产后腹直肌分离的超声诊断与分型分类研究

Ultrasonic diagnosis and typing classification of postpartum diastasis recti abdominis

  • 摘要:
    目的 采用高频超声研究产后腹直肌分离(DRA)的间距和类型, 建立DRA诊断和分型分类的标准。
    方法 采用便利序贯采集法抽取2020年1—12月在无锡市锡山人民医院住院分娩后常规复诊(产后3 d、6周和3个月)的产妇326例,采用高频超声测量DRA的间距和最大间距位置。
    结果 根据改良分型标准进行评估, 326例产妇中疑似和轻度分离者占多数,产后42 d复诊时,疑似和轻度分离患者比率分别为39.88%、28.83%;产后3个月复查时,分离恢复正常(≤2 cm)者比率为92.64%。产后6周分离>3 cm者有101例,根据改良分类标准分为Ⅰ型(脐上分离)72例(71.29%), Ⅳ-a型(脐上=脐下)1例(1.00%), Ⅳ-b型(脐上>脐下)20例(19.80%), Ⅳ-c型(脐下>脐上)1例(1.00%), Ⅲ型(脐部型)6例(5.94%), Ⅴ型1例(1.00%), 脐上和脐环区为最大分离距离。
    结论 改良分型分类标准更符合临床实际,有助于临床精准确定DRA康复治疗的时机和方案。

     

    Abstract:
    Objective To study the spacing and types of postpartum diastasis recti abdominis (DRA) by using high-frequency ultrasound, and to establish the criteria for diagnosis and typing classification.
    Methods A total of 326 pregnant women with postpartum routine recheck (3 days, 6 weeks and 3 months after delivery) in Xishan People's Hospital of Wuxi City from January to December 2020 were selected by convenient sequential acquisition method, and the spacing and maximum spacing position of DRA were measured by high-frequency ultrasound.
    Results According to the improved classification criteria, the suspected and slightly separated types were the major types in 326 pregnant women, and the proportions of patients with suspected and slightly separated types were 39.88% and 28.83%, respectively at the 42 day follow-up after delivery; the proportion of separation returning to normal (≤ 2 cm) was 92.64% in the re-examination at 3 months after delivery. There were 101 cases with separation>3 cm in 6 weeks after delivery, and according to improved classification criteria, they were divided into type Ⅰ (supraumbilical separation) in 72 cases (71.29%), type Ⅳ-a (supraumbilical was equal to subumbilical) in 1 case (1.00%), type Ⅳ-b (supraumbilical was greater than subumbilical type) in 20 cases (19.80%), type Ⅳ-c (subumbilical was greater than supraumbilical) in 1 case (1.00%), type Ⅲ (umbilical type) in 6 cases (5.94%), and type Ⅴ in 1 case (1.00%), and the maximum separation distance was between the supraumbilical region and the umbilical ring region.
    Conclusion Improved typing classification criteria is more conform to clinical practice, and is helpful to establish the timing and plan of rehabilitation treatment.

     

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