耻骨联合分离课件.ppt

1;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.;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.;;The linea alba is easily identified by observing the confluence of the fibers of the external oblique in the midline.;The dotted line is placed on the linea alba; the fascia between the two rectus muscles is divided sharply but only through the fascia.;FOOT;HEAD;HEAD;FOOT;FOOT;;;;;;After the clamp is engaged, the symphysis is reduced using the clamp. The clamp must be leaned towards the feet in order to fully engage the tongs.;DEMONSTRATION OF THE REDUCED SYMPHYSIS PUBIS;If a standard 6-hole curved plate is used, a downward bend is essential at the outer aspect of the plate as the middle two screws on each side go into the symphyseal body while the last screw goes into the ramus, lateral to the pubic tubercle.;The plate is also contoured in order to fit the bend of the pelvis, which in men is usually an increased bend and in women, a slight opening of the plate.;;The first screw that is placed is left somewhat proud so as not to pull the plate over while the second screw is placed in a similar fashion eccentrically in the hole.;The two screws are then tightened together, allowing compression of the symphysis.;Anatomic reduction of the symphysis is achieved and all the