盆底治疗文献.doc

Glazer教授文献摘要Long Term Follow-Up After Treatment with Surface Electromyography-Assisted Pelvic Floor Muscle Rehabilitation Howard I. Glazer Ph.D.*From the Departments of Psychiatry and Obstetrics and Gynecology, Joan and Sanford Weill Medical College of Cornell University, New York, New York Dr. Glazer is a Clinical Associate Professor of Psychology in Psychiatry and in Obstetrics and Gynecology. Address reprint requests to: Howard I. Glazer Ph.D. 340 East 63rd St. #1A New York, N.Y. 10021 应用表面肌电评估及训练盆底肌肉功能障碍的长程数据回顾分析报告目的：对dysesthetic vulvodynia的患者进行长期随访，对应用表面肌电进行盆底肌肉功能进行评估及训练后的回访数据进行分析。研究方法：对1994-1996年间62例患有 dyesthetic vulvodynia 的患者进行回访，全部患者在治疗前均进行评估，治疗结束后症状均消失。43位患者对问卷提问进行答复，问卷内容包括：疼痛、具体治疗方法、日常功能、性功能状况等。结果：43例患者中有38位患者（88.4%）报告：进行完整的治疗过程后未再出现阴道疼痛症状；有3位患者报告：曾有一次阴道疼痛的急性发作，另有2位患者报告：曾有二次阴道疼痛的急性发作，以上5位患者均报告在平均19.8个月中未有疼痛发作。所有43例患者均报告在成功完成治疗后，平均39.5个月在未出现疼痛。在日常生活未见引发阴道疼痛的特殊对待及限制的报告。所有患者均报告性生活积极主动。结论：应用表面肌电对盆底肌肉功能进行康复训练对dysesthetic vulvodynia是一种确实的并且长期有效的治疗手段。介绍：dysesthetic vulvodynia 是一种无法解释的慢性、无接触、部位不确定的阴道疼痛综合症。典型表现为类似于烧灼感、刺痛感、易激惹或生硬感。以往dysesthetic vulvodynia的发生率一直未被重视，以前通常会在初诊时会被报告为性交困难、盆腔疼痛包括痛经（46%）、肠易激综合症（39%）。Treatment of Vulvar Vestibulitis Syndrome with Electromyographic Biofeedback of Pelvic Floor MusculatureHoward I. Glazer, Ph.D., Gae Rodke, M.D., Charles Swencionis, Ph.D., Ronny Hertz, D.D.S., M.D., Reprinted from ：THE JOURNAL OF REPRODUCTIVE MEDICINE Vol. 40 No. 4, April 1995With Permission of the First AuthorAbstractThirty-three women diagnosed as suffering from vulvar vestibulitis syndrome, marked by a significant history of long-term moderate to severe chronic introital dyspareunia and tenderness of the vulvar vestibule, were selected for treatment. Patients were given a computerized electromyographic evaluation of the pelvic floor muscles and were then provided with portable electromyographic biofeedback instrumentation and instructions on the conduct of daily, at-home, biofeedback-assisted pelvic floor muscle rehabilitation exercises. They received intermittent evaluations of pelvic floor muscles to ensure compliance and monitor their progress and symptom changes. The results show that after an average of 16 weeks of practice, pelvic floor muscle contractions increased 95.4%, resting tension levels decreased 68%, and the instability of the muscle at rest decreased by 62%. Subjective reports of pain decreased an average of 83%. Twenty-eight patients had abstained from intercourse for an average of 13 months. Twenty-two of these 28 patients resumed intercourse by the end of the treatment period. Six month follow-up indicated maintenance of therapeutic benefits. (J Reprod Med 1995;40 283-290) Keywords: vulvar diseases, electromyography, vulvar vestibulitis syndrome.盆底肌肉电刺激生物反馈治疗阴道前庭综合征摘要：33名妇女被检测出患有阴道前庭综合征而需要接受治疗，原因是长期的中度到高度的慢性阴道性交困难和阴道前庭疼痛引起的。患者先接受盆底肌肉的计算机处理的肌电图评估，然后接受便携式的肌电生物反馈设备和指导开展日常的居家的生物反馈协助的盆底肌肉复原练习。他们不断地接受盆底肌肉的评估以确保疗效以及监测她们的进步和症状的改善。结果显示：在平均16个星期的练习后，盆底肌肉收缩增强了95.4，静息张力下降了68，肌肉静息状态的不稳定性下降62，主观的疼痛报告平均下降了83。28名患者回避交往平均达到13个月。其中22名患者在疗程结束后重新开始交往。6个月跟踪调查治疗显示效果保持良好。关键词：阴道疼痛，肌电图，阴道前庭疼痛综合征Functional Rehabilitation of Pelvic Floor Muscles:A Challenge to TraditionHoward Glazer, PhD, and Dawn MacConkey, PT, RCMTHoward Glazer is a Clinical Associate Professor of Psychology in Psychiatry at Cornell University Medical College and an Associate Attending Psychologist at New York Hospital in New York City.Dawn MacConkey is a Physical Therapist at Physical Therapy Specialists in Denver, Colorado.Urol Nurs 1996;16:68-9. Copyright 1996 by the Society of Urologic Nurses and Associates Inc.We have found that the vast majority of patients referred to us for pelvic floor muscle rehabilitation have been given the traditional Kegel exercises by their physicians. Patients are typically instructed to identify the correct muscles by stopping the flow of urine and are then further instructed to contract and relax these muscles. On occasion, contraction duration and number of repetitions may be specified, but this tends to be highly variable. More often, instructions are simply to do these exercises as often as you can or integrate these exercises into your daily activities. Few patients comply with these instructions, and of those who do, few receive significant benefit.In the past, strengthening of pelvic floor muscles with surface electromyographic feedback has focused on isolating the pelvic floor muscles from their supportive accessory muscles (abdominals, adductors, piriformis, gluteals, etc.). We would like to challenge this tradition and introduce accessory augmented pelvic floor contractions (AAPFC) to enhance the rehabilitation of pelvic floor anal muscles in the treatment of urinary incontinence, detrusor instability, vulvodynia, interstitial cystitis, levator ani syndrome, prostatodynia, pelvic pain, and similar syndromes.盆底肌肉功能康复：对传统的挑战我们发现大多数缓和向我们反映她们的医生使用传统的凯格尔（Kegel）训练来复健盆底肌肉。患者通常被要求去找到终止漏尿的正确的肌肉，然后进行“收缩放松”训练肌肉。偶尔，收缩时间和重复次数被规定，但是这个管理通常是高度灵活可变的。往往，指导仅是“尽可能经常练习”或者“把训练纳入日常活动”。只有少数患者遵守了这些指导，而在那些遵守了指导方案的没有获得明显好转。过去，用表面肌电反馈强化盆底肌肉主要集中在从支持的附属的肌肉中（腹部的、内收肌、梨状肌、臀肌等）分离出盆底肌。我们想挑战传统方法引进附加扩张盆底肌收缩（AAPFC）加强盆底肌的复健，用于治疗尿失禁，盆骨疼和类似的综合征。Treating Vulvar Vestibulitis with Electromyographic Biofeedback of Pelvic Floor MusculatureEsperanza McKay, M.D. Raymond H. Kaufman, M.D. Uday Doctor, M.D.Zuzana Berkova, Ph.D. Howard Glazer, Ph.D. and Vladimir Redko, M.D.From the Department of Obstetrics and Gynecology* and Department of Anesthesiology, Baylor College of Medicine, Houston, Texas, and Department of anesthesiology, University of Texas Medical Branch, Houston, Texas.ABSTRACTOBJECTIVE:To evaluate the effectiveness of electromyographic biofeedback of pelvic floor musculature in the management of patients with moderate to severe vulvar vestibulitis syndrome. METHODS:Twenty-nine patients with moderate to severe vulvar vestibulitis syndrome were included in this study. Each patient was given a computerized electromyographic assessment of pelvic floor muscles. They were then provided with a portable electromyographic home trainer biofeedback device and specific instructions were given to perform biofeedback - assisted pelvic floor muscle rehabilitation exercises. The patients received monthly evaluations of the pelvic floor muscles to ensure and motivate compliance and monitor improvement and symptom changes. Patients were evaluated on a monthly basis relative to vestibulodynia and dyspareunia. RESULTS:Fifteen of the 29 treated patients (51.7%) demonstrated a marked decreased introital tenderness and 14 of these fifteen (93.3%) were able to resume sexual activity without discomfort. Nine patients (31.0%) demonstrated a significant decrease in introital tenderness and pain and 6 of the 9 (66.7%) resumed sexual activity. Thus 20 of the 29 women (69%) became sexually active. Following completion of treatment twenty-four (88.9%) reported negligible or mild pain, 5 of the 29 women did not show any significant improvement and none of these were able to resume sexual activity. Within six months of start of therapy 90% of individuals ultimately resuming sexual activity had done so. 盆底肌肉肌电生物反馈治疗阴道前庭综合征方法：29名患者都伴有中度到高度的阴道前庭综合征，被作为研究对象。每位患者接受计算机处理的盆底肌电评估。然后使用便携式的肌电图家庭生物反馈训练装置和专业指导说明书进行生物反馈辅助的盆底肌肉复健练习。这些患者每月接受盆底肌肉评估以家法她们顺从治疗以及监测进步和症状改善。患者通过一个月的相关的阴道疼痛和性交困难进行评估。结果：29名治疗的患者中15名（51.7）证明阴道疼痛显著下降，这15名中的14名（93.3）能够继续性生活而无不适感。9名患者（31.0）证明阴道不适和疼痛下降，而这9名中的6名能够继续性生活。因此，这29名患者中的20名（69）变得可以性生活活跃。随着治疗的结束，24名患者（88.9）报告仅有可以忽略的或者轻微的疼痛，29名中有5名没有显示明显的改善，这5名都不能继续开始性生活。经过6个月的治疗，90的患者基本可以并开始继续性生活。Clinical Management of VulvodyniaHoward I. Glazer1 and William J. Ledger2 1From the Departments of Psychiatry and Obstetrics and Gynecology, Joan, Joan and Sanford Weill Medical College of Cornell University, New York, New York.Dr. Glazer is a Clinical Associate Professor of Psychology in Psychiatry and in Obstetrics and Gynecology. 2Chairman Emeritus in the Departments of Obstetrics and Gynecology, and Given Foundation Professor at the Joan and Sanford Weill Medical College of Cornell University, New York, New York. AbstractVulvodynia, also known as burning vulva syndrome, is characterised by sensory abnormalities of the vulva and the surrounding tissue, such as an unpleasant burning and itching sensation, or a painful response to a stimulus that is not usually painful such as sexual intercourse or the touch of a cotton swab. Organic vulvodynia is often treatable once a cause has been established. Idiopathic vulvodynia, which consists of vulvar dysesthesia or vestibulodyniavulvar vestibulitis syndrome, often exists in conjunction with organic vulvodynia. Both entities should be treated concurrently, if possible. Several treatment methods exist for idiopathic vulvodynia and most may be used in conjunction with each other. Treatment options that are less invasive are often tried first, including hygienic and dietary changes, surface electromyographic biofeedback, and medications. Surgery, effective only for vestibulodyniavulvar vestibulitis syndrome and usually considered only for women refractory to other treatments, can be combined with other treatments (interferon, and sEMG biofeedback for example) to increase effectiveness. A pathway of treatment options is presented.阴道疼痛的临床处理阴道疼痛，也被认为是灼烧性阴道综合征，表现出阴道和周围组织感觉异常，诸如令人难受的灼烧和痒的感觉，或者是对于刺激的疼痛反应，那不同于性交痛或者药棉擦拭的疼痛。器官的疼痛通常原因一旦查明就可以治疗。先天的阴道疼痛，包括阴道感觉迟缓，或者阴道前庭综合征，通常存在于组织器官连接处。如果可能，两个部分都要同时治疗。多种治疗方法用于治疗先天的阴道疼痛，而大多数用于每部分的连接处。治疗方法的选则往往都是经过测试创伤很小的，包括卫生学，饮食改变，表面肌电生物反馈和药物治疗。外科手术是仅对那些其他方法都无效的患有阴道疼痛综合征的妇女，同时能配合其他治疗（例如干扰素、表面肌电生物反馈）增强疗效。本文描述了一个可选择的治疗路径。Pelvic Floor Muscle Biofeedback in the Treatment of Urinary Incontinence:A Literature ReviewHoward I. Glazer，Joan and Sanford Weill Medical College of Cornell University，New York Presbyterian HospitalCarolyn D. Laine，Saybrook Graduate School and Research CenterAbstract：Biofeedback is efficacious in the training of the pelvic floor musculature in order to enhance continence. This article reviews the an