MECHANISMS OF POSTERIOR VAGINAL PROLAPSE

阴道后脱垂的机制

• 批准号: 7699819
• 负责人: JOHN O.L. DELANCEY
• 金额: $ 22.45万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-01 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7699819
• 关键词: 3-Dimensional; Admixture; Affect; Age; Apical; Area; Biomechanics; Clinical; Computer Simulation; Condition; Conflict (Psychology); Connective Tissue; Control Groups; Data; Defect; Disease; Distal; Distress; Elements; Enterocele; Equipment and supply inventories; Failure; Fascia; Female; Frequencies; Functional disorder; Impairment; Individual; Lead; Length; Life Style; Ligaments; Linear Models; Location; Magnetic Resonance Imaging; Measurement; Measures; Modeling; Morphology; Muscle; Muscle Contraction; National Institute of Child Health and Human Development; National Institute of Diabetes and Digestive and Kidney Diseases; Normal Range; Numbers; Operative Surgical Procedures; Organ; Pattern; Pelvic Floor Disorders; Pelvic floor structure; Pelvis; Physiological; Population Control; Positioning Attribute; Protons; Ptosis; Purpose; Quality of life; Race; Rate; Recruitment Activity; Rectocele; Recurrence; Relative (related person); Research; Role; Scanning; Severities; Shipping; Ships; Site; Smooth Muscle; Statistical Models; Support System; Suspension substance; Suspensions; Symptoms; System; Techniques; Testing; Textiles; Tissues; Vagina; Vaginal Prolapses; Woman; case control; density; expectation; hymen; insight; levator ani muscle; response; size

Posterior vaginal wall prolapse (PVP), including enterocele and rectocele, is an enigmatic condition whose pathophysiology is poorly understood. ORWH, NICHD and NIDDK have each identified that female pelvic floor disorders such as PVP are in critical need of pathophysiology research. Competing hypotheses have been proposed relating to the causal roles of endopelvic fascia or levator ani muscle failure. However, data to resolve these conflicts are not available and are needed to establish the relative contributions of fascial and muscular abnormalities to PVP. This study will test the mechanistic hypothesis that the occurrence of PVP is not explained by a single mechanism but involves the interaction between fascial and muscle abnormalities. To test these hypotheses, we will recruit 75 cases with PVP and 75 controls of similar age and race. Aim 1. "Fascia", we will use mid-sagittal MR images made during maximal Valsalva to document the posterior wall location and morphology in 4 regions influenced by fascial support: 1) location of the posterior vaginal apex, 2) length of the posterior vaginal wall, 3) changes in the inclination of the distal vaginal wall, and 4) location of the perineal body. By comparing measurements between cases and controls, we will determine the contributions of abnormalities in each region to the occurrence and size of PVP. Aim 2. "Muscle", we will use multiplanar proton density MR scans to compare 1) presence of visible defects in the levator ani muscles, 2) cross sectional areas of the muscle, as well as measuring and 3) pelvic muscle contraction force during a maximal contraction. Using these data we will determine the contribution of muscular abnormalities. We will then use statistical modeling to determine the relative contributions of fascial versus muscular abnormalities. Aim 3. "Rectocele vs. Enterocele", we will test the strength of association between the 4 fascial and 3 muscle abnormalities and the two types of PVP using general linear modeling. Aim 4, "Biomechanical Modeling", we will use biomechanical analyses of fascia and muscle interactions in computer-based models to investigate patterns of muscle and connective tissue support site failures that lead to PVP. These insights are needed to advance our understanding of disease mechanisms so that we can reduce the 30% recurrence rate of prolapse after surgery, and develop preventative strategies to reduce the need for surgery in 200,000 women each year.

阴道后壁脱垂（PVP），包括肠元和直肠膨出，是一种神秘的状况 病理生理学知之甚少。或WH，NICHD和NIDDK各自确定了雌性骨盆 诸如PVP之类的地板疾病迫切需要病理生理学研究。竞争假设有 提出了与内伯筋膜或左旋肌肉肌肉衰竭的因果关系有关的。但是，数据 为了解决这些冲突，不可用，需要建立筋膜的相对贡献 和PVP的肌肉异常。这项研究将检验机械假设 PVP并未用单个机制来解释，而是涉及筋膜和肌肉之间的相互作用 异常。为了检验这些假设，我们将招募75例具有PVP和75个相似年龄对照的病例 和种族。目标1。“筋膜”，我们将使用Maximal Valsalva期间制作的中间签名MR图像记录 4个区域的后壁位置和形态受到筋膜支持的影响：1） 阴道后端，2）后阴道壁的长度，3）远端倾斜的变化 阴道壁和4）会阴体的位置。通过比较病例和对照之间的测量， 我们将确定每个区域中异常对PVP的发生和大小的贡献。目的 2。“肌肉”，我们将使用多帕质质子密度MR扫描比较1） 左臂ANI肌肉，2）肌肉的横截面区域以及测量和3）骨盆肌肉 最大收缩期间的收缩力。使用这些数据，我们将确定 肌肉异常。然后，我们将使用统计建模来确定 筋膜与肌肉异常。目标3。“直肠膨胀与肠肠息”，我们将测试 使用通用线性的4种筋膜和3个肌肉异常与两种类型的PVP之间的关联 造型。 AIM 4，“生物力学建模”，我们将使用筋膜和肌肉的生物力学分析 基于计算机模型的相互作用，以研究肌肉和结缔组织支撑位点的模式 导致PVP的失败。需要这些见解来促进我们对疾病机制的理解 这样我们就可以降低手术后的30％复发率，并发展预防 每年减少20万名女性手术需求的策略。