耻骨联合分离课件

The incision begins two finger breadths above the symphysis pubis.
The incision begins two finger breadths above the symphysis pubis.
RECTUS MUSCLE
Frequently, one of the rectus heads is avulsed from one of the symphyseal bodies. Occasionally there is a split in the rectus fascia. Nhomakorabea HEAD
RECTUS
FOOT
This is used to retract the rectus laterally.
HEAD
FOOT
SUPERIOR
RAMUS
With the rectus being held laterally, a bovi can be
used to clean the superior surface of the superior
The soft tissue is elevated superiorly and inferiorly from the external oblique and rectus fascia with the knife held essentially parallel with the body.
Gelpi retractors are placed at the wound edges to help identify Scarpa’s fascia and then the external oblique and rectus fascia.
EXTERNAL OBLIQUE FASCIA
HEAD
RECTUS
FOOT
By lifting the 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.
FOOT
RECTUS
HEAD
The 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 the pelvis.
ramus in the area in which the plate will be placed.
RECTUS
SYMPHYSEAL BODY
FOOT
HEAD
With the legs held together and the retractors in place, the symphyseal separation is already partly reduced. The sucker is within the symphyseal separation.
HEAD
RECTUS MUSCLE
FOOT
The rectus is then divided with a Bovi on top of the digit.
BLADDER
HEAD
FOOT
Once the rectus is split, a blunt retractor can be placed, eventually holding back the bladder. In this figure, the bladder region is visualized just proximal to the symphyseal region underneath the rectus.
HEAD
FOOT
The linea alba is easily identified by observing the confluence of the fibers of the external oblique in the midline.
HEAD
FOOT
The dotted line is placed on the linea alba; the fascia between the two rectus muscles is divided sharply but only through the fascia.
HEAD
RECTUS MUSCLE
FOOT
Blunt dissection between the rectus muscle is performed, allowing protection of the peritoneum proximally, and bladder and bladder neck distally.
The soft tissue is elevated superiorly and inferiorly from the external oblique and rectus fascia with the knife held essentially parallel with the body.
耻骨联合分离
AP X-RAY DEMONSTRATING APC TYPE 2 SYMPHYSEAL SEPARATION
INLET VIEW DEMONSTRATING SEPARATION OF THE SYMPHYSIS
OUTLET VIEW
The patient is prepped, such that the symphysis is exposed inferiorly, the umbilicus superiorly and the ASIS laterally.