基于有限元法研究顺产肛提肌损伤与盆底疾病的发生  

Injury of Levator Ani Muscles and Occurrence of Pelvic Floor Diseases during Vaginal Delivery Based on Finite Element Method

作　　者：周琳夕 谷雪莲[1] 杜洪灵[2] ZHOU Linxi;GU Xuelian;DU Hongling(School of Medical Instrument and Food Engineering,University of Shanghai for Science and Technology,Shanghai 200093,China;Department of Obstetrics and Gynecology,People’s Hospital of Shanghai Putuo District,Shanghai 200333,China)

机构地区：[1]上海理工大学医疗器械与食品学院,上海200093 [2]上海市普陀区人民医院妇产科,上海200333

出　　处：《医用生物力学》2020年第6期732-738,共7页Journal of Medical Biomechanics

基　　金：上海市生物医学工程研究生示范实践基地(1017308011);微创励志创新基金(YS30810147)。

摘　　要：目的模拟阴道分娩及休息时骨盆韧带肌的生物力学特性,探讨阴道分娩时肛提肌损伤、盆腔器官脱垂及压力性尿失禁。方法建立正常的骨盆-韧带-肌肉三维非线性有限元模型,计算不同腹压和载荷下肛提肌应力、应变分布及损伤情况;计算Ⅰ、Ⅱ、Ⅲ型压力性尿失禁以及盆腔脏器脱垂的应力、应变分布及损伤情况。结果腹压为1 kPa,载荷为3、5、8 kPa和腹压为1.5 kPa,载荷为3、5、8 kPa情况下,肛提肌最高等效应力分别为14、29、43、86、144、230 kPa;Ⅰ、Ⅱ、Ⅲ型压力性尿失禁以及盆腔脏器脱垂的应力为1.69、1.01、0.70、1.58 MPa。结论阴道分娩造成肛提肌的耻骨直肠肌和耻骨尾骨肌中部受损,与盆底功能障碍肛提肌损伤部位一致。用科学方法找出盆底在阴道分娩时的精确损伤部位,为临床医生预防盆底疾病和制定产后康复训练提供参考依据。Objective To simulate the biomechanical characteristics of pelvic-ligament-muscle during vaginal delivery and rest,and to explore the injury of levator ani muscles during vaginal delivery,pelvic organ prolapse and stress urinary incontinence.Methods The three-dimensional(3D)nonlinear finite element model of pelvisligament-muscle was established to calculate the stress and strain distributions and injury of levator ani muscles under different abdominal pressures and loads.The stress and strain distributions as well as damage of type Ⅰ,Ⅱ,Ⅲstress urinary incontinence and pelvic organ prolapse were also calculated.Results The highest equivalent stresses of levator ani were 14,29,43,86,144,230 kPa,respectively,when the abdominal pressure was 1 kPa under the load of 3,5,8 kPa and the abdominal pressure was 1.5 kPa under the load of 3,5,8 kPa.The stresses of type Ⅰ,Ⅱ,Ⅲstress urinary incontinence and pelvic organ prolapse were 1.69,1.01,0.70,1.58 MPa.Conclusions Vaginal delivery would result in the damage to the puborectalis and the middle of the pubococcipital muscle,which was consistent with the damage of the anal levator muscle with pelvic floor dysfunction.This study uses scientific method to find out the exact location of pelvic floor injury during vaginal delivery,which can provide references for clinicians to prevent pelvic floor disease and formulate post natal rehabilitation training.

关 键 词：顺产腹压 骨盆 韧带 压应力 位移 生物力学 

分 类 号：R318.01[医药卫生—生物医学工程]