耻骨联合分离

1、关于耻骨联合分离第一张，PPT共三十六页，创作于2022年6月AP X-RAY DEMONSTRATING APC TYPE 2SYMPHYSEAL SEPARATION第二张，PPT共三十六页，创作于2022年6月INLET VIEW DEMONSTRATING SEPARATION OF THE SYMPHYSIS第三张，PPT共三十六页，创作于2022年6月OUTLET VIEW第四张，PPT共三十六页，创作于2022年6月The patient is prepped, such that the symphysis is exposed inferiorly, the umbilicu

2、s superiorly and the ASIS laterally.第五张，PPT共三十六页，创作于2022年6月The incision begins two finger breadths above the symphysis pubis.第六张，PPT共三十六页，创作于2022年6月The incision begins two finger breadths above the symphysis pubis.第七张，PPT共三十六页，创作于2022年6月Frequently, one of the rectus heads is avulsed from one of the

3、symphyseal bodies. Occasionally there is a split in the rectus fascia.RECTUS MUSCLE第八张，PPT共三十六页，创作于2022年6月Gelpi retractors are placed at the wound edges to help identify Scarpas fascia and then the external oblique and rectus fascia.第九张，PPT共三十六页，创作于2022年6月The soft tissue is elevated superiorly and i

4、nferiorlyfrom the external oblique and rectus fascia withthe knife held essentially parallel with the body.EXTERNALOBLIQUEFASCIA第十张，PPT共三十六页，创作于2022年6月The soft tissue is elevated superiorly and inferiorlyfrom the external oblique and rectus fascia withthe knife held essentially parallel with the bod

5、y.第十一张，PPT共三十六页，创作于2022年6月The linea alba is easily identified by observing the confluence of the fibers of the external oblique in the midline.FOOTHEAD第十二张，PPT共三十六页，创作于2022年6月The dotted line is placed on the linea alba; the fascia between the two rectus muscles is dividedsharply but only through the

6、 fascia.HEADFOOT第十三张，PPT共三十六页，创作于2022年6月FOOTBlunt dissection between the rectus muscle is performed, allowing protection of the peritoneum proximally, and bladder and bladder neck distally.RECTUS MUSCLEHEAD第十四张，PPT共三十六页，创作于2022年6月HEADFOOTThe rectus is then divided with a Bovi on top of the digit.REC

7、TUS MUSCLE第十五张，PPT共三十六页，创作于2022年6月HEADFOOTBLADDEROnce the rectus is split, a blunt retractor can be placed,eventually holding back the bladder. In this figure, thebladder region is visualized just proximal to the symphyseal region underneath the rectus.第十六张，PPT共三十六页，创作于2022年6月FOOTRECTUSBy lifting th

8、e rectus superiorly with the finger, a Hohmann retractor can be placed through the periosteum at the superior and proximal edge of the superior ramus just lateral to the symphyseal body. HEAD第十七张，PPT共三十六页，创作于2022年6月FOOTHEADRECTUSThis is used to retract the rectus laterally.第十八张，PPT共三十六页，创作于2022年6月Wi

9、th the rectus being held laterally, a bovi can beused to clean the superior surface of the superiorramus in the area in which the plate will be placed.SUPERIORRAMUSFOOTHEAD第十九张，PPT共三十六页，创作于2022年6月SYMPHYSEALBODYRECTUSWith the legs held together and the retractors in place,the symphyseal separation is

10、 already partly reduced.The sucker is within the symphyseal separation.FOOTHEAD第二十张，PPT共三十六页，创作于2022年6月FOOTHEADRECTUSThe Weber clamp is used to reduce the symphysis. It should be placed superficial and distal to the rectus insertion rather than dissecting the rectus subperiosteally from the front of

11、 the pelvis.第二十一张，PPT共三十六页，创作于2022年6月FOOTHEADRECTUSIn the figure, the rectus muscles are allowed to fall back to their neutral position so that the clamp can be pushed through the superficial tissues distal to them.第二十二张，PPT共三十六页，创作于2022年6月After the clamp is engaged, the symphysis is reducedusing th

12、e clamp. The clamp must be leaned towardsthe feet in order to fully engage the tongs.REDUCTION第二十三张，PPT共三十六页，创作于2022年6月DEMONSTRATION OF THE REDUCED SYMPHYSIS PUBISFOOTHEAD第二十四张，PPT共三十六页，创作于2022年6月If a standard 6-hole curved plate is used, a downward bend isessential at the outer aspect of the plate

13、as the middletwo screws on each side go into the symphyseal body whilethe last screw goes into the ramus, lateral to the pubic tubercle.第二十五张，PPT共三十六页，创作于2022年6月The plate is also contoured in order to fit the bend of thepelvis, which in men is usually an increased bend and inwomen, a slight opening

14、of the plate.第二十六张，PPT共三十六页，创作于2022年6月DRILLINGECCENTRICALLYThe screws immediately adjacent to the symphysis are placed angling slightly away from the symphysis, paralleling the posterior aspect of the symphyseal body and eccentrically within the plate screw holes to allow for some compression.第二十七张，

15、PPT共三十六页，创作于2022年6月The first screw that is placed is left somewhat proudso as not to pull the plate over while the second screwis placed in a similar fashion eccentrically in the hole.DRILLEDECCENTRICALLYRAMUS第二十八张，PPT共三十六页，创作于2022年6月The two screws are then tightened together, allowing compression o

16、f the symphysis.第二十九张，PPT共三十六页，创作于2022年6月Anatomic reduction of the symphysis is achievedand all the screw holes are filled.第三十张，PPT共三十六页，创作于2022年6月RECTUSAfter fixation, a Hemovac drain should be placed in the space of Retzius, as demonstrated here. Once the wound is thoroughly irrigated and the drain is placed, the rectus fascia is closed. FOOTHEAD第三十一张，PPT共三十六页，创作于2022年6月EDGE OFRECTUS FASCIAIt is important not to tie through the entire rectus muscle,as this may cause necrosis of part of that muscle. 第三十二张，PPT共三十六页，创作于2022年6月Completed runnin