Original scientific paper
PELVIC BONE SYSTEM CHANGES AND PATHOGENESIS OF GENITAL PROLAPSE – A RADIOPELVIMETRIC STUDY
Momčilo B. Lazarevski
Abstract
Radiopelvimetric investigations, on the colpocystographies in I position, are carried out on 476 patients: 392 genital prolapses and 84 control cases in the period from April 1, 1968 to February 28, 1973. Out of classic pelvic bone parameters, an original measure – distance »X« is introduced, which characterizes the anterior compartment of the pelvis directly exposed to the action of the intra-abdominal force.
The pelvic bone system of prolapse cases presents a horizontalization and an infundibular caudal enlargement. Thus, in total uterine prolapses, the middle pelvis is larger for 6.7%, the pelvic outlet for 13.8% and the distance »X« is longer for 56.7%; the pelvic inlet is more horizontal for 9.8° in comparison to the control cases. The nutation of the sacrum, associated¬ with dorsal transposition of its inferior part and the antero-posterior rotation of the whole pelvis around a center located in the acetabulum seem to be the causes. The relations of these changes to the aging process are studied, too. Showing quantitative identity with changes found in prolapse cases, this analysis also demonstrates their clear progress parallel to the patients aging. In the group of patients aged over 61 years, the horizontalization is more accentuated (14.5°) than the infundibular caudal pelvic enlargement; the distance »X« is longer for 91.4% and nutation, curving and »shortening« of the sacrum are found in comparison with patients aged less than 30 years. In contrast, the pelvis of the control cases, without relation to their age, looks like the pelvis of young patients aged less than 30 years and to the pelvis of nulliparous women aged less than 35 years. Consequently, it is possible to suppose that a part of the population, who during their whole life preserve »youthful« form of the pelvis, should be protected from prolapse development. As such bone changes could be provoked by overloading due to human erect position, they could represent the mechanism by which the aging and the body overloading influence the development of genital prolapses.
Due to the enlargements of the middle pelvis and of the pelvic outlet, pelvic suspension and sustention systems are exposed to distensions, provoking a decrease of arrows of their cupolas with a consequent decrease of resistance and deterioration. The calculations demonstrated that the resistance of the pelvic diaphragm in the total uterine prolapses group is three times lower than in the control cases. On the other hand, the augmentation of distance »X« in the group of patients aged over 61 years, exposes their ventral pelvic compartment to a three times greater force in comparison to that of the group of patients aged less than 30 years. By introducing a biomechanical approach, the author throws a new light on this domain of gynecology, permitting¬ better understanding of the complex pathogenesis of genital prolapse, which enables a more sophisticated prevention and treatment of this disease.
Keywords
genital prolapse; etiopathogenesis of genital prolapses; pelvis anthropology; pelvic bone system; erect posture in humans
Hrčak ID:
15569
URI
Publication date:
1.3.2004.
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