行了特别检查，尤其是在 ATLA 上方的区域。在闭孔筋膜内发现 ATLA 上方有一些骨骼肌纤维，并通过 Masson 三色染色切片得到证实。我们的肌电图 (EMG) 和解剖学数据表明，LAM 腱膜的附着延伸超过 ATLA 到耻骨上支的下缘。新发现的 LAM 附着可以为 MFPP 或 CPP 的临床诊断和治疗提供参考位置。
