初产妇耻骨联合及盆底支持结构急性损伤的MRI表现  

MRI features of acute injury of the pubic symphysis and pelvic floor support structure in primipara

作　　者：曾飘娥 江元慧[2] 周延[1] 韩劲松[2] 谢立志 刘剑羽[1] ZENG Piao’e;JIANG Yuanhui;ZHOU Yan;HAN Jinsong;XIE Lizhi;LIU Jianyu(Department of Radiology,Peking University Third Hospital,Beijing 100191,China;Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China;MR Imaging Research Center,General Electric(China)Healthcare,Beijing 100026,China)

机构地区：[1]北京大学第三医院放射科,北京100191 [2]北京大学第三医院妇产科,北京100191 [3]通用电气(中国)医疗集团MR影像研究中心,北京100026

出　　处：《实用放射学杂志》2020年第2期239-242,250,共5页Journal of Practical Radiology

基　　金：北京大学第三医院临床重点项目青年项目(BYSY2018052).

摘　　要：目的观察初产妇产后耻骨联合及盆底支持结构急性损伤的MRI表现,探讨其与分娩方式的关系.方法前瞻性选取北京大学第三医院30例初产妇,在产后2~3 d行盆底矢状位、冠状位、轴位T2WI及抑脂T2WI扫描.初产妇按分娩方式分为剖宫产组(5例)、正常阴道分娩组(18例)、产钳助产组(7例).同期选取10例未孕未育的女性作为对照组.结果(1)产后耻骨联合急性损伤:初产妇耻骨联合间距较未分娩女性增宽(t=4.26,P=0.000),不同分娩方式间无统计学差异(F=0.96,P=0.619);21例(70%)出现耻骨联合骨髓水肿,不同分娩方式无显著差异(χ^2=0.794,P=0.672);仅1例剖宫产产妇出现左侧耻骨皮质下骨折;7例(23.3%)初产妇出现耻骨联合纤维软骨撕脱,其中1例经剖宫产术,2例经正常阴道分娩,4例经产钳助产,差异无统计学意义,但在经产钳助产产妇中多见(χ^2=6.01,P=0.050);(2)产后肛提肌腱弓急性损伤:初产妇肛提肌腱弓水肿、积液,3种分娩方式间肛提肌腱弓损伤程度有统计学差异,产钳助产组损伤程度加重.10例未生育女性未见耻骨联合及肛提肌腱弓急性损伤.结论产后MRI可观察到初产妇耻骨联合及肛提肌腱弓急性损伤,产钳助产可能加重耻骨联合纤维软骨撕脱和肛提肌腱弓急性损伤,产后MRI对揭示产后耻骨联合疼痛及盆底功能障碍机制可能具有一定价值.Objective To observe the MRI features of the pubic symphysis and pelvic floor support structures in primipara,and to explore their relationship with mode of delivery.Methods 30 primiparas were collected prospectively from the Peking University Third Hospital and performed pelvic floor sagittal,coronal,axial T2WI and fat saturation T2WI on 2—3 days after dclivcry.The primiparas were divided into cesarean section group(5 cases),normal vaginal delivery group(18 cases),and forceps delivery group(7 cases)according to the mode of delivery.10 nulliparous women were collected as a control group.ResuIts(1)Postpartum pubic symphysis acute injury:the pubic symphysis width of primiparas was wider than that of nulliparous women(t=4.26,P=0.000),but there was no statistical difference between different modes of delivery(F=0.96,P=0.619);21(70%)had pubic symphysis bone marrow edema,with no significant difference between different modes of delivery(χ^2=0.794,P=0.672);only 1 case with cesarean section had left pubic bone inferior fracture;7(23.3%)of the primiparas had pubic symphysis fibrocartilage avulsion with 1 case in cesarean section,2 in the normal vaginal delivery group,and 4 in the forceps delivery group.The difference did not reach statistical significance,but it was more common in the forceps delivery(χ^2=6.01,P=0.050).(2)Postpartum arcus tendineus musculi levatoris ani acute injuryjedema of the arcus tendineus musculi levatoris ani was found in the primiparas,and the degree of tendineus musculi levatoris ani injury between the three modes of delivery was statistically different.10 nulliparous women did not show any acute injury in the pubic symphysis and tendineus musculi levatoris ani.Conclusion Postpartum MRI can observe the acute injury of the pubic symphysis and tendineus musculi levatoris ani,and forceps delivery may aggravate the pubic symphysis fibrocartilage avulsion and tendineus musculi levatoris ani injury.Postpartum MRI may have a certain value to reveal the mechanism of postpartum pubic symphysis pain an

关 键 词：磁共振成像 分娩损伤 耻骨联合 肛提肌腱弓 剖宫产 阴道分娩 产钳助产 

分 类 号：R445.2[医药卫生—影像医学与核医学] R714.46[医药卫生—诊断学]