School of Engineering and Mathematical Sciences, University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia.
Eur J Obstet Gynecol Reprod Biol. 2022 Oct;277:97-100. doi: 10.1016/j.ejogrb.2022.08.010. Epub 2022 Aug 23.
To examine whether hiatal expansion and levator avulsion have a role in the causation of pelvic organ prolapse (POP).
Data from studies which showed a strong association of hiatal expansion and levator avulsion were analysed for causation against an alternative view, POPcausation by ligament/connective tissue damage.
Some studies potentially fitted the "Regularity Theory of Causality"; i.e., an apparent cause, occurred with such regularity as to be considered a cause. However, these studies failed the logical requirement of "unconditional": all levator avulsions were to be followed directly by occurrence of POP, if the association were to be considered valid. Two studies which placed a large mesh behind the rectum and around puborectalis muscle greatly diminished levator expansion, but POP recurred in 78% of the women by 12 months. These results invalidated hypotheses of cause (levator expansion) and effect (prolapse).
Levator avulsion/hiatal expansion co-occurs with POP. The cause for both is likely inability of the birth canal to plasticize" sufficiently to prevent simultaneous damage to the hiatal muscles and surrounding fascias and ligaments, which explains the co-occurrence. Greater than 90% cure of POP by site-specific repair of up to 4 pelvic ligaments supported the alternative hypothesis of simultaneous damage to pelvic ligaments to cause prolapse.
探讨膈疝扩张和提肌撕裂是否与盆腔器官脱垂（POP）的发生有关。
分析了一些研究的数据，这些研究显示膈疝扩张和提肌撕裂与 POP 之间存在强烈的关联，以评估其因果关系，同时也考虑了另一种观点，即韧带/结缔组织损伤导致 POP。
一些研究可能符合“因果关系的规律性理论”；即，一个明显的原因，以如此规律的方式发生，以至于被认为是一个原因。然而，这些研究未能满足“无条件”的逻辑要求：如果这种关联被认为是有效的，那么所有的提肌撕裂都应该直接导致 POP 的发生。两项将大网片置于直肠后方和耻骨直肠肌周围的研究大大减少了提肌的扩张，但在 12 个月时，78%的女性 POP 再次复发。这些结果否定了提肌扩张（原因）和脱垂（结果）的假设。
提肌撕裂/膈疝扩张与 POP 同时发生。两者的原因可能是由于产道不能充分“塑性化”，从而不能防止膈疝肌肉和周围筋膜及韧带同时受损，这解释了两者的同时发生。通过对多达 4 条骨盆韧带的特定部位修复，超过 90%的 POP 得到治愈，支持了同时损伤骨盆韧带导致脱垂的替代假说。
