女性盆底系统解剖形态差异影响器官脱垂的生物力学机制
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1.昆明理工大学;2.昆明医科大学第一附属医院

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Anatomical morphological differences of female pelvic floor system affect the biomechanical mechanism of organ prolapse
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1.Kunming University of Science and Technology;2.The First Affiliated Hospital of Kunming Medical University

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    摘要:

    目的 研究盆底系统解剖形态差异如何影响盆底器官脱垂,阐释盆底器官脱垂的发生机制。方法 基于正常生理与脱垂病理盆底的MR影像开发盆底二维矢状面生物力学有限元模型,在腹压的作用下对比研究盆底整体形位特征的改变与盆底器官脱垂之间的联系。结果相较于生理盆底,初始形位特征异常盆底的子宫宫颈与阴道前壁中段向下以及生殖裂隙的最大位移增加百分比分别为152.7%、695.2%与476%,病理盆底的子宫宫颈与阴道前壁中段向下以及生殖裂隙的最大位移增加百分比分别为513.5%、1833.3%与1572%,以上两者都发生了膀胱膨出、阴道前壁与子宫脱垂现象,而生理盆底并未发生盆底器官脱垂现象。结论 盆底器官初始形位特征的改变,将会导致盆底支撑功能与受力区域的改变,最终导致其在腹压下更容易发生器官脱垂。另外,初始形位特征的改变使得病理盆底缺乏相应的支撑功能,在其他因素的影响下更容易使得盆腔内的器官组织发生更大的形位特征的改变,可能会导致盆腔内其他器官组织筋膜损伤,从而导致更为严重的脱垂现象。

    Abstract:

    Objective To study how the anatomical morphological difference of pelvic floor system affects pelvic floor organ prolapse and explain the mechanism of pelvic floor organ prolapse. Methods A two-dimensional sagittal biomechanical finite element model of pelvic floor was developed based on MR Images of normal physiological pelvic floor and prolapsed pelvic floor. The relationship between the overall shape and position characteristics of pelvic floor and pelvic floor organ prolapse was compared under the action of abdominal pressure. Results Compared with the physiological pelvic floor, the maximum displacement increases percentage of cervix and anterior vaginal wall and genital hiatus are 152.7%, 695.2% and 476%, and the maximum displacement increase percentage of pathological pelvic floor is 513.5%, 1833.3% and 1572%, respectively. Cystocele, prolapse of anterior vaginal wall and uterus occurred in both cases, but no prolapse of pelvic floor organs occurred in physiological pelvic floor. Conclusions Changes in the initial morphologic characteristics of the pelvic floor organs will lead to alterations in the pelvic floor's supportive function and stress areas, ultimately making it more susceptible to organ prolapse under abdominal pressure. Furthermore, the change in the initial morphologic characteristics makes the pathological pelvic floor lack the corresponding support function, which is more likely to make the pelvic organs and tissues under the influence of other factors to undergo a greater change in the morphologic characteristics and may lead to other organs and tissues in the pelvic cavity fascial injury, thereby leading to a more serious prolapse phenomenon.

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  • 收稿日期:2025-01-16
  • 最后修改日期:2025-03-26
  • 录用日期:2025-03-27
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