盆底肌筋膜手法治疗女性盆底功能障碍的效果及对盆底肌电的影响  

Effect of Pelvic Floor Myofascial Manipulation on Female Pelvic Floor Dysfunction and Its Impact on Pelvic Floor Electromyography

作　　者：张蓬蓉 柳标[2] 凌云 ZHANG Peng-rong;LIU Biao;LING Yun(Department of Rehabilitation Medicine,Suzhou Kowlood Hospital,Shanghai Jiao Tong University School of Medicine,Suzhou,Jiangsu 215028,China;Department of Ultrasound,Suzhou Kowlood Hospital,Shanghai Jiao Tong University School of Medicine,Suzhou,Jiangsu 215028,China;Department of Rehabilitation Medicine,Xinghai Hospital of Suzhou Industrial Park,Suzhou,Jiangsu 215021,China)

机构地区：[1]上海交通大学医学院苏州九龙医院康复医学科,江苏苏州215028 [2]上海交通大学医学院苏州九龙医院超声科,江苏苏州215028 [3]苏州工业园区星海医院康复医学科,江苏苏州215021

出　　处：《临床误诊误治》2022年第12期53-57,共5页Clinical Misdiagnosis & Mistherapy

基　　金：上海市科学技术委员会科研计划项目(190172014)。

摘　　要：目的探究盆底肌筋膜手法治疗对盆底功能障碍(PFD)患者的效果及对盆底肌电的影响。方法选取2019年1月—2022年3月收治的PFD 120例,按治疗方法分为研究组和对照组各60例,对照组采用常规Kegel盆底肌锻炼法治疗,研究组采用肌筋膜手法联合常规Kegel盆底肌锻炼法治疗。比较2组治疗前及治疗4周后盆底肌电指标(Ⅰ类肌纤维最大电位、Ⅱ类肌纤维最大电位、前静息肌电值、后静息肌电值),盆底超声参数[膀胱尿道后角(PVA)、膀胱逼尿肌厚度(DWT)、尿道旋转角(URA)、肛提肌裂口面积(LHA)],盆底功能[盆底功能障碍问卷20(PFDI-20)、盆腔器官脱垂/尿失禁性功能问卷(PISQ-12)、尿失禁问卷简表(ICI-Q-SF)],以及尿流动力学指标[最大膀胱容积、残余尿量(PVR)、最大尿流率(Q_(max))、逼尿肌最大压力(Pdet_(max))]。结果治疗4周后,2组Ⅰ类肌纤维最大电位、Ⅱ类肌纤维最大电位、最大膀胱容积、Q_(max)水平及PISQ-12评分均高于治疗前,且研究组高于对照组(P<0.05);治疗4周后,2组前静息肌电值、后静息肌电值、PVA、DWT、URA、LHA、PVR、Pdet_(max)水平及PFDI-20、ICI-Q-SF评分均低于治疗前,且研究组低于对照组(P<0.05)。结论盆底肌筋膜手法治疗在提高PFD患者盆底功能、改善患者盆底肌电生理水平方面具有显著效果,且可改善患者尿流动力学水平。Objective To explore the effect of pelvic floor myofascial manipulation on pelvic floor dysfunction(PFD)and its impact on pelvic floor electromyography.Methods A total of 120 patients with PFD treated from January 2019 to March 2022 were selected,and divided into the research group(n=60)and the control group(n=60)according to treatment methods.The control group was treated with conventional Kegel pelvic floor muscular exercise,and the research group was treated with myofascial manipulation combined with conventional Kegel pelvic floor muscular exercise.The pelvic floor electromyography indexes(maximum potential of ClassⅠmuscle fibers,maximum potential of ClassⅡmuscle fibers,pre-resting electromyography value,post-resting electromyography value),pelvic floor ultrasound parameters[posterior vesicourethral angle(PVA),detrusor wall thickness(DWT),urethral rotation angle(URA),and levator ani hiatus area(LHA)],pelvic floor function[Pelvic Floor Dysfunction Questionnaire 20(PFDI-20),Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire(PISQ-12),the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form(ICI-Q-SF)],and urine flow mechanics indexes[maximum bladder volume,postvoid residual urine volume(PVR),maximum urine flow rate(Q_(max)),maximum detrusor pressure(Pdet_(max))]were compared between the two groups before treatment and at 4 weeks after treatment.Results At 4 weeks after treatment,the maximum potential of ClassⅠmuscle fiber,maximum potential of ClassⅡmuscle fiber,maximum bladder volume,Q_(max) level and PISQ-12 score in the two groups were significantly higher than those before treatment,and significantly higher in the research group than in the control group(P<0.05).At 4 weeks after treatment,the levels of pre-resting EMG,post-resting EMG,PVA,DWT,URA,LHA,PVR,Pdet_(max) and scores of PFDI-20 and ICI-Q-SF in the two groups were significantly lower than those before treatment,and significantly lower in the research group than in the control group(P<0.0

关 键 词：盆底功能障碍 肌筋膜手法 盆底肌电 膀胱尿道后角 膀胱逼尿肌厚度 残余尿量 最大尿流率 逼尿肌最大压力 

分 类 号：R711.7[医药卫生—妇产科学]