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Biomechanical characterisation of uterine ligaments. Implications for the pelvic floor

type de publication      article dans une revue internationale avec comité de lecture
date de publication 2011
auteur(s) Rivaux Géraldine; Rubod Chrystèle; Dedet Bruno; Brieu Mathias; Gabriel Boris; De Landsheere Laurent; Devos P.; Delmas Vincent; Cosson Michel
journal (abréviation) Pelvi-Perineologie (Pelvi-Perineologie)
volume (numéro) 6 (2)
  
pages 67 – 74
résumé Pelvic organ prolapse (POP) affects one-third of women of all ages, and is a major concern for gynaecologic surgeons. Many elements and risk factors make the physiopathology of prolapse complex. Pelvic ligaments seem to play a predominant role in pelvic floor dysfunction. The aim of our study is to define the mechanical properties of uterine ligaments to gain a better understanding of their role in the physiopathology and surgery of POP.
The uterosacral, round and broad ligaments were removed from female cadavers with no history of prolapse or pelvic surgery. A total of 13 cadavers were used. Each ligament was tested for uniaxial tensile strength at constant deformation rate. The large number of results obtained enabled a statistical study of mechanical properties.
The mechanical tests performed on uterine ligaments taken from 13 female cadavers showed the existence of nonlinear elastic behaviour. In this case, the mechanical behaviour of the ligaments could be expressed by two parameters C(0) and C(1), relating to stiffness at low and high deformation rates. Intra-individualreproducibility was satisfactory. The uterosacral ligament was found to be the stiffest of the three ligaments studied, at both low and high deformation rates. Inter-individual dispersion was noted. Each subject studied displayed lateralisation, with one side (either right or left) stiffer than the other. A vaginal tissue sample was also taken from 11 of the 13 subjects, which made it possible to show that vaginal tissue is less stiff than ligament tissue.
The hyperelastic mechanical behaviour of the uterosacral, round and broad ligaments was shown for the first time. This approach showed that the uterosacral ligament is stiffer than the round and broad ligaments and vaginal tissue. Therefore, it appears that it plays a more important role in pelvic floor support. Further mechanical studies of these ligaments in POP would provide further answers to the aetiologies of the recurrence of prolapse after curative surgery.
mots clés Uterine ligaments; Pelvic floor; Prolapse; Gynaecology; Urology
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