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目的通过磁共振成像(MRI)技术,构建女性重度盆腔器官脱垂(POP)患者子宫骶韧带(USL)和主韧带(CL)的数字化三维重建模型,探讨两种韧带主要MRI测量参数的临床意义。方法选择Ⅲ~Ⅳ期女性POP患者26例为脱垂组,健康女性志愿者18例为对照组,对两组进行盆腔MRI检查,分别测量并比较两组左右侧骶主韧带的位置、起止点距离、宽度、厚度、体积、信号强度(SI)、曲率及USL之间角度、CL之间角度、同侧骶主韧带角度等参数的变化。结果与对照组比较,脱垂组双侧USL均相对于坐骨棘水平发生位置下移(P<0.05);双侧USL的SI均低于对照组(P<0.05)。与对照组比较,双侧CL相对于弓状韧带的位置显著后移(P<0.05);双侧CL曲率均大于对照组(P<0.05)。脱垂组双侧骶主韧带角度均大于对照组(P<0.05)。轻度和重度子宫脱垂(UP)组中左侧及右侧USL信号强度比较,差异均有统计学意义(P<0.05),且均与UP程度呈负相关(r左=-0.431,P=0.028;r右=-0.420,P=0.032)。结论通过MRI测量USL信号强度将进一步辅助量化诊断UP。USL及CL的起始位置、USL信号强度、CL曲率及骶主韧带角度可以作为重度盆腔器官脱垂的MRI测量参数。
Objective To establish a digital three-dimensional reconstruction model of uterosacral ligament (USL) and primary ligament (CL) in women with severe pelvic organ prolapse (POP) through magnetic resonance imaging (MRI), and to explore the clinical significance of the main MRI parameters of the two ligaments . Methods Totally 26 women with stage Ⅲ ~ Ⅳ female POP were selected as prolapsed group and 18 healthy female volunteers as control group. The pelvic MRI examination was performed on both groups. The position of the left and right main sacral ligaments and the start and end points of both groups were measured and compared Distance, width, thickness, volume, signal intensity (SI), angle of curvature and USL, angle between CL, angle of the main ipsilateral sacral ligament and so on. Results Compared with the control group, the bilateral USL in the prolapse group shifted downward relative to the level of the ischial spine (P <0.05). The SI of bilateral USL was lower than that in the control group (P <0.05). Compared with the control group, the position of bilateral CL relative to the arcuate ligament was significantly shifted (P <0.05), and the curvature of bilateral CL was greater than that of the control group (P <0.05). Prolapse group bilateral sacral main ligament angle were greater than the control group (P <0.05). There was significant difference between the left and right USL signal intensity in mild and severe uterine prolapse (UP) group (P <0.05), and both were negatively correlated with UP (r = -0.431, P = 0.028; r right = -0.420, P = 0.032). Conclusion Measuring the intensity of USL signal by MRI will further assist in quantifying UP. The location of USL and CL, USL signal intensity, CL curvature, and sacral main ligament angle can be used as MRI parameters for severe pelvic organ prolapse.