Functional anatomy of the female pelvic floor
Functional anatomy of the female pelvic floor
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DOI：
10.1196/annals.1389.034
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发表时间：
2007-01-01
期刊：
影响因子：
--
通讯作者：
Delancey, John O. L.
中科院分区：
文献类型：
--
作者：
Ashton-Miller, James A.;Delancey, John O. L.
在女性的解剖结构，防止失禁和生殖器官脱垂的腹压增加，在日常活动中，包括括约肌和支持系统。在尿道中，膀胱颈和尿道括约肌机制的作用维持尿道闭合压力高于膀胱压力。随着年龄的增长和产次的增加，括约肌横纹肌纤维的数量会减少。在尿道和膀胱颈下的支撑性吊床提供了牢固的后挡，在腹压增加期间尿道抵靠该后挡被压缩，以将尿道闭合压力保持在快速增加的膀胱压力之上。该支撑层由阴道前壁和结缔组织组成，该结缔组织通过肛提肌的耻骨阴道部分将阴道前壁连接到骨盆骨，子宫骶骨韧带和主韧带组成骨盆筋膜的腱弓。在休息时，肛提肌保持尿生殖裂孔的闭合。此外，还招募他们在面对与内脏加速度相关的惯性负荷以及涉及腹壁肌肉组织和膈肌招募的日常活动中的腹部加压时维持食管裂孔闭合。阴道分娩与肛提肌缺陷、生殖器官脱垂和尿失禁的风险增加有关。计算机模型表明，阴道分娩使肛提肌的组织拉伸率高达3.3，阴部神经的应变率高达33%。需要进行研究，以更好地确定这些条件的病理机制。
The anatomic structures in the female that prevent incontinence and genital organ prolapse on increases in abdominal pressure during daily activities include sphincteric and supportive systems. In the urethra, the action of the vesical neck and urethral sphincteric mechanisms maintains urethral closure pressure above bladder pressure. Decreases in the number of striated muscle fibers of the sphincter occur with age and parity. A supportive hammock under the urethra and vesical neck provides a firm backstop against which the urethra is compressed during increases in abdominal pressure to maintain urethral closure pressures above the rapidly increasing bladder pressure. This supporting layer consists of the anterior vaginal wall and the connective tissue that attaches it to the pelvic bones through the pubovaginal portion of the levator ani muscle, and the uterosacral and cardinal ligaments comprising the tendinous arch of the pelvic fascia. At rest the levator ani maintains closure of the urogenital hiatus. They are additionally recruited to maintain hiatal closure in the face of inertial loads related to visceral accelerations as well as abdominal pressurization in daily activities involving recruitment of the abdominal wall musculature and diaphragm. Vaginal birth is associated with an increased risk of levator ani defects, as well as genital organ prolapse and urinary incontinence. Computer models indicate that vaginal birth places the levator ani under tissue stretch ratios of up to 3.3 and the pudendal nerve under strains of up to 33%, respectively. Research is needed to better identify the pathomechanics of these conditions.