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Prévention primaire des troubles de la statique pelvienne: contribution de l’angle d’incidence pelvienne

Primary prevention of pelvic floor disorders: contribution of the pelvic incidence angle

  • Article Original / Original Article
  • Published:
Pelvi-périnéologie

Résumé

Objet

Le but de ce travail était d’évaluer la valeur de l’angle d’incidence pelvienne (IP) comme facteur prédictif de descente périnéale. Ce facteur morphologique osseux, acquis à la fin de la croissance, n’a jamais été corrélé à un trouble de la statique pelvienne.

Méthodes

Dans une étude rétrospective de 197 femmes, la descente du périnée au repos et durant la poussée est évaluée à partir de défécographies. L’angle d’IP (53° ± 9 °C, indépendant de la position du sujet) est défini comme l’angle entre la droite perpendiculaire au milieu du plateau supérieur du sacrum et la droite reliant ce dernier avec le milieu de l’axe bicoxofémoral. L’angle d’IP était corrélé à la descente périnéale.

Résultats

L’angle d’IP était statistiquement plus grand lors de la descente du périnée au repos (64 versus 53 °C; p < 10−6). Comme facteur prédictif d’une descente du périnée au repos, une grande IP (> 62 °C) avait une sensibilité (73 %), une spécificité (82 %), une valeur prédictive positive (81 %) et une valeur prédictive négative (75 %).

Conclusion

Une grande IP (> 62 °C) est un facteur prédictif de la descente périnéale au repos avant l’apparition des autres facteurs de risque liés à l’âge. Une grande IP (> 62 °C) s’accompagne d’un large porte-à-faux et d’une horizontalisation du périnée, provoquant une augmentation des contraintes entre les insertions de celui-ci. Une simple radiographie du bassin de profil pourrait permettre de dépister un pelvis à risque de trouble de la statique pelvienne.

Abstract

Purpos

The aims were to assess the relationship between pelvic floor disorders and pelvic morphology, evaluated by the pelvic incidence angle, which might be a predictive factor of pelvic organ prolapse and/or anal incontinence: these hypotheses are not documented.

Methods

In a retrospective study of 197 women, pelvic organ prolapse at rest and during straining were measured by defecography. The pelvic incidence angle (53° ± 9 °C reliable morphological parameter, independent of subject position, constant for an adult, not related to age, no sexual difference) is measured between the line perpendicular to the sacral plate at its midpoint and the line connecting this point to the middle of the axis of the femoral head. One way-Anova and a Pearson matrix correlation were used.

Results

The angle of incidence was measurably greater in cases of perineal descent at rest. (64 versus 53 °C; P < 10−6). As a predictive factor of perineal descent at rest, a greater pelvic incidence (> 62 °C) had sensitivity (73.2%), specificity (82.2%), positive predictive value (80.7 %) and negative predictive value (75%).

Conclusion

With incidence > 62 °C, a large overhang between the insertions increases the strain on the perineum which is rather horizontal. A large angle of incidence could be considered a predictive factor of perineal descent at rest before the apparition of others acquired with age, such as parity, delivery, menopause, age, perineal surgery, obesity, diabetes, straining at stool, pudendal neuropathy.

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Authors and Affiliations

  1. Département de médecine physique et de réadaptation, CHU Carémeau, 5, rue du Professeur-Debré, F-30029, Nîmes cedex 4, France

    C. Boulay & J. Pélissier

  2. Laboratoire d’anatomie, UFR de médecine Montpellier-Nîmes, avenue Kennedy, F-30907, Nîmes cedex, France

    C. Boulay, M. Prudhomme & D. Prat-Pradal

  3. Service du Professeur-B.-Chabrol, centre de référence desmaladies neuromusculaires de l’enfant, CHU La Timone-Enfants, 264, rue Saint-Pierre, F-13385, Marseille cedex 05, France

    C. Boulay

  4. Département des maladies de l’appareil digestif et de cancérologie digestive, CHU Carémeau, 5, rue du Professeur-Debré, F-30029, Nîmes cedex 04, France

    P. Pouderoux

  5. U215 Inserm, CHU Raymond-Poincaré, 104, boulevard Raymond-Poincaré, F-92380, Garches cedex, France

    G. Duval-Beaupère

  6. Département de chirurgie digestive et de cancérologie digestive, CHU Carémeau, 5, rue du Professeur-Debré, F-30029, Nîmes cedex 04, France

    M. Prudhomme

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  1. C. Boulay
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  2. M. Prudhomme
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  4. P. Pouderoux
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  5. G. Duval-Beaupère
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Correspondence to C. Boulay.

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Boulay, C., Prudhomme, M., Prat-Pradal, D. et al. Prévention primaire des troubles de la statique pelvienne: contribution de l’angle d’incidence pelvienne. Pelv Perineol 4, 97–105 (2009). https://doi.org/10.1007/s11608-009-0242-0

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