An unusual form of duplicate bladder exstrophy
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Objective:To report the therapeutic effectiveness of open reduction and internal fixation for symphysis pubis diastasis in pelvic fractures and explore the role of that procedure.Methods:From Apr.1995 to Jan.2001,14 patients with symphysis pubis diastasis were treated in the department.All cases underwent open reduction and internal fixation with reconstruction plates through Pfannenstiel approaches.Pelvic pain,gait and pelvic morphology were inspected and followed up.Results:All patients obtained anatomic reduction and resumed pelvic morphology.The post-operative results were satisfactory through an average of 19 months following up despite three patients existing pelvic pain behind symphysis pubis.Conclusion:Open reduction and internal fixation can repair pelvic morphology and biomechanical characteristics and it is an effective method for the treatment of symphysis pubis diastasis in pelvic fractures.
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目的 探讨小切口重建钢板桥接内固定治疗耻骨联合分离的疗效.方法 对2005年7月至2009年7月收治并获得完整随访的135例耻骨联合分离患者资料进行回顾性分析,男98例,女37例;年龄19～66岁,平均37.8岁;耻骨联合分离均≥2.5cm.所有患者采用双侧小切口显露放置接骨板及固定螺钉部位,C型臂X线机监控下解剖复位分离的耻骨联合,将重建钢板置于耻骨联合后方,采用桥接方法固定.结果所有患者术后获8～48个月(平均24.5个月)随访.术后无切口感染及膀胱尿道、髂腹股沟神经、精索(子宫圆韧带)损伤等并发症发生.手术复位情况根据Matta评定标准:优98例,良35例,可2例.无钢板断裂、螺钉松动及折断现象.根据改良的Merled'Aubigne和Postel评分标准评定疗效:优53例,良71例,中9例,差2例,优良率为91.9%.结论采用小切口有限显露治疗耻骨联合分离损伤小、术后恢复好、患者满意度高,是治疗耻骨联合分离的一种有效技术。
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Closed reduction of the symphysis pubis in a patient with an open-book type disruption of the pelvic ring failed because of interposition of the bladder and retroperitoneal fat. The problem of maintaining reduction with an external fixation device is discussed.
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To investigate treatment methods and therapeutic effects of the diastasis of the symphysis pubis.Thirteen patients with diastasis of the symphysis pubis, including 7 male and 6 female, ranging in age from 20 to 54 years,were treated according to classification based on the pelvic stability. Five patients of type I were treated with conservative methods, five patients of type II were treated with external fixation, and three patients with type III were treated with posterior internal fixation combined with anterior external fixation.All the patients were followed-up and the duration of the follow-up ranged from 4 to 62 months, with an average of 14 months. According to the reduction, pain,gait, limb length and movement of hip,the therapeutic effects were evaluated. There were 7 patients obtaining excellent results, 5 good, 1 fair, the excellent and good rate was 92.3%.Treatment methods should be chosen in view of the differences of the patients with diastasis of the symphysis pubis. The external fixation has advantages of simple operation, decreased wound and stable fixation.
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Fractures of the pelvis constitute a small but significant proportion of skeletal injuries. However, they are associated with significant morbidity and mortality, including damage to the urogenital system, especially the urethra and urinary bladder. We report the rare finding of bladder herniation and entrapment after reduction of a traumatic symphyseal diastasis by external fixation and the diagnosis of these injuries with computed tomography. A comprehensive review of the literature is also performed, to improve understanding and provide guidelines for evaluation and treatment of pelvic injuries with suspected bladder involvement.
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The research proposes a surgical technique for patients with chronic pubic symphysis diastasis and bladder herniation by means of a pelvic reconstruction technique. Three patients were treated initially in other hospitals and referred to us. All presented with pubic symphysis diastasis greater than 7 cm and bladder herniation. Two patients were initially treated with external fixation, and in one patient, the symphysis diastasis had been completely neglected. All cases presented good evolution with the proposed technique, which is described in details in the paper.
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Summary— We report on 2 cases of traumatic distasis of the symphysis pubis in the female with injury to the soft tissue supports of the bladder neck resulting in urinary incontinence, unnoticed until discharge from hospital.
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Objective To investigate the clinical and radiographic outcome of traumatic pubic symphyseal diastases fixed with the locked plate. Methods From December 2007 to December 2009,17 patients(11 males,6 females,at mean age of 45.3 years)with pubic symphysis diastasis of unstable pelvic ring injuries were treated with open reduction and fixation with the locked plate.According to Tile classification system,five patients were with type B1 fractures,one with type B2,one with type B3,six with type C1,three with type C2 and one with type C3.All operations were performed under general anesthesia.Pubic symphyseal diastasis was treated by open reduction and fixation with the locked plate.There were 13 patients with associated posterior pelvic disruption,of which seven patients were treated by open reduction via anterior approach and fixed wich the reconstruction plates,three by close reduction and fixed with percutaneoua sacroiliac cannulated screws and three by posterior approach and fixed with M type plates. Results Of all the patients,16 patients were followed up for a mean time of 16 months(6-30months),which showed mean blood loss of 200 ml(50-600 ml)and mean hospital stay of 21 days (14-62 days).The clinical outcome was measured according to Majeed scores system,which showed excellent results in seven patients,good in seven and fair in two. Conclusions The locked plate fixation takes advantages of sailsfactory clinical outcomes with less operative trauma and a lower implant failure and wound infection rate in treatment of traumatic pubis symphysis diastasis.Locked plate fixation of symphysis call be performed alone when the posterior pelvic ring is only partially disrupted (Tile B).Posterior fixation construction should be used if the pelvic ring is under complete instability(Tile C).
Key words:
Pelvis; Pubic symphyseal diastasis; Frature fixation,internal
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To review the results of bladder-neck reconstruction in patients with repaired bladder exstrophy and pubic diastasis.Nine girls (mean age 7 years, range 4-17) and four boys (mean age 9 years, range 5-15) underwent a modified Young-Dees-Leadbetter bladder-neck reconstruction with augmentation cystoplasty (YDL-C). The patients were reviewed retrospectively (follow-up, 1-6 years) to assess continence, particularly in relation to the degree of pubic diastasis measured on an appropriate abdominal radiograph.Ten patients were continent; seven girls and one boy are managed by clean intermittent catheterization (CIC) and one girl and one boy void normally. One girl who would not allow CIC and one boy in whom CIC was not possible are incontinent and are scheduled for construction of a continent diversion. One incontinent boy who also would not allow CIC was lost to follow-up. Public diastasis had no bearing on the surgical results, the 10 continent patients having diastasis ranging from 4 to 9 cm (mean 5.5 cm) and the incontinent patients a diastasis of 3.4 and 6.5 cm (mean 4.5 cm).Young-Dees-Leadbetter bladder-neck reconstruction with augmentation cystoplasty is a satisfactory operation in patients with bladder exstrophy. We believe that the rate of continence reflected a competent tubularization with an adequate bladder capacity and assured bladder emptying. A closed pelvis with approximated public bones is not necessary to achieve this objective.
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