Apical Ligament and Levator Muscle Interactions in Pelvic Organ Prolapse

盆腔器官脱垂中顶韧带和提肌的相互作用

• 批准号: 8549847
• 负责人: JOHN O.L. DELANCEY
• 金额: $ 24.26万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-06-01 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8549847
• 关键词: Apical; Behavior; Birth; Cells; Cervical; Cervix Uteri; Characteristics; Clinical; Computers; Data; Defect; Devices; Disease model; Distress; Epidemic; Failure; Future; Genitourinary system; Goals; Hysterectomy; Image; Impairment; Injury; Instruction; Knowledge; Lead; Length; Life; Ligaments; Location; Longevity; MRI Scans; Magnetic Resonance Imaging; Measurement; Measures; Muscle; Organ; Patients; Pelvic Floor Disorders; Pelvic floor dysfunction; Pelvic floor structure; Pelvis; Play; Prevention; Property; Ptosis; Recruitment Activity; Relative (related person); Repeat Surgery; Reproduction; Research; Rest; Risk; Role; Selection for Treatments; Severities; Sex Characteristics; Suspension substance; Suspensions; Testing; Uterus; Vagina; Vaginal delivery procedure; Woman; Women' s Group; Work; clinically relevant; improved; in vivo; insight; levator ani muscle; ligament injury; neuromuscular; operation; pressure; prevent; repaired; technique development; three-dimensional modeling; volunteer

Vaginal birth confers an 8-fold increase in the risk for a woman developing prolapse, a condition that results in 200,000 operations per year and carries up to a 25% reoperation rate at 10 years. Two primary causes for prolapse have emerged: 1) descent of the cervix and upper vagina (apical descent) involving the cardinal/uterosacral ligaments, and 2) neuromuscular damage to the levator ani muscles during vaginal birth. The relationship between these factors is unknown. It is the overall goal of our research to discover the basic mechanism whereby muscle and ligament failure interact producing prolapse. Our theoretical work suggests the working hypothesis that levator damage leads to opening of the levator urogenital hiatus and results in exposure of the vaginal wall to a pressure differential that pulls downward on the apical supports. Lack of data concerning ligament stiffness prevents a quantitative understanding of these relationships. We will recruit and test 50 asymptomatic volunteers and 50 women with pelvic organ prolapse to accomplish the following aims. Aim 1 will use a new servoactuator device to measure the in vivo ligament force-displacement behavior ("stiffness") to determine the role of different ligament properties in prolapse. Aim 2 will make static and dynamic MRI images and clinical pelvic floor measurements to establish the relative contribution to apical descent by a) muscle impairment b) ligament properties. Aim 3 will create subject-specific 3D models of the cardinal and uterosacral ligaments, which will be used to and determine the measurement differences in cardinal and uterosacral elongation in apical descent. The results of this study will provide data that can lead to clinically relevant tests to, for example, identify which patients need an operation to support the apex. It will also provide the much needed data, validating an overall disease model concerning interactions between ligament support and muscle damage. This research will be helpful in developing strategies for improved prevention and treatment selection and a better understanding of why muscle damage at birth causes prolapse later in life.

阴道出生赋予女性出现脱垂的风险增长8倍，这种情况每年导致200,000次手术，在10年时重新手术率高达25％。出现了脱垂的两个主要原因：1）涉及基质/子宫内韧带的子宫颈和上阴道的下降，以及2）在阴道出生过程中对左旋肌肉肌肉的神经肌肉损害。 这些因素之间的关系尚不清楚。我们研究的总体目标是发现肌肉和韧带衰竭与产生脱垂相互作用的基本机制。我们的理论工作表明，有效的假设是，悬臂损伤会导致伸出液化性裂隙的打开，并导致阴道壁暴露于压力差，该压力差向下拉下顶端支撑。 缺乏有关韧带刚度的数据阻止了对这些关系的定量理解。我们将招募和测试50名无症状志愿者和50名骨盆器官脱垂的女性，以实现以下目标。 AIM 1将使用新的焊接器装置来测量体内韧带 - 置换行为（“刚度”），以确定不同韧带特性在脱垂中的作用。 AIM 2将使静态和动态的MRI图像和临床骨盆底测量值通过a）肌肉障碍b）韧带特性来确定对顶端下降的相对贡献。 AIM 3将创建主教和子宫菌韧带的特定主体3D模型，这些模型将用于并确定顶式下降中基本主教和子宫伸长的测量差异。 这项研究的结果将提供可能导致临床相关测试的数据，例如确定哪些患者需要手术来支持顶点。它还将提供急需的数据，从而验证了有关韧带支撑和肌肉损害之间相互作用的整体疾病模型。这项研究将有助于制定改善预防和治疗选择的策略，并更好地理解为什么出生时肌肉损害会导致生命后期脱垂。