Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden.
Stockholm Hernia Center, Stockholm, Sweden.
BJS Open. 2023 Jan 6;7(1). doi: 10.1093/bjsopen/zrac162.
Rectus diastasis is a common sequela of pregnancy and is associated with functional disabilities such as back pain, abdominal core instability, abdominal muscle weakness, urinary incontinence, and psychological issues such as a negative body image. The aim of this study was to evaluate the effect of the TOR concept (training, operation, and rehabilitation), a novel concept for treating abdominal wall insufficiency combined with rectus diastasis, after pregnancy. TOR consists of preoperative evaluation of symptoms and custom-designed abdominal core training, tailored rectus diastasis repair, and individual progressive postoperative rehabilitation.
A consecutive series of women diagnosed with rectus diastasis and core dysfunction resistant to training, underwent plication of the linea alba between 2018 and 2020. After surgery, all patients participated in an individually designed rehabilitation programme over a 4-month interval. Physical function was recorded before surgery and 1 year after surgery using the disability rating index questionnaire. Symptoms associated with core instability were recorded before and 1 year after surgery. Quality of life was assessed using the SF-36. The abdominal wall anatomy was assessed with ultrasound before and 1 year after surgery.
Seventy-one women were included and all attended 1-year follow-up. Response rate was 81.7 per cent (58) for the disability rating index, and 59.2 per cent (42) for SF-36. Self-reported physical function (disability rating index) improved in 54 of 58 patients (93.1 per cent), with a median score reduction of 91.3 per cent. Core instability symptoms decreased significantly. All SF-36 subscales improved significantly compared with preoperative scores, reaching levels similar to or higher than the normative Swedish female population. No recurrence of rectus diastasis was seen at the 1-year follow-up.
Surgical reconstruction within the TOR concept resulted in significant improvements in physical function and quality of life as well as a significant decrease in symptoms of core instability.
腹直肌分离是妊娠的常见后遗症，与腰痛、腹部核心不稳定、腹部肌肉无力、尿失禁以及负面身体形象等心理问题有关。本研究旨在评估 TOR 理念（训练、手术和康复）治疗妊娠后合并腹直肌分离的腹壁缺陷的效果。TOR 包括术前评估症状和定制的腹部核心训练、量身定制的腹直肌分离修复以及个体化的术后渐进式康复。
2018 年至 2020 年，连续系列诊断为腹直肌分离和核心功能障碍经训练无法改善的女性患者接受了白线缝合术。手术后，所有患者都在 4 个月的时间内参加了个体化的康复计划。使用残疾评定指数问卷在术前和术后 1 年记录身体功能。在术前和术后 1 年记录与核心不稳定相关的症状。使用 SF-36 评估生活质量。在术前和术后 1 年使用超声评估腹壁解剖结构。
71 名女性患者纳入研究，所有患者均接受了 1 年随访。残疾评定指数的应答率为 81.7%（58 例），SF-36 为 59.2%（42 例）。58 例患者中有 54 例（93.1%）自我报告的身体功能（残疾评定指数）得到改善，中位数评分降低 91.3%。核心不稳定症状显著减轻。与术前相比，所有 SF-36 子量表均显著改善，达到与瑞典女性正常人群相似或更高的水平。在 1 年随访时，没有发现腹直肌分离复发。
TOR 理念下的手术重建可显著改善身体功能和生活质量，并显著减轻核心不稳定症状。
