基于有限元法研究顺产肛提肌损伤与盆底疾病的发生
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1.上海理工大学;2.普陀区人民医院

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上海市生物医学工程研究生示范实践基地(1017308011);微创励志创新基金(YS30810147)


Study on the injury of levator ani muscle in the course of labor and pelvic floor diseases based on the finite element method
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Affiliation:

1.University of Shanghai for Science and Technology;2.Putuo District people'3.'4.s Hospital of Shanghai,Shanghai

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Shanghai biomedical engineering graduate demonstration practice base (1017308011); minimally invasive inspirational Innovation Fund (ys30810147)

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    摘要:

    目的 建立骨盆-韧带-肌肉的盆底有限元模型,研究其在模拟顺产和盆底疾病的情况下盆底的生物力学特性,为临床产后盆底康复的治疗提供参考。模拟阴道分娩与静息状态下骨盆-韧带-肌肉的生物力学特性,并探究阴道分娩与盆腔脏器脱垂、压力性尿失禁在肛提肌部位的损伤情况,为临床治疗盆腔脏器脱垂、压力性尿失禁提供力学依据。 方法 建立正常的骨盆-韧带-肌肉的三维非线性有限元模型,计算7种不同工况下(静息状态,顺产状态)肛提肌的应力应变的分布,位移的大小及损伤情况 ;计算I,II,III型压力性尿失禁,盆腔脏器脱垂的应力应变的分布,位移的大小及损伤情况。 结果 顺产过程中肛提肌的应力分别为0.086MPa,0.144MPa,0.230MPa,I,II,III型压力性尿失禁,盆腔脏器脱垂的应力为1.69MPa,1.01MPa,0.70MPa,1.58MPa。结论 阴道分娩造成肛提肌耻骨直肠肌和耻骨尾骨肌中部受损,与盆底功能障碍肛提肌的损伤部位一致,故用生物力学证明阴道分娩造成盆底功能障碍性疾病且肛提肌损伤患者更易造成盆底功能障碍性疾病。释放集中应力改善盆底中受损伤的肛提肌,从而改善整体生物力学环境的方法是治疗盆底疾病的康复机制

    Abstract:

    Abstract: Objective To simulate the biomechanical characteristics of pelvic-ligament-muscle during vaginal delivery and rest, and to explore the injury of levator ani muscle in vaginal delivery, pelvic organ prolapse and stress urinary incontinence. To provide a mechanical basis for clinical treatment of pelvic organ prolapse and stress urinary incontinence. Methods A three-dimensional finite element model of pelvis-ligament-muscle was established to calculate the stress-strain distribution, displacement and injury of levator ani muscle under 7 different working conditions (tension, abdominal pressure, load changes).The stress-strain distribution, displacement and injury of type I stress urinary incontinence, type II stress urinary incontinence, type III stress urinary incontinence and organ prolapse were calculated. Results Vaginal delivery, organ prolapse, type I stress urinary incontinence, type II stress urinary incontinence, type III stress urinary incontinence, the maximum stress position of type III stress urinary incontinence appears in the middle of the puborectal muscle and the junction of the puborectal muscle and the obturator muscle. Conclusion Vaginal delivery, organ prolapse, type I stress urinary incontinence, type II stress urinary incontinence, type III stress urinary incontinence damaged the same parts.Spontaneous delivery can easily lead to organ prolapse, type I stress urinary incontinence, type II stress urinary incontinence, type III stress urinary incontinence, and the vulnerable sites are in the middle of the puborectal muscle and the junction of the puborectal muscle and the obturator muscle.

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  • 收稿日期:2019-10-21
  • 最后修改日期:2019-12-17
  • 录用日期:2019-12-31
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