Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
Department of Obstetrics and Gynecology, Beaumont Dearborn, Dearborn, MI, USA.
Int Urogynecol J. 2022 Jan;33(1):107-114. doi: 10.1007/s00192-021-04824-9. Epub 2021 May 24.
Test the hypotheses that (1) cardinal ligament (CL) straightening and lengthening occur with parity and prolapse, (2) CL straightening occurs before lengthening, and (3) CL length is correlated with level III measures.
We performed a secondary analysis of MRIs from women in three groups: (1) nulliparous with normal support, (2) parous with normal support, and (3) uterine prolapse (POP-Q point C > - 4 and Ba > 1 cm). The 3D stress MRI images at rest and maximal Valsalva were analyzed. CLs were traced from their origin to cervico-vaginal insertions. Curvature ratio was calculated as curved length/straight length. Level III measures included urogenital hiatus (UGH), levator hiatus (LH), and levator bowl volume (LBV), and their correlations with CL length were calculated.
Ten women were included in each group. Compared to the nulliparous group, CL length was 18% longer in parous controls (p = .04) and 59% longer with prolapse (p < .01) at rest, while at Valsalva, CL length was 10% longer in parous controls (p = .21) and 49% longer with prolapse (p < .01). Curvature ratios showed 18% more straightening in women with prolapse compared to parous controls (p < .01). Curved CL length and level III measures were moderately to strongly correlated: UGH (rest: R = 0.68, p < .01; Valsalva: R =0.80, p < .01), LH (rest: R = 0.60, p < .01; Valsalva: R = 0.78, p < .01), and LBV (rest: R = 0.71, p < .01; Valsalva: R =0.89, p < .01).
Our findings suggest that the CLs undergo three times as much lengthening with prolapse as with parity; however, straightening only occurs with prolapse. Strong correlations exist between level I and level III support.
测试以下假设：（1）主韧带（CL）在妊娠和脱垂时会变直和变长；（2）CL 先变直后变长；（3）CL 长度与 III 级测量值相关。
我们对三组女性的 MRI 进行了二次分析：（1）无脱垂且支持正常的未产妇；（2）脱垂且支持正常的经产妇；（3）子宫脱垂（POP-Q 点 C>-4 和 Ba>1cm）。对静息和最大瓦氏动作下的 3D 应力量图进行分析。从起点到宫颈阴道插入处追踪 CL。计算曲率比为弯曲长度/直线长度。III 级测量包括尿生殖膈间隙（UGH）、肛提肌间隙（LH）和肛提肌盆容积（LBV），并计算它们与 CL 长度的相关性。
每组纳入 10 名女性。与未产妇组相比，静息时经产妇对照组的 CL 长度长 18%（p=0.04），脱垂时长 59%（p<0.01），而在瓦氏动作时，经产妇对照组的 CL 长度长 10%（p=0.21），脱垂时长 49%（p<0.01）。与经产妇对照组相比，脱垂女性的 CL 曲率比增加 18%（p<0.01）。弯曲的 CL 长度与 III 级测量值中度至高度相关：UGH（静息：R=0.68，p<0.01；瓦氏动作：R=0.80，p<0.01）、LH（静息：R=0.60，p<0.01；瓦氏动作：R=0.78，p<0.01）和 LBV（静息：R=0.71，p<0.01；瓦氏动作：R=0.89，p<0.01）。
我们的研究结果表明，CL 在脱垂时的伸长量是妊娠时的三倍，而变直仅发生在脱垂时。I 级和 III 级支持之间存在很强的相关性。
