极度屈髋外展对骨产道及产程的影响

Effect of extremity bend coxa and abduction thigh on bony birth canal and labor

目的观察极度屈髋外展屈膝对骨产道及产程的影响。方法对骨产道的影响：选产后志愿者行骨盆摄片，正、侧位（平卧、截石、极度屈髋外展屈膝）片，观察骨产道的变化。对产程的影响：随机对平产者分为极度屈髋外展屈膝分娩组、常规截石位分娩纽，观察两组产程的区别。结果骨盆改变：随平卧位、截石位、极度屈髋外展屈膝位的改变，正位片：耻骨联合的长度（耻骨联合上、下缘间距）增长，由（28±5）mm增长至（38±7）mm，骶骨上缘至耻骨联合上缘间距缩短，由（170±20）mm缩短至（128±12）mm，耻骨联合上升。侧位片：“骨盆倾斜度”减小，由62°±4。减小至46°±6°；腰椎与骶椎前线形成的夹角增大，由125°±7°增大至137°±6°。以上骨盆改变差异均有统计学意义。而入口前后径、横径并未缩短，即骶骨岬变得低平；产程观察：与常规截石位分娩组对比，第二产程（29±12）min、（42±19）min，两组比较差异有统计学意义。结论①采用本分娩体位对骨产道的影响：正位片骶骨上缘至耻骨联合上缘间距缩短，表现在侧位片即是“骨盆倾斜度”的减小，正位片耻骨联合长度增加，相对应侧位片腰、骶椎位前线形成的夹角增大，其综合改变使骨盆轴变得平直。②本分娩体位对缩短第二产程有统计学意义。

Objective To investigate the effect of extremity bend coxa and abduct thigh to bony birth canal and labor. Methods Random controled clinical study. Sixty - eight spontaneous delivery puerpera were randomly divided into extremity bend coxa group and general dorsosacral position group, observed labor of two groups, and took normotopia - lateral position pictures of pelvis at postpartum, including dorsal position, dorsosacral position and extremity bend eoxa and abduct thigh position. Results Compared the three positions：At extremity bend coxa position：①In the normotopia position pictures： the spacing from the superior border to the inferior border of pubic tubercle（ 38±7 ）mm was longer than dorsosacral position （ 29±5 ） mm, the spacing from the superior border of sacrum to the superior border of pubic tubercle（ 128±12） mm was shorter than dorsosacral position （ 170±20） mm, the position of pubic tubercle was ascensused. ②In the lateral position pictures：the inclination of pelvis（ 46°±6°） was smaller than dorsosacral position（ 62°±4°） ,the included angle between lumbar vertebrae and the front line of lumbar （137°±6°） was larger than dorsosacral position （ 125°±7°） , they all had statistical significance difference. But there was no difference between dorsal position and dorsosacral position. The length of true conjugate and the across diameter of pelvic inlet had no change in the three positions. Comparing to the dorsosacral position, the second stage of labor at extremity bend coxa position was shorter, （42±19 ） rain, （ 29±12 ） rain, the statistical difference of them was significant. Conclusions The influence of extremity bend coxa and abduct thigh position to bony birth canal was more even and strightly than other position. It can significantly abbreviate the second stage of labor.