耻骨联合分离.pptVIP

* 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. The incision begins two finger breadths above the symphysis pubis. The incision begins two finger breadths above the symphysis pubis. Frequently, one of the rectus heads is avulsed from one of the symphyseal bodies. Occasionally there is a split in the rectus fascia. RECTUS MUSCLE Gelpi retractors are placed at the wound edges to help identify Scarpa’s fascia and then the external oblique and rectus fascia. The soft tissue is elevated superiorly and inferiorly from the external oblique and rectus fascia with the knife held essentially parallel with the body. EXTERNAL OBLIQUE FASCIA The soft tissue is elevated superiorly and inferiorly from the external oblique and rectus fascia with the knife held essentially parallel with the body. The linea alba is easily identified by observing the confluence of the fibers of the external oblique in the midline. FOOT HEAD 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 FOOT FOOT Blunt dissection between the rectus muscle is performed, allowing protection of the peritoneum proximally, and bladder and bladder neck distally. RECTUS MUSCLE HEAD HEAD FOOT The rectus is then divided with a Bovi on top of the digit. RECTUS MUSCLE HEAD FOOT BLADDER 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. FOOT RECTUS 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. HEAD FOOT HEAD RECTUS This