育龄妇女盆底肌肉的超声波形态测量法

Е. V. En'kova, К. I. Obernikhin, Е. V. Belov, Е. S. Dukhanina, N. N. Patlataya, D. V. Sudakov
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摘要

由于样本量较小,迄今为止对无阴道妇女进行的生物测量研究受到了限制。骨盆底肌肉在妇女的一生中发挥着重要作用。它们能固定和维护盆腔器官,在分娩过程中起到拉伸作用,确保产道的形成,同时也是女性疝气形成的潜在部位。该肌群功能受损可导致肌肉过度收缩(慢性骨盆疼痛综合征)或过度拉伸(骨盆器官脱垂)。本研究的目的是利用三维超声波扫描(声纳图)评估无阴道妇女盆底肌肉的形态特性。材料和方法观察组由 60 名育龄中期妇女组成,她们因主诉会阴和骨盆局部出现各种疼痛、性欲和性生活质量下降而向妇产科医生求诊,经临床确诊为盆底肌肉功能不全。对照组由 30 名经临床检查无盆底肌肉功能障碍的女性组成。将患者纳入研究的主要标准是育龄期(18-45 岁)和妇产科自然分娩史。结果我们发现,盆腔肌筋膜结构变化的声像图标记不明显并不是肌肉功能障碍的重要预后标准,因为形态测量参数的主要变化是盆底肌肉衰竭形成的可靠标志。结论超声形态测量法可评估肌肉和筋膜结构大小的动态变化,可用于妇产科医生的临床实践。早期诊断出骨盆肌筋膜复合体结构的异常,就可以及早采取预防和及时治疗的措施。
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Ultrasound Morphometry of the Pelvic Floor Muscles in Women of Reproductive Age
Biometric studies in nulliparous women conducted to date are limited by small sample sizes. The pelvic floor muscles perform an important function throughout a woman’s life. They provide fixation and maintenance of the pelvic organs, stretches during childbirth, ensuring the formation of the birth canal, and are a potential site for the formation of a hernia in the female body. Impaired function of this muscle group can lead to either excessive muscle contraction (chronic pelvic pain syndrome) or excessive stretching (pelvic organ prolapse). The purpose of the study is to assess the morphometric properties of the pelvic floor muscles in nulliparous women using 3D ultrasound scanning (sonography). Material and methods. The observation group consisted of 60 women of middle reproductive age who applied for an appointment with an obstetriciangynecologist with complaints of pain of various types localized in the perineum and pelvis, decreased desire and quality of sexual life, clinically confirmed by a diagnosis of incompetence of the pelvic floor muscles. The control group consisted of 30 women without dysfunction of the pelvic floor muscles according to clinical examination. The main criterion for inclusion of patients in the study was reproductive age - 18–45 years and natural childbirth in obstetric and gynecological history. Results. We found that the absence of visible sonographic markers of changes in the myofascial structures of the pelvis is not a prognostically significant criterion for muscle dysfunction, since predominantly changes in morphometric parameters are a reliable sign of the formation of pelvic floor muscle failure. Conclusion. The ultrasound morphometry method, which allows one to assess dynamic changes in the size of muscle and fascial structures, can be used in the clinical practice of an obstetrician-gynecologist. Early diagnosis of a violation of the structure of pelvis myofascial complex will allow early implementation of measures aimed at prevention and timely treatment.
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