PDF(Pubmed)
Abstract：
OBJECTIVE: In order to improve the knowledge POP physiopathology and POP repair, a generic biomechanical model of the female pelvic system has been developed. In the literature, no study has currently evaluated apical prolapse repair by posterior sacrospinous ligament fixation using a generic model nor a patient-specific model that personalize the management of POP and predict surgical outcomes based on the patient\'s pre-operative Magnetic Resonance Imaging. The aim of our study was to analyze the influence of a right and/or left sacrospinous ligament fixation and the distance between the anchorage area and the ischial spine on the pelvic organ mobility using a generic and a patient-specific Finite Element model (FEM) of the female pelvic system during posterior sacrospinous ligament fixation (SSF).
METHODS: Firstly, we used a generic 3D FEM of the female pelvic system previously made by our team that allowed us to simulate the mobility of the pelvic system. To create a patient-specific 3D FEM of the female pelvic system, we used a preoperative dynamic pelvic MRI of a 68 years old woman with a symptomatic stage III apical prolapse and cystocele. With these 2 models, a SSF was simulated. A right and/or left SSF and different distances between the anchorage area and the ischial spine (1 cm, 2 cm and 3 cm.) were compared. Outcomes measures were the pelvic organ displacement using the pubococcygeal line during maximal strain: Ba point for the most posterior and inferior aspect of the bladder base, C point the cervix\'s or the vaginal apex and Bp point for the anterior aspect of the anorectal junction.
RESULTS: Overall, pelvic organ mobility decreased regardless of surgical technique and model. According to the generic model, C point was displaced by 14.1 mm and 11.5 mm, Ba point by 12.7 mm, and 12 mm and Bp point by 10.6 mm and 9.9 mm after left and bilateral posterior SSF, respectively. C point was displaced by 15.4 mm and 11.6 mm and Ba point by 12.5 mm and 13.1mm when the suture on the sacrospinous ligament was performed at 1 cm and 3 cm from the ischial spine respectively (bilateral posterior SSF configuration). According to the patient-specific model, the displacement of Ba point could not be analyzed because of a significative and asymmetric organ displacement of the bladder. C point was displaced by 4.74 mm and 2.12 mm, and Bp point by 5.30 mm and 3.24 mm after left and bilateral posterior SSF respectively. C point was displaced by 4.80 mm and 4.85 mm and Bp point by 5.35 mm and 5.38 mm when the suture on the left sacrospinous ligament was performed at 1 cm and 3 cm from the ischial spine, respectively.
CONCLUSIONS: According to the generic model from our study, the apex appeared to be less mobile in bilateral SSF. The anchorage area on the sacrospinous ligament seems to have little effect on the pelvic organ mobilities.
BACKGROUND: ClinicalTrials.gov Identifier: NCT04551859.
METHODS: Firstly, we used a generic 3D FEM of the female pelvic system previously made by our team that allowed us to simulate the mobility of the pelvic system. To create a patient-specific 3D FEM of the female pelvic system, we used a preoperative dynamic pelvic MRI of a 68 years old woman with a symptomatic stage III apical prolapse and cystocele. With these 2 models, a SSF was simulated. A right and/or left SSF and different distances between the anchorage area and the ischial spine (1 cm, 2 cm and 3 cm.) were compared. Outcomes measures were the pelvic organ displacement using the pubococcygeal line during maximal strain: Ba point for the most posterior and inferior aspect of the bladder base, C point the cervix\'s or the vaginal apex and Bp point for the anterior aspect of the anorectal junction.
RESULTS: Overall, pelvic organ mobility decreased regardless of surgical technique and model. According to the generic model, C point was displaced by 14.1 mm and 11.5 mm, Ba point by 12.7 mm, and 12 mm and Bp point by 10.6 mm and 9.9 mm after left and bilateral posterior SSF, respectively. C point was displaced by 15.4 mm and 11.6 mm and Ba point by 12.5 mm and 13.1mm when the suture on the sacrospinous ligament was performed at 1 cm and 3 cm from the ischial spine respectively (bilateral posterior SSF configuration). According to the patient-specific model, the displacement of Ba point could not be analyzed because of a significative and asymmetric organ displacement of the bladder. C point was displaced by 4.74 mm and 2.12 mm, and Bp point by 5.30 mm and 3.24 mm after left and bilateral posterior SSF respectively. C point was displaced by 4.80 mm and 4.85 mm and Bp point by 5.35 mm and 5.38 mm when the suture on the left sacrospinous ligament was performed at 1 cm and 3 cm from the ischial spine, respectively.
CONCLUSIONS: According to the generic model from our study, the apex appeared to be less mobile in bilateral SSF. The anchorage area on the sacrospinous ligament seems to have little effect on the pelvic organ mobilities.
BACKGROUND: ClinicalTrials.gov Identifier: NCT04551859.
摘要：
目的：为了提高对POP病理生理学和POP修复的认识，已开发出女性骨盆系统的通用生物力学模型。在文学中,目前尚无研究使用通用模型或患者特异性模型评估骶棘后韧带固定术修复根尖脱垂,该模型可根据患者术前磁共振成像对POP进行个性化处理并预测手术结果.我们研究的目的是使用通用和患者特定的有限元模型（FEM）分析右和/或左骶棘韧带固定以及锚固区域与坐骨脊柱之间的距离对骨盆器官活动性的影响。后骶棘韧带固定（SSF）期间的女性骨盆系统。
方法：首先，我们使用了我们团队先前制作的女性骨盆系统的通用3DFEM，使我们能够模拟骨盆系统的活动性。要创建女性骨盆系统的患者特定3DFEM，我们使用了一名68岁女性的术前动态骨盆MRI，该女性有症状的III期根尖脱垂和膀胱膨出。有了这两种型号，模拟了SSF。右侧和/或左侧SSF以及锚固区域和坐骨脊柱之间的不同距离（1厘米，2厘米和3厘米。）进行了比较。结果测量是在最大应变期间使用耻骨尾线进行盆腔器官移位：膀胱底部最后部和最下部的Ba点，C点子宫颈或阴道顶点和肛门直肠交界处前部的Bp点。
结果：总体而言，无论手术技术和模型如何，盆腔器官的活动性都会降低。根据通用模型，C点位移14.1mm和11.5mm，Ba点12.7毫米，左侧和双侧后侧SSF后的12mm和10.6mm和9.9mm的Bp点，分别。当分别在距坐骨脊柱1cm和3cm处进行骶棘韧带缝合时，C点移位15.4mm和11.6mm，Ba点移位12.5mm和13.1mm（双侧后SSF构型）。根据患者特定模型，由于膀胱的明显和不对称的器官位移，无法分析Ba点的位移。C点位移4.74mm和2.12mm，和Bp点分别在左侧和双侧后部SSF后5.30mm和3.24mm处。在距坐骨脊柱1cm和3cm处进行左骶棘韧带缝合时，C点移位4.80mm和4.85mm，Bp点移位5.35mm和5.38mm。分别。
结论：根据我们研究的通用模型，在双侧SSF中，顶点的流动性似乎较小。骶棘韧带上的锚固区域似乎对盆腔器官动员几乎没有影响。
背景：ClinicalTrials.gov标识符：NCT04551859。
方法：首先，我们使用了我们团队先前制作的女性骨盆系统的通用3DFEM，使我们能够模拟骨盆系统的活动性。要创建女性骨盆系统的患者特定3DFEM，我们使用了一名68岁女性的术前动态骨盆MRI，该女性有症状的III期根尖脱垂和膀胱膨出。有了这两种型号，模拟了SSF。右侧和/或左侧SSF以及锚固区域和坐骨脊柱之间的不同距离（1厘米，2厘米和3厘米。）进行了比较。结果测量是在最大应变期间使用耻骨尾线进行盆腔器官移位：膀胱底部最后部和最下部的Ba点，C点子宫颈或阴道顶点和肛门直肠交界处前部的Bp点。
结果：总体而言，无论手术技术和模型如何，盆腔器官的活动性都会降低。根据通用模型，C点位移14.1mm和11.5mm，Ba点12.7毫米，左侧和双侧后侧SSF后的12mm和10.6mm和9.9mm的Bp点，分别。当分别在距坐骨脊柱1cm和3cm处进行骶棘韧带缝合时，C点移位15.4mm和11.6mm，Ba点移位12.5mm和13.1mm（双侧后SSF构型）。根据患者特定模型，由于膀胱的明显和不对称的器官位移，无法分析Ba点的位移。C点位移4.74mm和2.12mm，和Bp点分别在左侧和双侧后部SSF后5.30mm和3.24mm处。在距坐骨脊柱1cm和3cm处进行左骶棘韧带缝合时，C点移位4.80mm和4.85mm，Bp点移位5.35mm和5.38mm。分别。
结论：根据我们研究的通用模型，在双侧SSF中，顶点的流动性似乎较小。骶棘韧带上的锚固区域似乎对盆腔器官动员几乎没有影响。
背景：ClinicalTrials.gov标识符：NCT04551859。
