The Most Common Functional Disorders and Factors Affecting Female Pelvic Floor

The pelvic floor (PF) is made of muscles, ligaments, and fascia, which ensure organ statics, maintain muscle tone, and are involved in contractions. This review describes the myofascial relationships of PF with other parts of the body that determine the proper functions of PF, and also provides insight into PF disorders and the factors contributing to them. PF plays an important role in continence, pelvic support, micturition, defecation, sexual function, childbirth, and locomotion, as well as in stabilizing body posture and breathing, and cooperates with the diaphragm and postural muscles. In addition, PF associates with distant parts of the body, such as the feet and neck, through myofascial connections. Due to tissue continuity, functional disorders of muscles, ligaments, and fascia, even in the areas that are distant from PF, will lead to PF disorders, including urinary incontinence, fecal incontinence, prolapse, sexual dysfunction, and pain. Dysfunctions of PF will also affect the rest of the body.

Relationship Between High Intra-Abdominal Pressure and Compliance of the Pelvic Floor Support System in Women Without Pelvic Organ Prolapse: A Finite Element Analysis

Background: The objective of this study was to study the relationship between high intra-abdominal pressure and the compliance of the pelvic floor support system in a normal woman without pelvic organ prolapse (POP), using a finite element model of the whole pelvic support system.Methods: A healthy female volunteer (55 years old) was scanned using magnetic resonance imaging (MRI) during the Valsalva maneuver. According to the pelvic structure contours traced by a gynecologist and anatomic details measured from dynamic MRI, a finite element model of the whole pelvic support system was established, including the uterus, vagina with cavity, cardinal and uterosacral ligaments, levator ani muscle, rectum, bladder, perineal body, pelvis, and obturator internus and coccygeal muscles. This model was imported into ANSYS software, and an implicit iterative method was employed to simulate the biomechanical response with increasing intra-abdominal pressure.Results: Stress and strain distributions of the vaginal wall showed that the posterior wall was more stable than the anterior wall under high intra-abdominal pressure. Displacement at the top of the vagina was larger than that at the bottom, especially in the anterior–posterior direction.Conclusion: These results imply potential injury areas with high intra-abdominal pressure in non-prolapsed women, and provide insight into clinical managements for the prevention and surgical repair plans of POP.

SCHANZ OSTEOTOMY A FADING ART

The pelvic support osteotomy is a useful surgical procedure for the salvage of damaged hips of patients in whom arthrodesis or hip arthroplasty are not appropriate either surgically or nancially. It is a procedure that has much to offer the adolescent or young adult who has painful limping, restriction of hip motion and early onset fatigue to walking as a consequence of hip destruction from AVN, TB hip, old neglected dislocation of hip, neglected acetabulum fracture or persistent severe hip dysplasia. A successful pelvic support osteotomy reduces limp by reducing the Trendelenburg lurch and compensating the limb length inequality. It provides stability by taking support on the hemipelvis and facilitates a more energy-efcient gait. In this article, the authors present their own experience with palliative Schanz osteotomy.

DOUBLE FEMORAL OSTEOTOMY FOR THE TREATMENT OF SEVERE SEQUELAE OF THE IMMATURE HIP

ABSTRACT Objective: To evaluate the results of double femoral osteotomy for the treatment of severe sequelae of the hip. Methods: Immature patients with anatomical loss of the hip were treated with pelvic support osteotomy in the distal femur to correct lower limb shortening, they were evaluated clinically and radiographically. Results: Eleven cases (eleven hips) were assessed with verage follow-up of three years. The mean age of the patients was 14.7 years. Seven patients had sequela of infectious arthritis; three had sequela of developmental dysplasia of the hip and one patient had a sequela of slipped capital femoral epiphysis. Preoperatively, the gluteus medius was insufficient in all patients, and it became negative in ten of them. The average of lower limb shortening was 5 cm (2.5 to 7 cm) and reduced shortening was 1.9 cm (0 to 4 cm). According to Paley Classification, 72.7% of complications were considered problems, 90.9% were considered obstacles and 27.2% complications, among which the limitation of the knee flexion was the most frequent. Conclusion: The technique yielded good results, considering the severity of the sequela and the absence of a better therapeutic option. No important sequela was associated with the treatment. Level of Evidence IV, Case series.

Tip-Over Stability Analysis of a Pelvic Support Walking Robot

Discussed in this paper is the tip-over stability analysis of a pelvic support walking robot. To improve the activities of daily living (ADL) in hemiplegic patients, a pelvic support walking robot is proposed to help patients facilitating their rehabilitation. During the gait training with the robot, the abnormal man-machine interaction forces may lead to the tip-over of the robot, which is not beneficial to the rehabilitation process. A new method is proposed to predict the possibility of tipping over and evaluate the stability of the robot based on statics model, dynamics model, and zero-moment point (ZMP) theory. Through the interaction forces and moments analysis with static case, the safe point (ZMP) is studied, and the influence factors of force/moment are analyzed by dynamics case. An optimization algorithm based on the genetic algorithm (GA) is proposed to reduce the risk of tipping over. The simulation results show that the optimization algorithm can keep the robot from tipping over when the interaction forces exceed the safety threshold.