盆底恢復指導Pelvicfloorrecoveryguide產(chǎn)后恢復培訓章PostpartumRe

盆底恢復指導Pelvicfloorrecoveryguide產(chǎn)后恢復培訓課程-章PostpartumRecoveryTrainingCourse目錄（Content）1.骨盆及盆底肌的結(jié)構(gòu)與功能Structureandfunctionofpelvisandpelvicfloormuscles3.產(chǎn)后骨盆矯正Postpartumpelviscorrection2.產(chǎn)后盆底肌恢復Postpartumpelvicfloorrehabilitation骨盆及盆底肌的結(jié)構(gòu)與功能Structureandfunctionofpelvisandpelvicfloormuscles一、骨盆結(jié)構(gòu)與分部（Pelvicstructureandassociatedstructure）骨盆的分界（Boundaryofthepelvis）骨盆的組成（Thecompositionofthepelvis）010203骨盆的類型（Typeofthepelvis）(一)骨盆的組成（Thecompositionofthepelvis）骨骼(bones)關(guān)節(jié)(joints)韌帶(ligaments)骨盆(Thepelvis)：女性骨盆是胎兒陰道娩出時必經(jīng)的骨性產(chǎn)道。其大小形狀對分娩有直接影響。（Thefemalepelvisisthebonybirthcanalthatthefetusmustpassthroughduringvaginaldelivery.Itssizeandshapedirectlyaffectthedeliveryprocess）(一)骨盆的組成（Thecompositionofthepelvis）骨盆由骶骨、尾骨及左右兩塊髖骨組成。（Thebonesofthepelvisconsistofsacrum,coccyx,leftandrighthipbones.）每塊髖骨又由髂骨、坐骨及恥骨融合而成；（Eachhipboneiscomposedoftheilium,ischium,andpubis;）骶骨由5-6塊骶椎合成；（thesacrumiscomposedof5-6sacralvertebrae;）尾骨由4-5塊尾椎合成。(thecoccyxiscomposedof4-5caudalvertebrae.）骨盆的骨骼（Thebonesofthepelvis）:(一)骨盆的組成（Thecompositionofthepelvis）恥骨聯(lián)合（pubicsymphysis）骶髂關(guān)節(jié)（sacroiliacjoint）骶尾關(guān)節(jié)（sacrocaudaljoint）骨盆的關(guān)節(jié)（Thejointsofthepelvis）:(一)骨盆的組成（Thecompositionofthepelvis）骨盆的韌帶（

Ligamentsofthepelvis）:骶棘韌帶寬度即坐骨切跡寬度，是判斷骨盆是否狹窄的重要指標。(Thewidthofthesacrospinousligamentisthewidthofthesciaticnotch,whichisanimportantindicatorofwhetherthepelvisisnarrowornot.）骶、尾骨與坐骨結(jié)節(jié)之間的骶結(jié)節(jié)韌帶(thesacrotuberousligamentbetweenthesacrum）骶、尾骨與坐骨棘之間的骶棘韌帶(thesacrospinousligamentbetweenthesacrum,coccyxandsciaticspine.）(一)骨盆的組成（Thecompositionofthepelvis）骨盆的標記(Marksofthepelvis）:骶髂坐骨棘恥骨弓髂前上棘（anteriorsuperioriliacspine）坐骨棘（ischialspine）恥骨弓（pubicarch）（二）骨盆的分界(Boundaryofthepelvis)真骨盆又稱小骨盆，又稱骨產(chǎn)道，是胎兒娩出的通道。(Thetruepelvis,alsoknownasthepelvisminor,andthebonybirthcanal,whichisthechannelforthedeliveryofthefetus.）以恥骨聯(lián)合上緣，髂恥緣、骶岬上緣的連線為界，分為假骨盆和真骨盆。(Itisdividedintofalsepelvisandtruepelvisbythelineofthesuperiormarginofpubicsymphysis,iliopubicmarginandthesuperiormarginofsacralpromontory.）（三）骨盆的類型（Typeofthepelvis）根據(jù)骨盆形狀分為4種類型（Accordingtotheshapeofthepelvis,therearefourtypes）：類人猿型（anthropoid）01020304女型（gynecoid）扁平型（platypelloid）男型（android）（三）骨盆的類型（Typeofthepelvis）正常女型骨盆的特點：(Characteristicsofthenormalfemalepelvis:）：骨盆入口呈橫橢圓形(thepelvicentranceistransverseoval)髂骨翼寬而淺(theiliacwingiswideandshallow)入口橫徑較前后徑稍長；恥骨弓較寬(thetransversediameteroftheinletisslightlylongerthantheanterior-posteriordiameter;thepubicarchiswider)兩側(cè)坐骨棘間徑≥10cm(thediameterbetweentheischialspineonbothsidesis≥10cm)二、盆底肌的結(jié)構(gòu)與功能（Structureandfunctionofthepelvicfloor）會陰(Perineum)骨盆底的功能(Functionofthepelvicfloor)骨盆底的位置(Locationofthepelvicfloor)骨盆底的組織(Structureofthepelvicfloor)01020304（二）骨盆底的位置(Functionofthepelvicfloor)盆腔臟器賴以承載并保持正常位置(Pelvicorgansaresupportedandmaintainedinanormalposition）骨盆底由多層肌肉和筋膜所組成，封閉骨盆出口(Thepelvicflooriscomposedofmultiplelayersofmusclesandfascia,whichclosesthepelvicoutlet）（二）骨盆底的位置（Locationofthepelvicfloor）骨盆底的前方為恥骨聯(lián)合下緣(Thefrontofthepelvicflooristhelowermarginofthepubicsymphysis)后方為尾骨尖(therearisthecoccyx)兩側(cè)為恥骨降支、坐骨升支及坐骨結(jié)節(jié)(thesidesarethedescendingbranchofthepubis,theascendingbranchoftheischium,andtheischialtuberosity)（二）骨盆底的位置（Locationofthepelvicfloor）

兩側(cè)坐骨結(jié)節(jié)前緣的連線將骨盆底分為前、后兩部：(Thelineoftheanteriorborderoftheischialtuberosityonbothsidesdividesthepelvicfloorintoanteriorandposteriorparts)前部(theanteriorpart)：為尿生殖三角，又稱尿生殖區(qū)，有尿道和陰道通過。(theanteriorpartistheurogenitaltriangle,alsocalledtheurogenitalarea,throughwhichtheurethraandvaginapass.)后部(Theposteriorpart)：為肛門三角，又稱肛區(qū)，有肛管通過。(Theposteriorpartistheanaltriangle,alsoknownastheanalregion,throughwhichtheanalcanalpasses.)（三）骨盆底的組織（Structureofthepelvicfloor）骨盆底有3層組織（Thepelvicfloorhas3layersoftissue）:010302外層（outerlayer）中層（middlelayer）內(nèi)層（innerlayer）（三）骨盆底的組織（Structureofthepelvicfloor）外層：即淺層筋膜與肌肉。（Theouterlayer：superficialfasciaandmuscle）淺肌肉層（球海綿體肌、坐骨海綿體肌、會陰淺橫肌、肛門外括約?。?superficialmusclelayer(bulbocavernosus,Ischiocavernosus,superficialtransverseperinealandexternalanalsphincter）會陰淺筋膜（superficialperinealfascia）（三）骨盆底的組織（Structureofthepelvicfloor）中層：即泌尿生殖膈(Themiddlelayer：theurogenitaldiaphragm）又稱三角韌帶，其上有尿道與陰道穿過(alsoknownasthetriangularligament,onwhichurethraandvaginapassthrough）由上、下兩層堅韌筋膜及層薄肌肉組成，覆蓋于由恥骨弓與兩坐骨結(jié)節(jié)所形成的骨盆出口前部三角形平面上(consistingoftwolayersoftoughfasciaandathinlayerofmuscles,coveringthetriangularanteriorportionofthepelvicoutlet）（三）骨盆底的組織（Structureofthepelvicfloor）中層(Themiddlelayer）在兩層筋膜間有一對由兩倒坐骨結(jié)節(jié)至中心腱的會陰深橫肌及位于尿道周圍的尿道括約肌。(Betweenthetwolayersoffasciaareapairofdeeptransverseperinealmusclesandaurethralsphincterlocatedaroundtheurethra.）（三）骨盆底的組織（Structureofthepelvicfloor）內(nèi)層(Theinnerlayer）即盆膈（Thepelvicdiaphragm）為骨盆底最里面最堅韌層，由肛提肌及其內(nèi)外面各覆一層筋膜所組成，亦為尿道、陰道及直腸貫通。(Itistheinnermostandtoughestlayerofthepelvicfloorandiscomposedoflevatoranimuscleandalayeroffasciacoveringtheinnerandoutersides,allowingpassagefortheurethra,vaginaandrectum)（三）骨盆底的組織（Structureofthepelvicfloor）內(nèi)層(Theinnerlayer）每側(cè)肛提肌由前內(nèi)向后外由3部分組成:肛提肌是位于骨盆底的成對扁肌，向下向內(nèi)合成漏斗形。(Thelevatoraniisapairedbroadmusclelocatedonthepelvicfloor,whichformafunnelshapedownwardandinward.)恥尾肌:為肛提肌主要部分，位于最內(nèi)側(cè)。經(jīng)產(chǎn)婦的此層組織易受損傷而導致膀胱、直腸膨出(Thepubococcygeusisthemainpartoftheanallevatoranimuscleandislocatedattheinnermostside.Thislayeroftissueofparouswomenisvulnerabletoinjuryandvesicoceleandrectocele)01（三）骨盆底的組織（Structureofthepelvicfloor）內(nèi)層(Theinnerlayer）每側(cè)肛提肌由前內(nèi)向后外由3部分組成:肛提肌是位于骨盆底的成對扁肌，向下向內(nèi)合成漏斗形。(Thelevatoraniisapairedbroadmusclelocatedonthepelvicfloor,whichformafunnelshapedownwardandinward.)髂尾肌:為居中部分；從腱弓后部開始，向中間及向后走行，與恥尾肌會合，再經(jīng)肛門兩側(cè)至尾骨；(Thepuborectalisisthemiddlepart,startingfromtheposteriorpartofthetendonarch,travelingtowardthemiddleandbackward,meetingwiththeiliococcygeus,andthenpassingthroughbothsidesoftheanustothecoccyx;)02（三）骨盆底的組織（Structureofthepelvicfloor）坐尾肌:為靠外后方的肌束，有加強盆底托力以及加強肛門與陰道括約肌的作用03(Theiliococcygeusistheexternalandposteriormusclebundlethatstrengthensthepelvicfloorsupportandstrengthenstheanalandvaginalsphincter)（四）會陰（Perineum）廣義的會陰(Perineuminabroadsense

）是指封閉骨盆出口的所有軟組織；

(referstoallsofttissuethatclosesthepelvicoutlet.)

前為恥骨聯(lián)合下緣；(Theanterioristhelowermarginofpubicsymphysis;)后為尾骨尖；(Theposterioristhetipofcoccyx;)

兩側(cè)為恥骨下支、坐骨支、坐骨結(jié)節(jié)和骶結(jié)節(jié)韌帶(Onbothsidesaretheinferiorpubicramiandinferiorischialrami,ischialtuberosityandthesacrotuberousligament.)（四）會陰（Perineum）狹義的會陰(perineuminanarrowsense）指陰道口與肛門之間的軟組織，厚3-4cm；(whichisthesofttissuebetweenthevaginalopeningandtheanus,withathicknessofonly3-4cm;）由外向內(nèi)逐漸變窄呈楔狀(itgraduallynarrowsfromoutsidetoinsidetoformawedge;）表面為皮膚及皮下脂肪，內(nèi)層為會陰中心腱，又稱會陰體，妊娠期會陰組織變軟有利于分娩(thesurfaceisskinandsubcutaneousfat,andtheinnerlayeristhecentraltendonoftheperineum,alsoknownastheperinealbody,whichbecomessoftduringpregnancytofacilitatedelivery.）分娩時要保護此區(qū)，以免造成會陰裂傷。(protectthisareaduringdeliverytoavoidperineallacerationcausedbyrapiddeliveryofthefetus.）產(chǎn)后盆底肌恢復Postpartumpelvicfloorrehabilitation(pelvicfloormuscle)(bladder)(rectum)(uterus)一、概念（Overview）腹腔內(nèi)壓力把子宮向陰道方向推一、概念（Overview）(thepressureintheabdominalcavitypushestheuterustowardthevagina)盆底功能障礙性疾病(pelvicfloordysfunction)一、概念（Overview）尿道、膀胱、陰道、直腸等，這些器官無法維持在正常位置，從而出現(xiàn)相應功能障礙，如大小便失禁、盆底臟器脫垂等。(urethra,bladder,vagina,rectum,etc.asbefore,andtheseorganscannotbemaintainedintheirnormalposition,thuscorrespondingdysfunctionoccurs,suchasurinaryandfecalincontinence,pelvicfloororganprolapse,etc.)二、產(chǎn)后盆底肌恢復時間（Postpartumpelvicfloormusclerecoverytime）產(chǎn)后42天常規(guī)進行盆底肌訓練(Pelvicfloormuscletrainingshouldberoutinelycarriedoutforwomen42daysafterdelivery）一般，6個月以內(nèi)可以全部完成(Generallyspeaking,pelvicfloormusclerecoverycanbecompletedwithin6months)身體較為虛弱者可能需要1年的時間才可以完全恢復好。(Motherswithweakerphysiquemayneedlongertime,1yeartofullyrecover)三、盆底肌康復訓練的方法（PelvicFloorRehabilitationTrainingMethods）盆底肌鍛煉：凱格爾運動（Pelvicfloormuscleexercise:Kegelexercise）:最簡單、易行、安全有效(Thesimplest,easy,safeandeffectivepelvicfloorrehabilitationmethod）方法：做縮緊肛門的動作，每次收緊不少于3s，然后放松。連續(xù)做15～30min，每天進行2～3次。(Method:tightentheanusfornolessthan3secondseachtime,andthenrelax.Doitcontinuouslyfor15to30minutes,2to3timesaday.)注意鍛煉開始前應排空膀胱。(Notethatthebladdershouldbeemptiedbeforeexercise.）三、盆底肌康復訓練的方法（PelvicFloorRehabilitationTrainingMethods）電刺激治療（Electricstimulationtreatment）:通過探頭，電流直接作用于陰部肌肉，不需要患者意識控制即可實現(xiàn)肌肉的收縮和舒張，適用于盆底肌差，而無法主動完勝收縮動作的患者。(throughtheprobe,electriccurrentdirectlyactsonthepudendalmuscles,whichcanachievemusclecontractionandrelaxationwithouttheconsciouscontrolofthepatient.Itissuitableforpatientswhohavepoorpelvicfloormusclesandunabletotaketheinitiativetocompletethecontractionaction.)三、盆底肌康復訓練的方法（PelvicFloorRehabilitationTrainingMethods）生物反饋治療（Electricstimulationtreatment）:通過探頭，將陰道內(nèi)的壓力，肌電活動等生物信息進行處理，并反饋到屏幕上，通過視覺和聽覺的方式顯示給患者，使患者能夠有意識的去控制收縮和放松，以達到更好的鍛煉效果。(Throughtheprobe,biologicalinformationsuchaspressureandmyoelectricactivityinthevaginaisprocessedandfedbacktothescreen,whichisdisplayedtothepatientthroughvisualandauditorymeans,sothatthepatientcanconsciouslycontrolthecontractionandrelaxationtoachievebetterexerciseresults.)三、盆底肌康復訓練的方法（PelvicFloorRehabilitationTrainingMethods）侵入式儀器使用注意事項(Electricstimulationtreatment）:婦科炎癥期間不建議使用(tisnotrecommendedtousethemduringgynecologicalinflammation)產(chǎn)后惡露未排凈前不建議使用(Itisnotrecommendedtousethembeforepostpartumlochiaends.)三、盆底肌康復訓練的方法（PelvicFloorRehabilitationTrainingMethods）侵入式儀器使用注意事項(Electricstimulationtreatment）:經(jīng)期避免使用(Avoidusingduringmenstruation)

產(chǎn)后傷口未完全恢復前避免使用(Avoidusingitbeforepostpartumwoundhasfullyhealed)

體內(nèi)有心臟起搏器等電子元件的用戶禁止使用(Clientswithelectroniccomponentssuchascardiacpacemakersintheirbodiesareprohibitedfromusingthem)產(chǎn)后骨盆矯正Postpartumpelviscorrection產(chǎn)后骨盆松弛(Postpartumloosenedpelvis)女性骨盆為生殖器官所在部位，也是胎兒娩出的通道。(Thefemalepelvisiswherethereproductiveorgansarelocated,anditisalsothechannelforthedeliveryofthefetus.)骨盆上有脊柱，下有股骨，所以骨盆除了支持上部軀體的重量使均勻分布于下肢外，還具有獨立支持和保護盆腔內(nèi)器官的作用。(Thepelvishasaspineontopandafemuronthebottom,sothepelvisnotonlysupportstheweightoftheupperbodyandmakesitevenlydistributedinthelowerlimbs,butalsoplaysanroleinsupportingandprotectingtheorgansinthepelvisindependently.)產(chǎn)后骨盆松弛(Postpartumloosenedpelvis)骨盆松弛的癥狀（Symptomsofloosenedpelvis）:關(guān)節(jié)變得柔軟，骨盆輪變得松弛(makingthejointssoft.,thepelvicbecomesloose)(pregnantmothersoftencomplainofpainattherootofthethighsandlowerback)大腿根部疼痛，腰痛產(chǎn)后骨盆松弛(Postpartumloosenedpelvis)骨盆松弛的癥狀（Symptomsofloosenedpelvis）:懷孕后期和分娩時恥骨聯(lián)合軟骨松弛，恥骨聯(lián)合可出現(xiàn)輕度分離，使骨盆的經(jīng)線暫時性的增大，利于分娩。(Thecartilageofpubicsymphysisisloosenedinlatepregnancyanddelivery,andthepubicsymphysiscanbeslightlyseparated,whichtemporarilyincreasesthelongitudeofpelvis,whichisconducivetodelivery.)產(chǎn)后骨盆松弛(Postpartumloosenedpelvis)骨盆松弛的癥狀（Symptomsofloosenedpelvis）:身材走樣變形（Outofshape）腰痛、肩酸（Backpain,shoulderpain）步行障礙（Walkingproblems）內(nèi)臟和子宮下垂、小便失禁(Visceralanduterineprolapse,urinaryincontinence）01020304產(chǎn)后骨盆矯正(Postpartumpelviscorrection)矯正的最佳時間:產(chǎn)后6周內(nèi)。(Thebesttimeforpelviscorrection:within6weeksafterdelivery.）產(chǎn)后6～12小時：起床輕微活動(6~12hoursafterdelivery:getupforlightactivities）

產(chǎn)后活動（Postpartumactivities）:第2天：室內(nèi)隨意走動并練習輕微的產(chǎn)后體操.(Seconddayafterdelivery:walkaroundindoorsandpracticelightpostpartumgymnastics）會陰側(cè)切或者剖宮產(chǎn)的產(chǎn)婦：適當推遲活動時間(Womenwhohaveundergonelateralepisiotomyorcesareansection:postponetheexercisetimeappropriately）產(chǎn)后骨盆矯正(Postpartumpelviscorrection)骨盆矯正儀(Thepelviscorrectiondevice）原理：利用科技控制氣墊（或氣囊），按照自身的力度承受能力可控調(diào)解檔位大小，有節(jié)奏的加壓放松，使骨盆在受到外力的作用下，逐漸恢復到生產(chǎn)前的骨盆狀態(tài)。(Principle:usestechnologytocontroltheaircushion(orairbag),adjustthegearsizeaccordingtoitsownstrengthandbearingcapacity,andrelaxthepressurerhythmically,sothatthepelviscangraduallyreturntothestatebeforechildbirthundertheactionofexternalforce.）產(chǎn)后骨盆矯正(Postpartumpelviscorrection)骨盆矯正儀(Thepelviscorrectiondevice）使用時間：在分娩48小時即可用。(Usagetime:Thepelviscorrectiondevicecanbeused48hoursafterdelivery.)產(chǎn)后骨盆矯正(Postpartumpelviscorrection)骨盆矯正帶(pelviccorrectionbelts）菱形式(diamondtype)腰帶式（belttype）提臀式(hipliftingtype)紗布式(gauzetype)產(chǎn)后骨盆矯正(Postpartumpelviscorrection)一般專業(yè)優(yōu)質(zhì)的骨盆帶，順產(chǎn)后三天就可以使用，

(Generally,professionalandhigh-qualitypelvicbeltcanbeusedthreedaysaftervaginaldelivery)剖腹產(chǎn)后七天傷口愈合后就可以使用，(andsevendaysaftercaesareansectionwoundhashealed)

每天白天佩戴八小時左右，松緊適中。(Itcanbeworneverydayduringthedayforabouteighthours,withmoderatetightness)骨盆矯正帶(pelviccorrectionbelts）產(chǎn)后骨盆矯正(Postpartumpelviscorrection)骨盆矯正帶(pelviccorrectionbelts）產(chǎn)后42天內(nèi)是骨盆恢復的最佳時間，(Within42daysafterdeliveryisthebesttimeforpelvicrecovery)骨盆帶最好佩戴2個月左右，需要每天堅持，(pelvicbeltisbestwornforabout2monthseveryday)一般8小時左右即可，(generallyabout8hours)最好夜間睡覺時不要使用。(itisbestnottouseatnightduringsleep)

凱格爾運動(Kegelexercise）骨盆恢復操(Pelvicrecoveryexercises)