MECHANISMS OF POSTERIOR VAGINAL PROLAPSE

阴道后壁脱垂(PVP)，包括肠膨出和直肠前突，是一种神秘的疾病，其 病理生理学知之甚少。ORWH，NICHD和NIDDK分别确认了女性骨盆 像PVP这样的地板疾病是迫切需要进行病理生理学研究的。相互竞争的假说 已被提出与盆内筋膜或提肛肌衰竭的原因有关。然而，数据 要解决这些冲突是不可用的，需要建立筋膜的相对贡献 以及PVP的肌肉异常。这项研究将检验机械假说，即 PVP不是由单一的机制解释的，而是涉及筋膜和肌肉之间的相互作用 异常现象。为了验证这些假设，我们招募了75名PVP患者和75名年龄相近的对照组。 和种族。目标1。“筋膜”，我们将使用在最大Valsalva期间拍摄的正中矢状面MR图像来记录 筋膜支持对4个区域的后壁位置和形态的影响：1)后壁的位置 阴道后端，2)阴道后壁长度，3)远端倾斜度的变化 阴道壁；4)会阴体位置。通过比较病例和对照之间的测量结果， 我们将确定每个区域的异常对PVP的发生和大小的贡献。目标 2.“肌肉”，我们将使用多平面质子密度磁共振扫描来比较1)可见缺陷在 提肛肌，2)肌肉的横截面积，以及测量和3)骨盆肌 最大收缩时的收缩力。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以下各项的相对贡献 筋膜和肌肉的异常。目标3.《直肠前突VS肠膨出》，我们来测试一下实力 4例筋膜和3例肌肉病变与两种类型PVP的关系 模特儿。目标4，“生物力学建模”，我们将使用筋膜和肌肉的生物力学分析 研究肌肉和结缔组织支持部位模式的计算机模型中的相互作用 导致PVP的故障。这些洞察力是促进我们对疾病机制的理解所必需的 因此，我们可以降低术后30%的脱垂复发率，并制定预防措施 减少每年200,000名妇女手术需求的战略。

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.