不同年龄正常女性及PDF患者肛提肌MRI特征研究

发布时间：2018-05-21 05:50

本文选题：肛提肌 + MRI成像　；参考：《河北联合大学》2014年硕士论文

【摘要】：目的运用MRI影像学技术，结合相关解剖学知识，对不同年龄组女性的正常肛提肌的形态及功能随时间的规律进行研究，在研究正常女性肛提肌的基础上，研究盆底功能障碍患者的肛提肌各项指标的变化。最后利用MRI三维重建技术建立女性盆底肌肉模型，直观地展现女性盆底肌肉的立体形态。方法1）正常女性肛提肌解剖形态随时间的变化规律：正常（或至少无巨大盆腔病变者）女性76例，按不同年龄分组。采用GE7503.0T全身MR扫描仪及研究所需的后处理软件。观察正常肛提肌各部分的分布，测量肛提肌裂隙宽度（LHW）、髂骨尾骨肌厚度（ICT）、髂骨尾骨肌角度（ICA）、提肌板角度（LPA）。采用SPSS13.0对采集到的数据进行统计学处理，分析数据变化趋势。2）对盆底功能障碍患者32例行核磁共振盆腔动静态扫描，通过分析原始图像，与对照组比较在肛提肌裂隙宽度（LHW）、髂骨尾骨肌厚度（ICT）、髂骨尾骨肌角度（ICA）、提肌板角度（LPA）方面的差异，总结盆底功能障碍患者肛提肌的变化特点并做数据分析。3）正常女性盆底肌MRI三维重建：将扫描得到的正常女性盆腔MRI图像数据导入制图软件，建立盆底肌肉3D模型。直观地观察女性盆底肌肉的形态及毗邻关系。结果1）正常女性肛提肌的解剖形态随时间的变化规律研究：随年龄的增长正常的提肌板角度变小甚至消失下垂，肛提肌裂孔宽度也随年龄增长而变大（P＜0.05），等等。诸如此类的肛提肌退变，都会造成盆底支撑力量的减弱，从而造成盆底功能的障碍甚至盆腔脏器脱垂。2）盆底功能障碍患者肛提肌解剖及功能的特点：盆底器官脱垂组的肛提肌裂隙宽度明显大于正常（P＜0.05）；正常对照组髂骨尾骨肌于静息和最大腹压时较PDF组厚（P＜0.05）；最大腹腔压力时， PDF组髂骨尾骨肌角度和提肌板角较正常组明显增大（P＜0.05）；经过最大腹压作用后，PDF组的髂骨尾骨肌角度及提肌板角度等与静息状态下比较也具有显著差异（P＜0.05）。3）正常女性盆底肌MRI三维重建：通过建立女性盆底肌肉三维模型，，直观地观察到肛提肌的形态。结论MRI影像学检查能够很好地显示肛提肌的正常或病理形态,动态观察可以评估肛提肌的功能改变。此外，以核磁共振为基础的三维重建技术，打破了二维图像局限性，能够清晰直观地呈现女性盆底肌肉的立体形态。
[Abstract]:Objective to study the morphology and function of the normal levator ani muscle in different age groups with the help of MRI imaging technique and related anatomical knowledge, and to study the pattern and function of the normal levator ani muscle in different age groups. To study the changes of various indexes of levator ani muscle in patients with pelvic floor dysfunction. Finally, the female pelvic floor muscle model was established by using MRI 3D reconstruction technique, and the stereoscopic shape of female pelvic floor muscle was displayed intuitively. Methods 1) the changes of anatomic morphology of levator ani muscle with time: 76 normal women (or at least no giant pelvic lesions) were divided into different age groups. GE7503.0T whole-body Mr scanner and post-processing software were used. The distribution of the normal levator ani muscle was observed, the width of the fissure of levator ani muscle was measured, the thickness of the iliac tailbone muscle was ICT10, the angle of the iliac coccyx muscle was ICAI, the angle of the levator muscle plate was measured. 32 patients with pelvic floor dysfunction underwent dynamic and static nuclear magnetic resonance scanning (MRI), and the original images were analyzed by analyzing the original images, using SPSS13.0 to process the collected data statistically and analyze the changing trend of the data. Compared with the control group, there were differences in the width of levator ani muscle (LHWN), the thickness of iliac coccyx muscle (ICTI), the angle of iliac coccyx muscle (ICA), and the angle of levator muscle plate (LPA). The changes of levator ani muscle in patients with pelvic floor dysfunction were summarized and the data were analyzed. 3) MRI reconstruction of normal female pelvic floor muscle was made. The 3D model of pelvic floor muscle was established by importing the MRI image data of normal female pelvic floor into the drawing software. The morphology and adjacent relationship of female pelvic floor muscles were observed intuitively. Results 1) the anatomic morphology of the levator ani muscle in normal women changed with time: the angle of the levator muscle plate decreased or even disappeared with age, and the width of the fissure of levator ani muscle became larger with age (P < 0.05), and so on. The degeneration of the levator ani muscle, such as this, reduces the support strength of the pelvic floor. The anatomic and functional characteristics of levator ani muscle in patients with pelvic floor dysfunction were as follows: the width of fissure of levator ani muscle in pelvic floor organ prolapse group was significantly larger than that in normal group (P < 0.05) and iliac bone tail in normal control group (P < 0.05). At rest and maximum abdominal pressure, skeletal muscle was thicker than PDF group (P < 0.05); at maximum celiac pressure, the angle of iliac coccyx muscle and levator muscle plate in PDF group was significantly larger than that in normal group (P < 0.05); after maximal abdominal pressure, the angle of iliac coccyx muscle and levator muscle plate in PDF group were significantly larger than those in normal group (P < 0.05). There was also significant difference between angle and rest (P < 0.05. 3) MRI reconstruction of normal female pelvic floor muscle: three dimensional model of female pelvic floor muscle was established. The shape of levator ani muscle was observed intuitively. Conclusion MRI imaging can well show the normal or pathological morphology of levator ani muscle, and dynamic observation can evaluate the functional changes of levator ani muscle. In addition, the 3D reconstruction technique based on MRI can break the limitation of two-dimensional image and can clearly and intuitively present the three-dimensional shape of female pelvic floor muscles.
【学位授予单位】：河北联合大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2

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