Symphyseal dissection results from high-energy trauma and usually occurs in poly trauma context. The treatment is only orthopedic in our department. The aim of this work was to study the current therapeutic aspects ma...Symphyseal dissection results from high-energy trauma and usually occurs in poly trauma context. The treatment is only orthopedic in our department. The aim of this work was to study the current therapeutic aspects management of the disjunction of the pubic symphysis in the department of ortho-traumatology of CHU Gabriel Touré of Bamako MALI. This was a prospective and analytical study;from 1 July 2021 to 30 June 2022, within 15 patients classified according to Young and Burgess, with a functional evaluation according to Majeed and a minimum follow-up of 4 months. We report symphyseal disconnections accounted for 20.83% of the traumas of the pelvic ring, and 1.84% of patients hospitalized for fracture in the department during the period of the study. We noted a predominance of gender male in 87% of cases with a ratio of 2.75 and the average age in our series was 32 years, with extremes ranging from 18 to 63 and a SD of 13.96. The most common etiologies are APR with 66.7% and traditional mine slide cases with 20%, and the anteroposterior compression mechanism is most frequently encountered at 73.3%. The APCI types: 20%, APCII: 40% and VC: 20% of the Young and Burgess classification are the most found. The treatment of these patients was surgical in 53% cases by locked screw plate. The surgical approach of Pfannenstiel was preferred to the ilio-inguinal of Judet. Non-surgical treatment by trans-osseous traction and the wearing of a pelvic belt was recommended for cases of stable disjunction or severe associated lesions. The average length of stay is 17.27 days with extremes of 5 and 34 days. The functional assessment according to Majeed allowed us to classify 73.3% of patients’ cases as excellent, showing a good socio-professional reintegration. Symphyseal disjunction is a rare pathology but of serious functional consequences, regardless of the therapeutic method good management allows to minimize these functional sequelae.展开更多
BACKGROUND Widening of the pubic joint of more than 10 mm is diagnostic and defined as pubic symphysis diastasis and is considered a complication of vaginal childbirth or pregnancy.As it is a rare pathology(ranging fr...BACKGROUND Widening of the pubic joint of more than 10 mm is diagnostic and defined as pubic symphysis diastasis and is considered a complication of vaginal childbirth or pregnancy.As it is a rare pathology(ranging from 1 in 300 to 1 in 30000 pregnancies),no gold standard treatment has been defined.CASE SUMMARY This study examines two cases,a 27-year-old woman(gravida 1,para 1)and a 32-year-old woman(gravida 2,para 2),who presented to the clinic after uneventful vaginal deliveries.A normal pregnancy with no complications was observed in both patients.Severe pain in the pubic region occurred after labour and was accompanied by complicated locomotion.Pubic symphysis diastasis was confirmed radiologically and bed rest with lateral decubitus positioning was recommended.Oral non-steroidal antiinflammatory drugs were administered to relieve pain exacerbations.The symptoms decreased after treatment.Posttreatment magnetic resonance imaging(MRI)in the first case showed a reduction in symphyseal separation with no signs of osteitis.Three years later the symptoms recurred;MRI examination showed no further symphyseal widening or signs of osteitis.A relapse of symphyseal separation was diagnosed and conservative treatment was re-administered resulting in successful recovery.In the second case,pain recurred when the patient conceived for the second time.This time no benefit following conservative treatment was observed.Persistent pain and complicated locomotion led to scoliotic deformation of the lumbar part of the spine and leg length discrepancy,thus surgical treatment was chosen and internal pubic synthesis was performed.CONCLUSION Overall,surgical treatment resulting from insufficient conservative treatment showed a high risk of postoperative complications following the treatment of postpartum pubic symphysis diastasis.展开更多
BACKGROUND Separation of the pubic symphysis can occur during the peripartum period.Relaxin(RLX)is a hormone primarily secreted by the corpus luteum that can mediate hemodynamic changes during pregnancy as well as loo...BACKGROUND Separation of the pubic symphysis can occur during the peripartum period.Relaxin(RLX)is a hormone primarily secreted by the corpus luteum that can mediate hemodynamic changes during pregnancy as well as loosen the pelvic ligaments.However,it is unknown whether RLX is associated with peripartum pubic symphysis separation and if the association is affected by other factors.AIM To study the association between RLX and peripartum pubic symphysis separation and evaluate other factors that might affect this association.METHODS We performed a cross-sectional study of pregnant women between April 2019 and January 2020.Baseline demographic characteristics,including gestational age,weight,neonatal weight,delivery mode and duration of the first and second stages of labor,were recorded.The clinical symptoms were used as a screening index during pregnancy,and the patients with pubic symphysis and inguinal pain were examined by color Doppler ultrasonography to determine whether there was pubic symphysis separation.Serum RLX concentrations were evaluated 1 d after delivery using an enzyme-linked immunosorbent assay,and pubic symphysis separation was diagnosed based on postpartum X-ray examination.We used an independent-sample t test to analyze the association between serum RLX levels and peripartum pubic symphysis separation.Multivariate regression analysis was used to evaluate whether the association between RLX and peripartum pubic symphysis separation was confounded by other factors,and the association between RLX and the severity of pubic symphysis separation was also assessed.We used Pearson correlation analysis to determine the factors related to RLX levels as well as the correlation between the degree of pubic symphysis separation and activities of daily living(ADL)and pain.RESULTS A total of 54 women were enrolled in the study,with 15 exhibiting(observational group)and 39 not exhibiting(control group)peripartum pubic symphysis separation.There were no statistically significant differences in terms of maternal age,gestational age,pre-pregnancy weight,weight gain during pregnancy,delivery modes,or duration of the first or second stages of labor between the 2 groups.We did,however,note a statistically significant difference in serum RLX concentrations and neonatal weight between the observational and control groups(122.3±0.7μg/mL vs 170.4±42.3μg/mL,P<0.05;3676.000±521.725 g vs 3379.487±402.420 g,P<0.05,respectively).Multivariate regression analyses showed that serum RLX level[odds ratio(OR):1.022)and neonatal weight(OR:1.002)were associated with pubic symphysis separation peripartum.The degree of separation of the pubic symphysis was negatively correlated with ADL and positively correlated with pain.There was no statistically significant association between serum RLX levels and the severity of pubic symphysis separation after adjusting for confounding factors.CONCLUSION Serum RLX levels and neonatal weight were associated with the occurrence,but not the severity,of peripartum pubic symphysis separation.展开更多
Background: The pubic region is often involved in accidental hot water or soup-spill burns. Most of these wounds are superficial partial thickness burns. Due to their proximity to the urinary system, as well as vagina...Background: The pubic region is often involved in accidental hot water or soup-spill burns. Most of these wounds are superficial partial thickness burns. Due to their proximity to the urinary system, as well as vaginal and anal openings,these burns are easily contaminated. Daily dressings are routinely prescribed as the sole treatment. The cumbersome dressing process is uncomfortable and embarrassing for patients. Biobrane^(TM) is a bilayered biosynthetic dressing. Its coverage of superficial partial thickness burns promotes wound healing and allows one-time application.Case presentations: We report two patients who suffered superficial dermal burns over their pubic region. One patient had 23% total body surface area(TBSA) burns over her lower abdomen, both thighs and pubic region. The second patient had 10% TBSA burns that involved her perineum and the medial sides of both thighs and buttocks.Both were managed with the standard resuscitation protocol in the initial phase. Their burn injuries were managed by shaving, Foley catheterization and Biobrane^(TM) coverage. Their wounds healed uneventfully without complications.Full epithelization was achieved by post-operative day seven. Both patients consented to medical photography and academic publication.Conclusions: Shaving and catheterization improved the hygiene of the burns of the pubic area. The Biobrane^(TM)method circumvents the need of regular dressing changes, eliminating the pain due to dressing changes and preserving patient dignity.展开更多
A new method for curing the pubic symphsis separation is presented in this paper. The site of the pubic symphysis was injected with 1% lidocain,chymotrypsin,prednisolone;and some peroral drugs were administrated at th...A new method for curing the pubic symphsis separation is presented in this paper. The site of the pubic symphysis was injected with 1% lidocain,chymotrypsin,prednisolone;and some peroral drugs were administrated at the same time.And the disease could be cured in a week by using the therapy,with an excellent effect without relapse.展开更多
Background: Postoperative pubic or ischial stress fracture may be a complication after curved periacetabular osteotomy (CPO). The discontinuity of the superior pubic rami is a risk factor for this complication. We inv...Background: Postoperative pubic or ischial stress fracture may be a complication after curved periacetabular osteotomy (CPO). The discontinuity of the superior pubic rami is a risk factor for this complication. We investigated the stress field differences in standing and sitting positions after CPO. Methods: We used finite element analysis to assess the effects of inferior pubic rami and ischial fractures with or without discontinuity of superior pubic rami. We used the “union model”, obtained from a bony union at the osteotomy site of the superior pubic rami from 38-year-old woman who had undergone CPO for left hip dysplasia. We deleted the bony union region and created a discontinuity in the superior pubic rami equal to the non-union, creating the “discontinuity model”. We compared the stress field and stress value in the simulated standing and half weight-bearing positions on the operative side, one-legged standing position on the non-operative side, and the sitting position. Findings: In 4 cases, the inferior rami experienced the highest stress. Stress values in the discontinuity model were higher than those in the union model: 1.7 times in the case of one-legged standing on the operative side, 2.4 times in the case of half weight-bearing on the operative side, 3.8 times in the case of one-legged standing on the non-operative side, and 2.0 times in the sitting position, respectively. Interpretation: We recommend patients delay weight bearing on the operative side, avoid the sitting position as long as possible, and sit down slowly to prevent inferior pubic rami and ischial fractures after CPO.展开更多
Pubic symphysiolysis and retroperitoneal arterial vessel rupture after bareback horse riding is a rare traumatic combination. We report a case of a 59-year-old man who experienced severe pubic, abdominal and lower bac...Pubic symphysiolysis and retroperitoneal arterial vessel rupture after bareback horse riding is a rare traumatic combination. We report a case of a 59-year-old man who experienced severe pubic, abdominal and lower back pain due to a bounce after a asynchronous rhythm of horseback riding without a saddle. The patient was referred to our Emergency Department because of a suspected ruptured abdominal aortic aneurysm. Computer tomography demonstrated diastasis of the pubic symphysis, active bleeding of a branch of the left internal iliac artery and a massive retroperitoneal haematoma. The arterial bleeding was directly coiled in the emergency setting, the stable pubic symphysiolysis was treated conservatively and the haematoma was surgically drained after three days. Bareback horse riding can lead to a pelvic fracture and severe bleeding leading to haemodynamical instability and life threatening situations. Using proper protective equipment including a saddle to prevent equestrian injury should be emphasized.展开更多
Study objective: to verify if the PAA (angle of the pubic arch) is a predictive data for the mode of delivery, the duration of labour and the expulsion period. Methods: we chose to measure the PAA in 100 women rec...Study objective: to verify if the PAA (angle of the pubic arch) is a predictive data for the mode of delivery, the duration of labour and the expulsion period. Methods: we chose to measure the PAA in 100 women recruited, chosen from the 38th to the 42th week of gestation. The method involves the use of two-dimensional transperineal ultrasound. Data collection took place over a period of time from May to September 2015. The ante-partum data taken into consideration were the patient’s name and surname, PAA, parity, age, height; those acquired in the post-partum provide for the calculation in minutes of the active phase of labor, the duration of the expulsion period, the execution of the amniorrhexis and the use of the synthetic oxytocin, the fetal cranial circumference, the fetal weight and the position of the presented part. Results: results discovered ultrasoundly 100 PAA, with an average value of 115.5° and we proceeded by evaluating 90 vaginal births. Infants at birth had a CC with an average value of 34.5 mm. By relating the two variables PAA and CC for the dependent variable “period expulsion in minutes”, confirming that the expulsive period depends on the relationship between PAA and CC. The average of the minutes of the expulsion period is 50' in women with a PAA 〉 111.5° and a CC 〉 34.5 mm while in women with an PAA 〉 111.5° the media time is 30' regardless of the CC. It has been shown that oxytocin and amniorrhexis reduce the minutes of the expulsion period only in a case of PAA 〉 111.5° and a CC 〉 34.5 mm bringing them from 60' to 23'. Conclusion: the duration of the active phase of labor is not influenced by the PAA but it depends on external factors. In the case of the expulsion period, a predictability of the PAA on its duration is shown if the CC is taken into consideration; as regards the influence of the PAA on the method of delivery, it was not possible to carry out any analysis since all the useful cases had vaginal delivery.展开更多
Background: Pubic symphysis diastasis (PSD) is an uncommon complication of labor and delivery. Common risk factors of PSD include precipitous labor, rapid second stage of labor, intense uterine contractions, prior pel...Background: Pubic symphysis diastasis (PSD) is an uncommon complication of labor and delivery. Common risk factors of PSD include precipitous labor, rapid second stage of labor, intense uterine contractions, prior pelvic pathology, multiparity and macrosomia. Diagnosis is made clinically and confirmed by imaging. Management of PSD depends on the severity of symptoms and degree of symphysis separation. Standard therapy is conservative, but surgery may be needed in severe cases. Case Report: A 25-year-old female at term pregnancy presented in active labor and had a rapid second stage of labor without intravenous oxytocin or an epidural. She was subsequently diagnosed with severe PSD with a 5.5 cm separation. Her management included a pelvic binder, pain management, physical therapy, and serial imaging to monitor improvement. Discussion: In severe cases, surgery can be avoided in favor of conservative measures for the management of PSD. Multidisciplinary involvement with orthopedic surgery, radiology, physical therapy, and anesthesiology can play a vital role in optimal management. PSD may recur in future deliveries, but this does not preclude vaginal birth.展开更多
In order to promote China to take part in the activities of international standardization and improve the standardization level of China, Mr. Oliver Smoot, President of ISO, made a public speech on international stand...In order to promote China to take part in the activities of international standardization and improve the standardization level of China, Mr. Oliver Smoot, President of ISO, made a public speech on international standardization of the global economy at the invitation of SAC (Standardization Administration of China) on Nov. 1st.展开更多
A locked pubic ramus body is an unusual variant of lateral compression injury.Till date,there have been only 25 cases reported in the published literature.We herein described a case where the right pubic ramus was ent...A locked pubic ramus body is an unusual variant of lateral compression injury.Till date,there have been only 25 cases reported in the published literature.We herein described a case where the right pubic ramus was entrapped within the opposite obturator foramen with an overlap of greater than 4 cm,with associated urethral injury.When all maneuvers of closed and instrumented reduction failed,we per-formed a superior pubic ramus osteotomy on the left side and unlocked the incarcerated right pubic ramus.The osteotomy site was stabilized with a 6-hole recon plate.The patient underwent delayed urethral repair 10 weeks after the index surgery.At 3-year follow-up,the patient has sexual dysfunction especially difficulty in maintaining erection,secondary urethral stricture,heterotopic ossification,and breakage of implants.展开更多
Intramuscular hemangioma usually involues only a single muscle,but it may demonstrate regional involvement and can occasionally grow extremely large.In the latter condition,resection can be very difficult and occasion...Intramuscular hemangioma usually involues only a single muscle,but it may demonstrate regional involvement and can occasionally grow extremely large.In the latter condition,resection can be very difficult and occasionally lead to fatal uncontrollable bleeding during surgery.展开更多
Background:No standard monsplasty technique has existed until now.Although various monsplasty methods have been described,they exhibit high complication rates with sparse postoperative data.Studies that used pubic sus...Background:No standard monsplasty technique has existed until now.Although various monsplasty methods have been described,they exhibit high complication rates with sparse postoperative data.Studies that used pubic suspension techniques did not describe exact anatomical landmarks for the mons pexy.This study aimed to improve the aesthetic and functional appearance of the pubic region with long-term results for all grades of pubic ptosis or bulging with abdominoplasty and provide exact anatomical points to anchor the mons to the rectus sheath.Methods:This non-randomized prospective clinical trial included 30 patients with various degrees of abdominal wall laxity between December 2017 and September 2019.The surgical procedure was performed for female patients with pendulous abdomen,pubic ptosis or bulging,body mass index≤35 kg/m^(2),and age 18–60 years.All patients were followed for up to one year;patient satisfaction was assessed before and after surgery regarding aesthetic results and impact on outfits,hygiene,and sexual activity.Results:The marginal homogeneity test revealed a statistically significant patient satisfaction rate regarding outfits,sexual function,hygiene,and aesthetics.Regarding postoperative complications,seroma(one case)was managed by aspiration,and one case of wound dehiscence was managed conservatively with dressings.Conclusion:This study recommends a quick and reproducible monsplasty technique with a low complication rate,a technique that helps determine specific anatomical landmarks for anchoring the mons to the rectus sheath.Combining this technique with abdominal contouring is advisable for optimal aesthetic results and maintained lymphatic drainage in the pubic region.展开更多
文摘Symphyseal dissection results from high-energy trauma and usually occurs in poly trauma context. The treatment is only orthopedic in our department. The aim of this work was to study the current therapeutic aspects management of the disjunction of the pubic symphysis in the department of ortho-traumatology of CHU Gabriel Touré of Bamako MALI. This was a prospective and analytical study;from 1 July 2021 to 30 June 2022, within 15 patients classified according to Young and Burgess, with a functional evaluation according to Majeed and a minimum follow-up of 4 months. We report symphyseal disconnections accounted for 20.83% of the traumas of the pelvic ring, and 1.84% of patients hospitalized for fracture in the department during the period of the study. We noted a predominance of gender male in 87% of cases with a ratio of 2.75 and the average age in our series was 32 years, with extremes ranging from 18 to 63 and a SD of 13.96. The most common etiologies are APR with 66.7% and traditional mine slide cases with 20%, and the anteroposterior compression mechanism is most frequently encountered at 73.3%. The APCI types: 20%, APCII: 40% and VC: 20% of the Young and Burgess classification are the most found. The treatment of these patients was surgical in 53% cases by locked screw plate. The surgical approach of Pfannenstiel was preferred to the ilio-inguinal of Judet. Non-surgical treatment by trans-osseous traction and the wearing of a pelvic belt was recommended for cases of stable disjunction or severe associated lesions. The average length of stay is 17.27 days with extremes of 5 and 34 days. The functional assessment according to Majeed allowed us to classify 73.3% of patients’ cases as excellent, showing a good socio-professional reintegration. Symphyseal disjunction is a rare pathology but of serious functional consequences, regardless of the therapeutic method good management allows to minimize these functional sequelae.
文摘BACKGROUND Widening of the pubic joint of more than 10 mm is diagnostic and defined as pubic symphysis diastasis and is considered a complication of vaginal childbirth or pregnancy.As it is a rare pathology(ranging from 1 in 300 to 1 in 30000 pregnancies),no gold standard treatment has been defined.CASE SUMMARY This study examines two cases,a 27-year-old woman(gravida 1,para 1)and a 32-year-old woman(gravida 2,para 2),who presented to the clinic after uneventful vaginal deliveries.A normal pregnancy with no complications was observed in both patients.Severe pain in the pubic region occurred after labour and was accompanied by complicated locomotion.Pubic symphysis diastasis was confirmed radiologically and bed rest with lateral decubitus positioning was recommended.Oral non-steroidal antiinflammatory drugs were administered to relieve pain exacerbations.The symptoms decreased after treatment.Posttreatment magnetic resonance imaging(MRI)in the first case showed a reduction in symphyseal separation with no signs of osteitis.Three years later the symptoms recurred;MRI examination showed no further symphyseal widening or signs of osteitis.A relapse of symphyseal separation was diagnosed and conservative treatment was re-administered resulting in successful recovery.In the second case,pain recurred when the patient conceived for the second time.This time no benefit following conservative treatment was observed.Persistent pain and complicated locomotion led to scoliotic deformation of the lumbar part of the spine and leg length discrepancy,thus surgical treatment was chosen and internal pubic synthesis was performed.CONCLUSION Overall,surgical treatment resulting from insufficient conservative treatment showed a high risk of postoperative complications following the treatment of postpartum pubic symphysis diastasis.
基金The Science and Technology Development Plan of Taian,No.2018NS0203.
文摘BACKGROUND Separation of the pubic symphysis can occur during the peripartum period.Relaxin(RLX)is a hormone primarily secreted by the corpus luteum that can mediate hemodynamic changes during pregnancy as well as loosen the pelvic ligaments.However,it is unknown whether RLX is associated with peripartum pubic symphysis separation and if the association is affected by other factors.AIM To study the association between RLX and peripartum pubic symphysis separation and evaluate other factors that might affect this association.METHODS We performed a cross-sectional study of pregnant women between April 2019 and January 2020.Baseline demographic characteristics,including gestational age,weight,neonatal weight,delivery mode and duration of the first and second stages of labor,were recorded.The clinical symptoms were used as a screening index during pregnancy,and the patients with pubic symphysis and inguinal pain were examined by color Doppler ultrasonography to determine whether there was pubic symphysis separation.Serum RLX concentrations were evaluated 1 d after delivery using an enzyme-linked immunosorbent assay,and pubic symphysis separation was diagnosed based on postpartum X-ray examination.We used an independent-sample t test to analyze the association between serum RLX levels and peripartum pubic symphysis separation.Multivariate regression analysis was used to evaluate whether the association between RLX and peripartum pubic symphysis separation was confounded by other factors,and the association between RLX and the severity of pubic symphysis separation was also assessed.We used Pearson correlation analysis to determine the factors related to RLX levels as well as the correlation between the degree of pubic symphysis separation and activities of daily living(ADL)and pain.RESULTS A total of 54 women were enrolled in the study,with 15 exhibiting(observational group)and 39 not exhibiting(control group)peripartum pubic symphysis separation.There were no statistically significant differences in terms of maternal age,gestational age,pre-pregnancy weight,weight gain during pregnancy,delivery modes,or duration of the first or second stages of labor between the 2 groups.We did,however,note a statistically significant difference in serum RLX concentrations and neonatal weight between the observational and control groups(122.3±0.7μg/mL vs 170.4±42.3μg/mL,P<0.05;3676.000±521.725 g vs 3379.487±402.420 g,P<0.05,respectively).Multivariate regression analyses showed that serum RLX level[odds ratio(OR):1.022)and neonatal weight(OR:1.002)were associated with pubic symphysis separation peripartum.The degree of separation of the pubic symphysis was negatively correlated with ADL and positively correlated with pain.There was no statistically significant association between serum RLX levels and the severity of pubic symphysis separation after adjusting for confounding factors.CONCLUSION Serum RLX levels and neonatal weight were associated with the occurrence,but not the severity,of peripartum pubic symphysis separation.
文摘Background: The pubic region is often involved in accidental hot water or soup-spill burns. Most of these wounds are superficial partial thickness burns. Due to their proximity to the urinary system, as well as vaginal and anal openings,these burns are easily contaminated. Daily dressings are routinely prescribed as the sole treatment. The cumbersome dressing process is uncomfortable and embarrassing for patients. Biobrane^(TM) is a bilayered biosynthetic dressing. Its coverage of superficial partial thickness burns promotes wound healing and allows one-time application.Case presentations: We report two patients who suffered superficial dermal burns over their pubic region. One patient had 23% total body surface area(TBSA) burns over her lower abdomen, both thighs and pubic region. The second patient had 10% TBSA burns that involved her perineum and the medial sides of both thighs and buttocks.Both were managed with the standard resuscitation protocol in the initial phase. Their burn injuries were managed by shaving, Foley catheterization and Biobrane^(TM) coverage. Their wounds healed uneventfully without complications.Full epithelization was achieved by post-operative day seven. Both patients consented to medical photography and academic publication.Conclusions: Shaving and catheterization improved the hygiene of the burns of the pubic area. The Biobrane^(TM)method circumvents the need of regular dressing changes, eliminating the pain due to dressing changes and preserving patient dignity.
文摘A new method for curing the pubic symphsis separation is presented in this paper. The site of the pubic symphysis was injected with 1% lidocain,chymotrypsin,prednisolone;and some peroral drugs were administrated at the same time.And the disease could be cured in a week by using the therapy,with an excellent effect without relapse.
文摘Background: Postoperative pubic or ischial stress fracture may be a complication after curved periacetabular osteotomy (CPO). The discontinuity of the superior pubic rami is a risk factor for this complication. We investigated the stress field differences in standing and sitting positions after CPO. Methods: We used finite element analysis to assess the effects of inferior pubic rami and ischial fractures with or without discontinuity of superior pubic rami. We used the “union model”, obtained from a bony union at the osteotomy site of the superior pubic rami from 38-year-old woman who had undergone CPO for left hip dysplasia. We deleted the bony union region and created a discontinuity in the superior pubic rami equal to the non-union, creating the “discontinuity model”. We compared the stress field and stress value in the simulated standing and half weight-bearing positions on the operative side, one-legged standing position on the non-operative side, and the sitting position. Findings: In 4 cases, the inferior rami experienced the highest stress. Stress values in the discontinuity model were higher than those in the union model: 1.7 times in the case of one-legged standing on the operative side, 2.4 times in the case of half weight-bearing on the operative side, 3.8 times in the case of one-legged standing on the non-operative side, and 2.0 times in the sitting position, respectively. Interpretation: We recommend patients delay weight bearing on the operative side, avoid the sitting position as long as possible, and sit down slowly to prevent inferior pubic rami and ischial fractures after CPO.
文摘Pubic symphysiolysis and retroperitoneal arterial vessel rupture after bareback horse riding is a rare traumatic combination. We report a case of a 59-year-old man who experienced severe pubic, abdominal and lower back pain due to a bounce after a asynchronous rhythm of horseback riding without a saddle. The patient was referred to our Emergency Department because of a suspected ruptured abdominal aortic aneurysm. Computer tomography demonstrated diastasis of the pubic symphysis, active bleeding of a branch of the left internal iliac artery and a massive retroperitoneal haematoma. The arterial bleeding was directly coiled in the emergency setting, the stable pubic symphysiolysis was treated conservatively and the haematoma was surgically drained after three days. Bareback horse riding can lead to a pelvic fracture and severe bleeding leading to haemodynamical instability and life threatening situations. Using proper protective equipment including a saddle to prevent equestrian injury should be emphasized.
文摘Study objective: to verify if the PAA (angle of the pubic arch) is a predictive data for the mode of delivery, the duration of labour and the expulsion period. Methods: we chose to measure the PAA in 100 women recruited, chosen from the 38th to the 42th week of gestation. The method involves the use of two-dimensional transperineal ultrasound. Data collection took place over a period of time from May to September 2015. The ante-partum data taken into consideration were the patient’s name and surname, PAA, parity, age, height; those acquired in the post-partum provide for the calculation in minutes of the active phase of labor, the duration of the expulsion period, the execution of the amniorrhexis and the use of the synthetic oxytocin, the fetal cranial circumference, the fetal weight and the position of the presented part. Results: results discovered ultrasoundly 100 PAA, with an average value of 115.5° and we proceeded by evaluating 90 vaginal births. Infants at birth had a CC with an average value of 34.5 mm. By relating the two variables PAA and CC for the dependent variable “period expulsion in minutes”, confirming that the expulsive period depends on the relationship between PAA and CC. The average of the minutes of the expulsion period is 50' in women with a PAA 〉 111.5° and a CC 〉 34.5 mm while in women with an PAA 〉 111.5° the media time is 30' regardless of the CC. It has been shown that oxytocin and amniorrhexis reduce the minutes of the expulsion period only in a case of PAA 〉 111.5° and a CC 〉 34.5 mm bringing them from 60' to 23'. Conclusion: the duration of the active phase of labor is not influenced by the PAA but it depends on external factors. In the case of the expulsion period, a predictability of the PAA on its duration is shown if the CC is taken into consideration; as regards the influence of the PAA on the method of delivery, it was not possible to carry out any analysis since all the useful cases had vaginal delivery.
文摘Background: Pubic symphysis diastasis (PSD) is an uncommon complication of labor and delivery. Common risk factors of PSD include precipitous labor, rapid second stage of labor, intense uterine contractions, prior pelvic pathology, multiparity and macrosomia. Diagnosis is made clinically and confirmed by imaging. Management of PSD depends on the severity of symptoms and degree of symphysis separation. Standard therapy is conservative, but surgery may be needed in severe cases. Case Report: A 25-year-old female at term pregnancy presented in active labor and had a rapid second stage of labor without intravenous oxytocin or an epidural. She was subsequently diagnosed with severe PSD with a 5.5 cm separation. Her management included a pelvic binder, pain management, physical therapy, and serial imaging to monitor improvement. Discussion: In severe cases, surgery can be avoided in favor of conservative measures for the management of PSD. Multidisciplinary involvement with orthopedic surgery, radiology, physical therapy, and anesthesiology can play a vital role in optimal management. PSD may recur in future deliveries, but this does not preclude vaginal birth.
文摘In order to promote China to take part in the activities of international standardization and improve the standardization level of China, Mr. Oliver Smoot, President of ISO, made a public speech on international standardization of the global economy at the invitation of SAC (Standardization Administration of China) on Nov. 1st.
文摘A locked pubic ramus body is an unusual variant of lateral compression injury.Till date,there have been only 25 cases reported in the published literature.We herein described a case where the right pubic ramus was entrapped within the opposite obturator foramen with an overlap of greater than 4 cm,with associated urethral injury.When all maneuvers of closed and instrumented reduction failed,we per-formed a superior pubic ramus osteotomy on the left side and unlocked the incarcerated right pubic ramus.The osteotomy site was stabilized with a 6-hole recon plate.The patient underwent delayed urethral repair 10 weeks after the index surgery.At 3-year follow-up,the patient has sexual dysfunction especially difficulty in maintaining erection,secondary urethral stricture,heterotopic ossification,and breakage of implants.
文摘Intramuscular hemangioma usually involues only a single muscle,but it may demonstrate regional involvement and can occasionally grow extremely large.In the latter condition,resection can be very difficult and occasionally lead to fatal uncontrollable bleeding during surgery.
文摘Background:No standard monsplasty technique has existed until now.Although various monsplasty methods have been described,they exhibit high complication rates with sparse postoperative data.Studies that used pubic suspension techniques did not describe exact anatomical landmarks for the mons pexy.This study aimed to improve the aesthetic and functional appearance of the pubic region with long-term results for all grades of pubic ptosis or bulging with abdominoplasty and provide exact anatomical points to anchor the mons to the rectus sheath.Methods:This non-randomized prospective clinical trial included 30 patients with various degrees of abdominal wall laxity between December 2017 and September 2019.The surgical procedure was performed for female patients with pendulous abdomen,pubic ptosis or bulging,body mass index≤35 kg/m^(2),and age 18–60 years.All patients were followed for up to one year;patient satisfaction was assessed before and after surgery regarding aesthetic results and impact on outfits,hygiene,and sexual activity.Results:The marginal homogeneity test revealed a statistically significant patient satisfaction rate regarding outfits,sexual function,hygiene,and aesthetics.Regarding postoperative complications,seroma(one case)was managed by aspiration,and one case of wound dehiscence was managed conservatively with dressings.Conclusion:This study recommends a quick and reproducible monsplasty technique with a low complication rate,a technique that helps determine specific anatomical landmarks for anchoring the mons to the rectus sheath.Combining this technique with abdominal contouring is advisable for optimal aesthetic results and maintained lymphatic drainage in the pubic region.