骨盆环整体理论指导下产后耻骨联合分离的治疗效果

Holistic Pelvic Ring Concept in Treatment of Postpartum Pubic Symphysis Diastasis

目的观察在骨盆环整体理论指导下,产后耻骨联合分离患者进行悬吊下骨盆三维调整后骨盆带固定的治疗效果。方法2018年2月至2020年2月,本院产科分娩后耻骨联合分离的产妇30例,行骨盆环评估,根据评估结果,悬吊后三维调整骶髂关节和耻骨联合解剖复位,骨盆带固定6~8周。彩超监测复位后耻骨联合愈合,摘除骨盆带2周后复查骨盆X线;治疗前、摘除骨盆带时、摘除骨盆带2周后,采用疼痛视觉模拟评分(VAS)、改良Barthel指数(MBI)进行评定。结果摘除骨盆带2周后,患者VAS和MBI评分,以及耻骨联合分离距离、耻骨联合上缘差、髂骨翼宽度差、闭孔横径差及纵径差均较治疗前改善(t>2.509,P<0.05);其中VAS评分和MBI评分还较摘除骨盆带时改善(|t|>2.854,P<0.05),耻骨联合分离距离较摘除骨盆带时稍有增宽(t=2.319,P<0.05),但仍在正常值范围内。结论在骨盆环整体理论指导下治疗产后耻骨联合分离,能基本恢复骨盆解剖结构,避免出现代偿运动模式,提高后期生活质量。

Objective To observe the effect of pelvic band fixation with three-dimensional adjustment of suspended pelvis on patients with pubic symphysis diastasis under the holistic pelvic ring concept.Methods From February,2018 to February,2020,30 parturients with pubic symphysis diastasis were evaluated pelvic ring.They accepted three-dimensional adjustment of pelvis with suspension to restore the anatomical reduction of sacroiliac joint and the symphysis pubis according to the evaluation,and were fixed with pelvic band for six to eight weeks.The pubic symphysis union was monitored with color ultrasonography.They were reviewed with pelvic X-ray two weeks after removal of pelvic band,and assessed with Visual Analogue Scale(VAS)for pain and modified Barthel Index(MBI)before treatment,immediately after removal of the pelvic band and two weeks after removal of the pelvic band,while the pelvic ring structure was measured.Results The scores of VAS and MBI improved two weeks after pelvic band removal compared with those before treatment,as well as distance of pubic symphysis separation,upper margin difference of pubic symphysis,width difference of iliac wings,transverse and longitudinal diameter difference of obturator foramens(t>2.509,P<0.05).However,the scores of VAS and MBI improved two weeks after pelvic band removal compared with those immediately after removal of the pelvic band(|t|>2.854,P<0.05),while the distance of pubic symphysis separation increased(t=2.319,P<0.05),still in the normal reference value.Conclusion Correcting the post-partum pubic symphysis diastasis under the holistic pelvic ring concept can restore the anatomical structure of the pelvis,avoid the compensatory movement pattern,and improve the daily living in the later time.