切换至 "中华医学电子期刊资源库"
高级检索
中华疝和腹壁外科杂志(电子版)

中华疝和腹壁外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (06) : 566 -570. doi: 10.3877/cma.j.issn.1674-392X.2021.06.006

临床论著

育龄期妇女腹直肌间距的临床观察
余卓敏1, 余俊丽2, 侯泽辉1, 梁志强1, 刘伟3, 陈双1, 江志鹏1,†()   
  1. 1. 510655　广州，结直肠盆底疾病研究重点实验室中山大学附属第六医院胃肠、疝和腹壁外科
    2. 510655　广州，结直肠盆底疾病研究重点实验室中山大学附属第六医院超声科
    3. 510655　广州，结直肠盆底疾病研究重点实验室中山大学附属第六医院内镜外科
  • 收稿日期:2020-01-02 出版日期:2021-12-20
  • 通信作者: 江志鹏

Clinical observation of child-bearing age women inter-recti distance change

Zhuomin Yu1, Junli Yu2, Zehui Hou1, Zhiqiang Liang1, Wei Liu3, Shuang Chen1, Zhipeng Jiang1,†()   

  1. 1. Department of Gastrointestinal Surgery and Hernia Center, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou 510655, China
    2. Department of Ultrasound, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou 510655, China
    3. Department of Endoscopic surgery, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou 510655, China
  • Received:2020-01-02 Published:2021-12-20
  • Corresponding author: Zhipeng Jiang
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

余卓敏, 余俊丽, 侯泽辉, 梁志强, 刘伟, 陈双, 江志鹏. 育龄期妇女腹直肌间距的临床观察[J]. 中华疝和腹壁外科杂志(电子版), 2021, 15(06): 566-570.

Zhuomin Yu, Junli Yu, Zehui Hou, Zhiqiang Liang, Wei Liu, Shuang Chen, Zhipeng Jiang. Clinical observation of child-bearing age women inter-recti distance change[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2021, 15(06): 566-570.

目的

观察育龄期妇女腹直肌间距随时间变化的规律。

方法

本研究为横断面研究，研究对象为2017年8月至2018年3月到中山大学附属第六医院超声科体检或产检的201名育龄期妇女。其中，未育组（N1）30名，妊娠组（N2）141名，产后组（N3）30名。使用超声测量育龄期妇女的脐水平腹直肌间距离（IRD1）、脐与耻骨联合上缘连线中点腹直肌间距离（IRD2）、脐水平左右两侧腹直肌宽度（WRAL、WRAR），横断面观察并分析各组的腹直肌形态学变化特点。

结果

N1组的IRD1、IRD2、（WRAL+WRAR）/2平均值分别为（16.57±4.62）mm、0 mm、（72.03±11.38）mm。N2组的IRD1从妊早期开始随妊娠周数的增加而增加，孕21周后增加更为显著，直至分娩前（孕37~40周）达到高峰，平均值（92.41±23.40）mm；IRD2、WRAL和WRAR在妊早期变化不明显，在孕21周后（WRAL+WRAR）/2开始显著增加，分娩前达到高峰，平均值（113.27±18.5）mm。各数据变化存在较大的个体差异。N3组的WRAL、WRAR在产后1个月恢复正常；IRD1于产后3 d即可恢复41%，67.1%的妇女产后1个月可恢复至未育水平，产后超过1年者中约有26.6%的妇女IRD1仍>27 mm。IRD1（Y）与孕周（X1）和IRD2（X2）有相关性，模拟曲线方程（逐步法）Y=2.801X1+1.111X2-26.049，X1>21。

结论

女性在妊娠期及产后前腹壁的结构发生一系列形态学改变，此变化有一定的规律性，但个体差异较大。

关键词: 腹直肌, 腹直肌间距离, 腹直肌分离, 育龄期妇女
Objective

To observe the changes of inter-recti distance (IRD) in women of childbearing age over time.

Methods

The study is a cross-sectional study. The subjects of the study were 201 women of childbearing age who went to the Ultrasound Department of the Sixth Affiliated Hospital of Sun Yat-sen University from August 2017 to March 2018. Among them, 30 were in the non-fertile group (N1), 141 were in the pregnancy group (N2), and 30 were in the postpartum group (N3). Using ultrasound to measure the IRD at the umbilical level (IRD1), the IRD at the midpoint of the connection between the umbilical cord and the upper edge of the pubic symphysis (IRD2), and the width of the rectus abdominis at the left and right sides of the umbilical level (WRAL, WRAR). We observed and analyzed the characteristics of the morphological changes of the rectus abdominis in each group.

Results

Non-fertility group (N1): The mean IRD1 is (16.57±4.62) mm and IRD2 is 0 mm and (WRAL+WRAR)/2 is (72.03±11.38) mm. Pregnancy group (N2): The IRD1 of increased with the weeks of gestation from the early stage of pregnancy, and increased more significantly after 21 weeks of gestation, until it reached a peak before delivery (37to 40 weeks of gestation) with an average value of (92.41±23.40) mm at that time. IRD2, WRAL and WRAR did not change significantly in the early stage of pregnancy.After 21 weeks of gestation, (WRAL+WRAR)/2 began to increase significantly, and reached a peak before delivery with an average of (113.27±18.5) mm. There are large individual differences in the data changes. Postpartum group (N3): WRAL and WRAR returned to normal in one month after delivery. IRD1 recovered 41% in 3 days after delivery and 67.1% of women recovered to the level of non-fertility in one month after delivery. Approximately 26.6% of postpartum women have IRD1>27 mm for more than one year after delivery. IRD1 (Y) is correlated with gestational week (X1) and IRD2 (X2). The simulation curve equation (stepwise method) Y=2.801X1+1.111X2-26.049, X1>21.

Conclusion

A series of morphological changes occur in the structure of the abdominal wall in women during pregnancy and after delivery. This change has certain regularity, but there are large individual differences.

Key words: Recti abdominis, Inter-recti distance, Diastasis recti abdominis, Child-bearing age women
表1 参与研究的201名育龄期妇女的一般情况（±s）
组别 例数 年龄(岁) 体质量(kg) 身高(cm) 体质量指数(kg/m2)
未育组 30 28.9±2.0 50.9±3.0 161.5±0.6 19.5±1.1
妊娠组 141 29.2±0.4 51.7±0.7 158.7±0.5 20.6±0.3
产后组 30 33.1±1.3 52.8±1.6 158.6±1.0 17.6±1.4
P1值   >0.05 >0.05 >0.05 >0.05
P2值   >0.05 >0.05 >0.05 >0.05
图1 表示每个研究对象孕期IRD1、WRA、腹围的拟合曲线注：IRD1为脐水平两腹直肌间距离；WRA为腹直肌的宽度；图1A为孕期脐水平两腹直肌间距离（IRD1）变化；图1B为孕期脐水平腹直肌宽度（WRA）变化；图1C为孕期腹围变化
表2 未育组分别与妊娠组、产后组的IRD1、IRD2、WRA的比较（mm，±s）
组别 例数 IRD1 IRD2 WRA
未生育组 30 16.57±4.62 0 72.03±11.38
妊娠组        
孕1~4周 5 19.92±10.01 0 65.00±10.56
孕5~8周 5 25.82±3.30* 0 80.20±1.79
孕9~12周 17 21.69±7.15* 0 72.17±19.14
孕13~16周 10 22.65±5.67* 0 74.60±8.72
孕17~20周 5 18.11±8.27 0 74.80±8.04
孕21~24周 27 38.03±13.25** 0.35±1.81* 93.44±12.85**
孕25~28周 4 56.50±4.20** 0 97.25±13.30**
孕29~32周 32 58.68±19.53** 2.55±4.60* 100.91±16.5**
孕33~36周 14 82.07±29.42** 11.00±10.13* 110.21±15.6**
孕37~40周 22 92.41±23.40** 6.06±10.47* 113.27±18.5**
产后组        
产后3 d 6 47.67±8.19** 2.25±5.51* 84.83±15.59*
产后4周 4 28.53±5.13** 0 83.00±6.00
产后3个月 5 28.18±6.61** 0 82.80±7.19
产后12个月 15 23.07±11.37 1.80±4.48* 72.09±13.46
表3 多重线性回归分析结果的排除变量
变量 β t值 P值 偏相关
年龄 -0.039c -0.552 0.582 -0.057
身高 -0.039c -0.540 0.590 -0.055
体质量 -0.011c -0.160 0.873 -0.016
腹围 0.026c 0.340 0.734 0.035
体质量指数(孕前) 0.001c 0.010 0.992 0.001
表4 妊娠21周后IRD1的预测回归模型参数估计
变量 未标准化系数 标准化系数 t值 P值
β 标准错误
常量 -26.049 11.082   -2.351 <0.05
孕周(X1) 2.801 0.369 0.570 7.602 <0.05
IRD2(X2) 1.111 0.284 0.294 3.917 <0.05
[1]
Axer H, Keyserlingk DG, Prescher A. Collagen fibers in linea alba and rectus sheaths[J]. J Surg Res, 2001, 96(1): 127-134.
[2]
Lee DG, Lee LJ, McLaughlin L. Stability, continence and breathing: the role of fascia following pregnancy and delivery[J]. J Bodyw Mov Ther, 2008, 12(4): 333-348.
[3]
Richardson Carolyn A, Snijders Chris J, Hides Julie A, et al. The relation between the transversus abdominal muscles, sacroiliac joint mechanics, and low back pain[J]. Spine, 2002, 27(4): 399-405.
[4]
da Mota PGF, Pascoal AGA, Carita AIAD, et al. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain[J]. Man Ther, 2015, 20(1): 200-205.
[5]
Spitznagle TM, Leong FC, Van Dillen LR. Prevalence of diastasis recti abdominis in a urogynecological patient population[J]. Int Urogynecol J Pelvic Floor Dysfunct, 2007, 18(3): 321-328.
[6]
Akram J, Matzen SH. Rectus abdominis diastasis[J]. Scand J Plastic Reconstruct Surg, 2014, 48(3): 163-169.
[7]
Rath AM, Attali P, Dumas JL, et al. The abdominal linea alba: an anatomo-radiologic and biomechanical study[J]. Surg Radiol Anat, 1996, 18(4): 281-288.
[8]
Deter R L, Lee W, Yeo L, et al. Individualized growth assessment: conceptual framework and practical implementation for the evaluation of fetal growth and neonatal growth outcome[J]. Am J Obstet Gynecol, 2018, 218(2): S656-S678.
[9]
Mookerjee I, Solly NR, Royce SG, et al. Endogenous relaxin regulates collagen deposition in an animal model of allergic airway disease[J]. Endocrinology, 2006, 147(2): 754.
[10]
Liaw LJ, Hsu MJ, Liao CF, et al. The relationships between inter-recti distance measured by ultrasound imaging and abdominal muscle function in postpartum women: a 6-month follow-up study[J]. J Orthop SportsPhys Ther, 2011, 41(6): 435.
[11]
陈志强，张谷风，邹宁生, 等. 腹直肌与腹白线关系的形态学及生理学研究[J]. 解剖学杂志, 1987(4): 41-44.
[12]
Das SS, Saluja S, Vasudeva N. Biometrics of pyramidalis muscle and its clinical importance[J]. J Clin Diagn Res, 2017, 11(2): AC05-AC07.
[13]
Goldspink G, Scutt A, Martindale J, et al. Stretch and force generation induce rapid hypertrophy and myosin isoform gene switching in adult skeletal muscle[J]. Biochem Soc Trans, 1991, 19(2): 368-373.
[14]
Martin WD. A study of the effect of pregnancy on muscle fibers of the rectus abdominis muscle of the rat[J]. Anat Rec, 1979, 195(3): 455-462.
[15]
Lalatta CG, Barazzoni AM, Lucchi ML, et al. Histochemical types and sizes of fibers in the rectus abdominis muscle of guinea pig: adaptive response to pregnancy[J]. Anat Rec, 1987, 217(1): 23-29.
[16]
Dix DJ, Eisenberg BR. Myosin mRNA accumulation and myofibrillogenesis at the myotendinous junction ofstretched muscle fibers[J]. J Cell Biol, 1990, 111(1): 1885-1894.
[17]
Williams PE, Goldspink G. Changes in sarcomere length and physiological properties in immobilized muscle[J]. J Anat, 1978, 127(Pt 3): 459-468.
[18]
Williams P, Kyberd P, Simpson H, et al. The morphological basis of increased stiffness of rabbit tibialis anterior muscles during surgical limb-lengthening[J]. J Anat, 1998, 193(Pt 1): 131-138.
[19]
Goldspink G. Impairment of IGF-I gene splicing and MGF expression associated with muscle wasting[J]. Int J Biochem Cell Biol, 2006, 38(3): 481-489.
[20]
Coldron Y, Stokes MJ, Di JN, et al. Postpartum characteristics of rectus abdominis on ultrasound imaging[J]. Man Ther, 2008, 13(2): 112-121.
[1] 江庆, 顾军, 冯冠男, 郭建锋, 郑凯, 何秋娟, 周轶群, 邓学东. 产后42~60 d腹直肌间距的超声参考值范围[J]. 中华医学超声杂志（电子版）, 2021, 18(11): 1067-1072.
[2] 钟华, 巫燕玲, 陈英, 周玉婷, 曾梅青, 骆婕, 杨焰. 二维超声联合实时剪切波弹性成像评估腹直肌分离[J]. 中华医学超声杂志（电子版）, 2021, 18(09): 847-853.
[3] 付鹏, 江凌, 崔立刚. 高频超声在产后女性腹直肌分离评估中的应用价值[J]. 中华医学超声杂志（电子版）, 2021, 18(01): 79-83.
[4] 谢丹丹, 巩尊科, 樊莉琳, 张彩侠. 产后早期静力性收缩训练联合神经肌肉电刺激治疗产后腹直肌分离的疗效研究[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(03): 357-365.
[5] 王友华, 黄海, 骆剑华, 张焕彬, 周学鲁. 人工弓状线切开技术在弓状线变异腹腔镜全腹膜外腹股沟疝修补术中的应用：附视频[J]. 中华普通外科学文献(电子版), 2020, 14(05): 359-363.
[6] 刘颂, 王萌, 王峰, 陆晓峰, 管文贤, 郑黎明. 腹直肌厚度与腹腔深度在结肠癌根治性切除术后手术部位感染中的预测价值分析[J]. 中华普外科手术学杂志(电子版), 2018, 12(03): 211-214.
[7] 李炳根, 龚独辉, 赖泽如, 聂向阳. 产后腹直肌分离全腔镜下肌后/腹膜外补片修补术的临床研究[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 724-727.
[8] 张俊松, 刘玉海, 吴立胜. 腹直肌分离的外科治疗[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(05): 497-501.
[9] 张一忠, 蒋会勇, 吴卫东. 下腹部腹膜前间隙辨析-鞘后视野下的膜解剖[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(04): 394-400.
[10] 朱熠林, 邹振玉, 刘雨辰, 赵学飞, 杨慧琪, 王明刚, 陈杰. 腹直肌外侧入路完全内镜下肌后修补术治疗腹壁疝11例临床分析[J]. 中华疝和腹壁外科杂志(电子版), 2021, 15(06): 556-560.
[11] 曹桢, 刘子文. 产后腹直肌分离的研究进展[J]. 中华疝和腹壁外科杂志(电子版), 2021, 15(06): 549-552.
[12] 李光兴, 申英末. 腹直肌分离症的外科诊疗研究进展[J]. 中华疝和腹壁外科杂志(电子版), 2021, 15(01): 4-7.
[13] 王平, 黄永刚. 腹外斜肌转移肌瓣技术修补腹直肌缺失的临床应用[J]. 中华疝和腹壁外科杂志(电子版), 2019, 13(06): 511-514.
[14] 张红月, 陈健民, 王殿琛, 陈亚柯. 基质金属蛋白酶-2、基质金属蛋白酶组织抑制因子-2在不同年龄阶段成人腹股沟疝患者腹直肌前鞘中的表达及意义[J]. 中华疝和腹壁外科杂志(电子版), 2018, 12(03): 190-193.
[15] 赵新民, 陈源源, 方芳, 宋正亮, 明葛东. 超声引导双侧腹直肌鞘阻滞在小儿腹腔镜疝囊高位结扎术麻醉中的应用[J]. 中华临床医师杂志(电子版), 2020, 14(02): 90-93.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号