Hong Christopher X, Meer Elana, Cioban Max, Tischfield David J, Hassani Daisy B, Harvie Heidi S
Department of Obstetrics and Gynecology, Pennsylvania Hospital, 800 Spruce Street, Philadelphia, PA, USA.
Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.
Int Urogynecol J. 2022 Feb;33(2):369-376. doi: 10.1007/s00192-021-04888-7. Epub 2021 Jun 16.
We hypothesize that there are differences in the position and orientation of ring and Gellhorn pessaries in situ on magnetic resonance imaging (MRI).
This was a retrospective cohort study comparing MRI findings in 25 women with pessaries in situ at the time of imaging. Scanner coordinates for anatomic and pessary landmarks were obtained and transformed to 3D Pelvic Inclination Correction System coordinates using MATLAB software. The normal vector to the pessary disc was computed and compared to the positive y-axis in the sagittal and coronal planes to determine XY and YZ disc angles, respectively. Comparisons between groups were made using Wilcoxon rank, Fisher's exact, and Brown-Forsythe tests.
Twenty-one women with ring pessaries and four women with Gellhorn pessaries met inclusion criteria for the study. Women with ring pessaries were younger (68.4 vs. 80.7 years, p = 0.003) but had similar BMI, vaginal parity, history of hysterectomy, and anatomic characteristics. Ring pessaries had a smaller diameter (59.5 vs. 79.3 mm, p = 0.004) and were positioned further posterior with respect to the inferior pubic point (midpoint X position 42.6 vs. 29.5 mm, p = 0.004). There were significant differences in the magnitude and variance of the XY disc angle (57.0 ± 14.0 vs. -1.2 ± 2.8 degrees, p = 0.002 for magnitude, p = 0.012 for variance) but not the YZ disc angle (3.3 ± 30.6 vs. 1.5 ± 7.7 degrees, p > 0.05 for both) between groups.
We found differences in the position and orientation between ring and Gellhorn pessaries in situ using an anatomic 3D reference system. These findings provide insight into the mechanism of action of vaginal pessaries.
我们假设在磁共振成像（MRI）中，环形子宫托和盖尔霍恩子宫托在体内的位置和方向存在差异。
这是一项回顾性队列研究，比较了25名在成像时体内有子宫托的女性的MRI结果。获取了解剖学和子宫托标志点的扫描仪坐标，并使用MATLAB软件将其转换为三维骨盆倾斜校正系统坐标。计算子宫托盘的法向量，并分别在矢状面和冠状面与正y轴进行比较，以确定XY和YZ盘角。使用威尔科克森秩和检验、费舍尔精确检验以及布朗 - 福赛斯检验进行组间比较。
21名使用环形子宫托的女性和4名使用盖尔霍恩子宫托的女性符合该研究的纳入标准。使用环形子宫托的女性更年轻（68.4岁对80.7岁，p = 0.003），但在体重指数、阴道分娩次数、子宫切除史和解剖学特征方面相似。环形子宫托直径较小（59.5毫米对79.3毫米，p = 0.004），相对于耻骨下点位置更靠后（中点X位置42.6毫米对29.5毫米，p = 0.004）。两组之间XY盘角的大小和方差存在显著差异（57.0±14.0度对 -1.2±2.8度，大小p = 0.002，方差p = 0.012），但YZ盘角无显著差异（3.3±30.6度对1.5±7.7度，两者p>0.05）。
我们使用解剖学三维参考系统发现了环形子宫托和盖尔霍恩子宫托在体内的位置和方向存在差异。这些发现为阴道子宫托的作用机制提供了见解。
