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Abstract：
The female pelvic cavity involves muscles, ligaments, endopelvic fasciae and multiple organs where different pathologies may occur, namely the pelvic organ prolapse (POP). The synthetic implants are used for the reconstructive surgery of POP, but severe complications associated with their use have been reported, mainly related to their mechanical properties (e.g., implant stiffness) and microstructure. In this study, we mimicked a transvaginal reconstructive surgery to repair the apical ligaments (uterosacral ligaments (USLs) and cardinal ligaments (CLs)), by modeling, their impairment (90% and 50%) and/or total rupture. The implants to reinforce/replace these ligaments were built based on literature specifications and their mechanical properties were obtained through uniaxial tensile tests. The main aim of this study was to simulate the effect of mesh anchoring technique (simple stich and continuous stitch), and compare the displacement magnitude of the pelvic tissues, during Valsalva maneuver. The absence/presence of the synthetic implant was simulated when total rupture of the CLs and USLs occurs, causing a variation of the vaginal displacement (9% for the CLs and 27% for the USLs). Additionally, the simulations showed that there was a variation of the supero-inferior displacement of the vaginal wall between different anchoring techniques (simple stich and continuous stitch) being approximately of 10% for the simulation USLs and CLs implant. The computational simulation was able to mimic the biomechanical behavior of the USLs and CLs, in response to different anchoring techniques, which can be help improving the outcomes of the prolapse surgery.
摘要：
女性盆腔累及肌肉，韧带,肾盂内筋膜和可能发生不同病理的多个器官，即盆腔器官脱垂(POP)。合成植入物用于POP的重建手术，但是据报道，与使用它们相关的严重并发症，主要与它们的机械性能有关(例如，植入物刚度)和微观结构。在这项研究中,我们模仿了经阴道重建手术来修复根尖韧带（子宫骶韧带（USLs）和主韧带（CLs）），通过建模，它们的损伤(90%和50%)和/或总破裂。根据文献规范构建了用于增强/替换这些韧带的植入物，并通过单轴拉伸试验获得了它们的机械性能。本研究的主要目的是模拟网格锚固技术（简单的缝合和连续缝合）的效果，比较骨盆组织的位移大小，在Valsalva演习期间.当CL和USL发生完全破裂时，模拟合成植入物的不存在/存在。导致阴道移位的变化(CLs为9%，USL为27%)。此外,模拟显示,对于模拟USL和CLs植入物,不同锚定技术(简单缝合和连续缝合)之间的阴道壁超下位移差异约为10%.计算模拟能够模拟USL和CL的生物力学行为，针对不同的锚固技术，这可以帮助改善脱垂手术的结果。
