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<p>This study aimed to evaluate the short-term efficacy and safety of three-dimensional (3D) reconstruction from preoperative magnetic resonance angiography (MRA) in guiding transvaginal sacrospinous ligament fixation (SSLF) for POP-Q stage III-IV uterine prolapse, and to explore the value of this technology in optimizing perioperative surgical planning. This was a single-center randomized controlled trial conducted at a tertiary gynecological center in China from January 2024 to June 2025. A total of 100 patients with POP-Q stage III-IV uterine prolapse scheduled for uterus-preserving SSLF were randomly assigned to a study group (<i>n</i> = 50) or a control group (<i>n</i> = 50) using a random number table with allocation concealment. The study group underwent preoperative pelvic MRA with 3D reconstruction using Mimics 19.0 software to quantify sacrospinous ligament anatomy and its spatial relationship with adjacent neurovascular structures for individualized suture planning. The control group underwent traditional palpation-guided SSLF. Primary outcomes were operative time, intraoperative blood loss, and postoperative hospital stay. Secondary outcomes included postoperative complications (within 6 months) and Pelvic Floor Distress Inventory-20 (PFDI-20) scores at 1 month postoperatively. Sample size was calculated based on a preliminary pilot study with a power of 80% and a two-sided α of 0.05. Normality and homogeneity of variance were tested for continuous variables before statistical analysis. Independent t-tests (for normally distributed continuous variables) and chi-square tests (with Yates’ correction for small cell counts) were used for group comparisons. All analyses were performed in the intention-to-treat (ITT) population. The two groups were comparable in general demographic and clinical characteristics (all <i>P</i> &gt; 0.05). The study group had significantly shorter operative time (57.8 ± 10.2 vs. 76.3 ± 12.5&#xa0;min, <i>P</i> &lt; 0.001), less blood loss (44.9 ± 12.1 vs. 69.2 ± 15.8 mL, <i>P</i> &lt; 0.001), and shorter hospital stay (3.3 ± 0.6 vs. 4.6 ± 1.2 days, <i>P</i> &lt; 0.001). The postoperative complication rate was lower in the study group (6.0% vs. 24.0%, <i>P</i> = 0.012). The 1-month PFDI-20 score was significantly better in the study group (32.1 ± 6.5 vs. 41.5 ± 7.8, <i>P</i> &lt; 0.001). MRA measurements provided detailed anatomical parameters (e.g., ligament thickness: 3.4 ± 0.6&#xa0;mm; distance to internal pudendal artery: 18.3 ± 2.7&#xa0;mm). No patients were lost to follow-up during the 6-month follow-up period. Preoperative MRA-based 3D reconstruction may improve the precision of individualized surgical planning for SSLF, and is associated with reduced operative trauma, shorter short-term recovery, lower early postoperative complication rates, and better short-term pelvic floor function outcomes. This technology shows potential in enhancing the short-term safety and precision of SSLF, but its long-term efficacy and generalizability need to be verified by large-sample multi-center studies with extended follow-up.</p>

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3D MRA-Assisted Sacrospinous Ligament Fixation for Advanced Uterine Prolapse: Perioperative Outcomes and Safety Analysis

  • 期刊论文

  • 发表日期：

    2026年7月1日

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  • Chao Zhang,
  • Yajuan Gao,
  • Shuncang Zhang,
  • Xiaochun Huang,
  • Qing Su,
  • Ping Ren,
  • Ji Yang,
  • Huijuan Peng

摘要

This study aimed to evaluate the short-term efficacy and safety of three-dimensional (3D) reconstruction from preoperative magnetic resonance angiography (MRA) in guiding transvaginal sacrospinous ligament fixation (SSLF) for POP-Q stage III-IV uterine prolapse, and to explore the value of this technology in optimizing perioperative surgical planning. This was a single-center randomized controlled trial conducted at a tertiary gynecological center in China from January 2024 to June 2025. A total of 100 patients with POP-Q stage III-IV uterine prolapse scheduled for uterus-preserving SSLF were randomly assigned to a study group (n = 50) or a control group (n = 50) using a random number table with allocation concealment. The study group underwent preoperative pelvic MRA with 3D reconstruction using Mimics 19.0 software to quantify sacrospinous ligament anatomy and its spatial relationship with adjacent neurovascular structures for individualized suture planning. The control group underwent traditional palpation-guided SSLF. Primary outcomes were operative time, intraoperative blood loss, and postoperative hospital stay. Secondary outcomes included postoperative complications (within 6 months) and Pelvic Floor Distress Inventory-20 (PFDI-20) scores at 1 month postoperatively. Sample size was calculated based on a preliminary pilot study with a power of 80% and a two-sided α of 0.05. Normality and homogeneity of variance were tested for continuous variables before statistical analysis. Independent t-tests (for normally distributed continuous variables) and chi-square tests (with Yates’ correction for small cell counts) were used for group comparisons. All analyses were performed in the intention-to-treat (ITT) population. The two groups were comparable in general demographic and clinical characteristics (all P > 0.05). The study group had significantly shorter operative time (57.8 ± 10.2 vs. 76.3 ± 12.5 min, P < 0.001), less blood loss (44.9 ± 12.1 vs. 69.2 ± 15.8 mL, P < 0.001), and shorter hospital stay (3.3 ± 0.6 vs. 4.6 ± 1.2 days, P < 0.001). The postoperative complication rate was lower in the study group (6.0% vs. 24.0%, P = 0.012). The 1-month PFDI-20 score was significantly better in the study group (32.1 ± 6.5 vs. 41.5 ± 7.8, P < 0.001). MRA measurements provided detailed anatomical parameters (e.g., ligament thickness: 3.4 ± 0.6 mm; distance to internal pudendal artery: 18.3 ± 2.7 mm). No patients were lost to follow-up during the 6-month follow-up period. Preoperative MRA-based 3D reconstruction may improve the precision of individualized surgical planning for SSLF, and is associated with reduced operative trauma, shorter short-term recovery, lower early postoperative complication rates, and better short-term pelvic floor function outcomes. This technology shows potential in enhancing the short-term safety and precision of SSLF, but its long-term efficacy and generalizability need to be verified by large-sample multi-center studies with extended follow-up.