Investigation on the significance of pressure pain thresholds before and after treatment in female with myofascial chronic pelvic pain / 中国医师进修杂志

Objective To explore the therapeutic effect and clinical significance of pelvic floor rehabilitation technique in female with myofascial chronic pelvic pain (MCPP) by detecting the pressure pain thresholds (PPTs). Methods One hundred healthy female (control group) and 324 female MCPP patients (observation group) from January 2009 to December 2016 were selected. Automatic body surface and vaginal pressure pain detector was applied to detect two groups′PPTs of the 34 spots. The difference of PPTs at each spot was analyzed in two groups. In addition, 51 patients with moderate and severe MCPP were selected to record the changes of PPTs and pain scores before and after the treatment of pelvic floor rehabilitation technique. Results The average PPTs of the abdomen, vulva, pelvic floor and vaginal front and back fornix, bilateral adnexa uteri and sacrouterine ligament in the observation group were significantly lower than those in the control group (P<0.01 or<0.05). The average PPTs of the abdomen, vulva, pelvic floor muscles and vaginal front and back fornix, bilateral adnexa uteri and sacrouterine ligament of 51 MCPP patients after treatment were significantly higher than those before treatment (P<0.01). After treatment, PPTs and pain scores of the pelvic floor muscles, bilateral adnexa uteri, bilateral sacrouterine ligament, bilateral sacral spine ligament and vaginal front and back fornix were negatively correlated (r =- 0.78 to- 0.19, P = 0.01 to 0.04); there was a negative correlation between the PPTs and pain scores of the left and right latissimus dorsi (r=-0.28, P=0.04;r=-0.32, P=0.02). The complete remission rate with the pelvic floor rehabilitation technique in 51 patients with MCPP was 9.8％(5/51), the significant remission rate was 90.2％(46/51), and the total remission rate was 100.0％ (51/51). Conclusions Compared with the normal healthy ones, female with MCPP has lower PPTs in the abdomen, perineum, vagina and pelvic floor. The effect of pelvic floor rehabilitation technique on MCPP is well, which can increase patients′PPTs to reduce pain scores. It is a worthwhile method to treat these diseases.

Application value of transvaginal three-dimensional ultrasound technique in the perioperative period of pelvic floor disorder / 中国医师进修杂志

Objective To explore the value of three-dimensional ultrasonic technique in precise pelvic floor reparation. Methods One hundred and twenty-six patients with Ⅱ - Ⅳ degree pelvic organ prolapse were selected. The patients were divided into traditional group (57 cases, transvaginal hysterectomy and vaginal wall reparation) and study group (69 cases, transvaginal hysterectomy and vaginal wall reparation combined with indication of transvaginal three-dimensional ultrasound). The changes of perioperative indexes and postoperative recurrence rate were compared between 2 groups. Results There were no statistical differences in surgery time, intraoperative blood loss, retention catheterization time postoperative exhaust and defecation time duration in hospital and postoperative complication between 2 groups (P＞0.05). The subjective and objective cure rate 3 months after operation in both groups was 100.0% ; there were no statistical differences 6 months after operation between 2 groups (P＞0.05). The objective cure rates 12 and 24 months after operation in study group were significantly higher than those in traditional group: 20.0% (11/55) vs. 7.5% (5/67) and 27.3% (15/55) vs. 11.9% (8/67), and there were statistical differences (P＜0.05). Conclusions The recurrence rate of precise traditional pelvic floor reparation with the guidance of transvaginal three-dimensional ultrasound is significantly lower than that of traditional pelvic floor reparation.