耻骨联合区域相关解剖学进展及内固定治疗的生物力学特征

doi:10.3969/j.issn.2095-4344.2802

中国组织工程研究 ›› 2020, Vol. 24 ›› Issue (27): 4371-4375.doi: 10.3969/j.issn.2095-4344.2802

• 骨与关节综述 bone and joint review • 上一篇下一篇

耻骨联合区域相关解剖学进展及内固定治疗的生物力学特征

宫玉锁，周君，李盛华，朱艳国

甘肃省中医院，甘肃省兰州市 730050

收稿日期:2020-02-10 修回日期:2020-02-18 接受日期:2020-03-25 出版日期:2020-09-28 发布日期:2020-09-10
通讯作者: 周君，硕士，主治医师，甘肃省中医院，甘肃省兰州市 730050
作者简介:宫玉锁，男，1973年生，河北省人，汉族，2003年兰州大学医学院毕业，硕士，主任医师。
基金资助:
兰州市科技局人才创新创业项目(2017-RC-58)

Anatomic progress of pubic symphysis and biomechanical characteristics of internal fixation

Gong Yusuo, Zhou Jun, Li Shenghua, Zhu Yanguo

Gansu Provincial Hospital of TCM, Lanzhou 730050, Gansu Province, China

Received:2020-02-10 Revised:2020-02-18 Accepted:2020-03-25 Online:2020-09-28 Published:2020-09-10
Contact: Zhou Jun, Master, Attending physician, Gansu Provincial Hospital of TCM, Lanzhou 730050, Gansu Province, China
About author:Gong Yusuo, Master, Chief doctor, Gansu Provincial Hospital of TCM, Lanzhou 730050, Gansu Province, China
Supported by:
the Talent Innovation and Entrepreneurship program of Lanzhou Science and Technology Bureau, No. 2017-RC-58

摘要/Abstract

摘要：

文题释义：

耻骨联合：是骨盆两个联结副弓在骨盆前部所汇合之处，由两侧耻骨内侧面构成，关节面由透明软骨覆盖，一较厚的纤维软骨盘连接，关节的周围有前、后、上、下四韧带。耻骨联合属于微动关节，参与构成骨盆环，维持骨盆环稳定。

耻骨联合分离：是指骨盆前方两侧耻骨纤维软骨联合处，因各种因素出现分离移位，表现耻骨联合距离增宽或上下脱位。

背景：耻骨联合分离损伤大多与严重骨盆骨折损伤一起发生。由于耻骨联合解剖位置深在，且治疗效果常不尽如人意，有必要进行相关解剖及生物力学研究，以便更好指导临床诊疗。

目的：总结分析耻骨联合解剖学特点，生物力学研究现状，为临床治疗耻骨联合分离提供一定裨益。

方法：在中国知网、维普、PubMed数据库上以“耻骨联合分离”及“生物力学”作为中文检索词、“separation of pubic symphysis”和“biomechanics”作为英文检索词检索；检索时间为1984年4月至2020年2月。通过标题及摘要选取相关文献, 并阅读参考文献的标题和摘要, 从中再次挑选相关文献，剔除重复文献。

结果与结论：检索符合条件文献57篇，最终纳入文献33篇。①现解剖研究多集中于耻骨联合相关组成结构及周围韧带方面；②限于耻骨联合位置原因，未进一步深入研究，如周围韧带和肌肉起止点的精确分布，精确的神经和血液分布，还有待进一步研究；③对耻骨联合分离生物力学研究较少，且差异较大，有待深入研究达成共识；④伴随有限元发展，生物力学热点多集中在耻骨联合治疗方面；⑤因重建钢板和空心螺钉力学稳定性优良而做为耻骨联合分离常用固定方式，而经皮空心螺钉固定因其微创性成为今后发展趋势。

ORCID: 0000-0001-9019-3392(宫玉锁)

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 内固定, 钢板, 耻骨联合, 解剖, 韧带, 治疗力学, 综述

Abstract:

BACKGROUND: The separation injury of pubic symphysis is most commonly associated with severe pelvic fracture injuries. Because the anatomical position of the pubic symphysis is deep, and the curative effect is often unsatisfactory. Anatomical and biomechanical studies are necessary to better guide clinical diagnosis and treatment.

OBJECTIVE: To summarize and analyze the anatomical characteristics and biomechanical research status of pubic symphysis, and to provide some benefits for the clinical treatment of pubic symphysis separation.

METHODS: The authors retrieved CNKI, VIP, and PubMed with the key words of “separation of pubic symphysis” and “biomechanics” for articles published from April 1984 to February 2020. Relevant literature was selected by title and abstract, and the titles and abstracts of the references were read. The related literatures were selected again and the duplicate literatures were eliminated.

RESULTS AND CONCLUSION: There were 57 eligible literatures, and 33 were finally included. (1) The present anatomical study mainly focuses on the structure of pubic symphysis and its adjacent ligaments. (2) Because of the position of pubic symphysis, no further study was carried out. The precise distribution of the starting and ending points of the peripheral ligaments and muscles, and the precise nerve and blood distribution need further study. (3) There have been relatively few studies of pubic symphysis biomechanics, and they vary widely. It needs to be deeply studied and agreed upon. (4) With the development of finite element, the biomechanics focus on the treatment of pubic symphysis. (5) Due to good mechanical stability, the reconstructed plate and the hollow screw are used as common fixation for pubic symphysis separation. However, percutaneous hollow screw fixation has become the trend in the future because of its minimal invasion.

Key words: internal fixation, steel plate, pubic symphysis, anatomy, ligament, therapeutic mechanics, review

中图分类号:

宫玉锁, 周君, 李盛华, 朱艳国. 耻骨联合区域相关解剖学进展及内固定治疗的生物力学特征[J]. 中国组织工程研究, 2020, 24(27): 4371-4375.

Gong Yusuo, Zhou Jun, Li Shenghua, Zhu Yanguo. Anatomic progress of pubic symphysis and biomechanical characteristics of internal fixation[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(27): 4371-4375.

图/表（结果） 2

参考文献

[1] WALHEIM G, LERUD S, IBBE T. mobility of the pubic symphysis. Measurements by an electromechanical method. Acta Orthop Scand. 1984;55(2):203-208.

[2] GARRAS DN, CAROTHERS JT, OLSON SA. Single-leg-stance (flamingo) radiographs to assess pelvic instability: how much motion is normal? J Bone Joint Surg Am. 2008;90(10):2114-2118.

[3] AGGARWAL S, BALI K, KRISHNAN V, et al. Management outcomes in pubic diastasis:our experience with 19 patients. J Orthop Surg Res. 2011;(6):21.

[4] PUTNIS SE, PEARCE R, WALI UJ, et al. Open reduction and internal fixation of a traumatic diastasis of the pubic symphysis: one-year radiological and functional outcomes. J Bone Joint Surg Br. 2011; 3(1):78-84.

[5] WANG W, HAYAMI T, KAPILA S. Female hormone receptors are differentially expressed in mouse fibrocartilages. Osteoarthritis Cartilage. 2009;17(5):646-654.

[6] PIRES R, LABRONICI PJ, GIORDANO V, et al. Intrapartum pubic symphysis Disruption. Ann Med Health Sci Res. 2015;5(6):476.

[7] BAHLMANN F, MERZ E, MACCHIELLA D, et al. Ultrasound imaging of the symphysis fissure for evaluating damage to the symphysis in pregnancy and postpartum. Z Geburtshilfe Perinatol. 1993;197(1):27-30.

[8] BECKER I, WOODLEY SJ, STRINGER MD. The adult human pubic symphysis: a systematic review. J Anat. 2010;217(5):475-487.

[9] GARCIA JM, DOBLARE M, SERAL B, et al. Three-dimensional finite element analysis of several internal and external pelvis fixations. J Biomech Eng. 2000;122(5):516-522.

[10] KIAPOUR A, JOUKAR A, ELGAFY H, et al. Biomechanics of the sacroiliac joint: anatomy, function, biomechanics, sexual dimorphism, and causes of pain. Int J Spine Surg. 2020;14(Suppl 1):3-13.

[11] MEISSNER A, FELL M, WILK R, et al. Biomechanics of the pubic symphysis.Which forces lead to mobility of the symphysis in physiological conditions? Unfallchirurg. 1996;99(6):415-421.

[12] STEINITZ D, GUY P, PASSARIELLO A, et al. All superior pubic ramus fractures are not created equal. Can J Surg. 2004;47(6):422-425.

[13] SIMONIAN PT, ROUTT ML JR, HARRINGTON RM, et al. The acetabular T-type fracture. A biomechanical evaluation of internal fixation. Clin Orthop Relat Res. 1995;(314):234-240.

[14] 张少群,任茹霞,陈奕历,等.骶髂关节周围各韧带对骶髂关节稳定性的影响[J].医用生物力学,2019,34(5):500-506.

[15] HEFZY MS, EBRAHEIM N, MEKHAIL A, et al. Kinematics of the human pelvis following open book injury. Med Eng Phys. 2003;25(4):259-274.

[16] LI Z, KIM JE, DAVIDSON JS, et al. Biomechanical response of the pubic symphysis in lateral pelvic impacts:a finite element study. J Biomech. 2007;40 (12):2758-2766.

[17] EE CC, MANHEIMER E, PIROTTA MV, et al. Acupuncture for pelvicand back pain in pregnancy: a systematic review. Am J Obstet Gynecol. 2008;198(3):254-259.

[18] TILE M. Acute pelvic fractures:I. causation and classification. J Am Acad Orthop Surg. 1996;4(3):143-151.

[19] MU WD, WANG H, ZHOU DS, et al. Computer navigated percutaneous screw fixation for traumatic pubic symphysis diastasis of unstable pelvic ring injuries. Chin Med J (Engl). 2009;122(14):1699-1703.

[20] SCAGLIONE M, PARCHI P, DIGRANDI G, et al. External fixation in pelvic fractures. Musculoskeletal Surg, 2010;94(2):63-70.

[21] PONSEN K, JOOSSE P, VAN DIJKE GA, et al. External fxation of the pelvic ring:an experimental study on the role of pin diameter, pin position,and parasymphyseal fxator pins.Acta Orthop. 2007;78(5): 648-653.

[22] VARGA E, HEARN T, POWELL J, et al. Effects of method of internal fixation of symphyseal disruptions on stability of the pelvic ring.Injury. 1995;26(2):75-80.

[23] STUART PR, TALBOT D, MILNE DD. Internal fixation of pubic symphysis diastasis with a tension banding technique. Injury. 1990;21(4):223-224.

[24] CANO LP, GIRALDEZ SANCHEZ MA, MARTNEZ RJ, et al. Biomechanical analysis of a new minimally invasive system for osteosynthesis of pubis symphysis disruption.Injury. 2012;43:20-27.

[25] SAGI HC, PAPP S. Comparative radiographic and clinical outcome of two-hole and multi-hole symphyseal plating. J Orthop Trauma. 2008; 22(6):373-378.

[26] FENG Y, YU H, QIAN H, et al. Comparison of biomechanical characteristics and pelvic ring stability vsing different fixation methods to treat pubic symphysis diastasis: a finite element study. Medicine. 2015;94(49):2207.

[27] SIMONIAN PT, ROUTT ML, HARRINGTON RM, et al. Box plate fxation of the symphysis pubis: biomechanical evaluation of a new technique. J Orthop Trauma. 1994;8(6):483-489.

[28] LUJAN TJ, HENDERSON CE, MADEY SM, et al. Locked plating of distal femur fractures leads to inconsistent and asymmetric callus formation. J Orthop Trauma. 2010;24(3):156-162.

[29] 简争光,许运,史勇,等.锁定钢板固定修复侧方压缩旋转不稳骨盆环损伤:骨盆稳定性重建[J].中国组织工程研究,2015,19(48):7776-7783.

[30] PRASARN ML, ZYCH G, GASKI G. Biomechanical study of 4-hole pubic symphyseal plating: locked versus unlocked constructs. Orthopedics. 2012;35(7):1028-1032.

[31] 余可和.骨盆前环解剖研究及前环损伤空心螺钉与重建钢板治疗的有限元分析[D].济南:山东大学.2015:38.

[32] PARK M, YOON S, CHOI S, et al. Is there a clinical benefit of additional tension band wiring in plate fixation of the symphysis? BMC Musculoskeletal Disorders. 2017;18(1):40.

[33] 马坤龙,朱磊,方跃.耻骨联合分离的治疗进展[J].中国修复重建外科杂志, 2014,28(2):250-254.

耻骨联合区域相关解剖学进展及内固定治疗的生物力学特征

Anatomic progress of pubic symphysis and biomechanical characteristics of internal fixation

PDF

可视化

摘要/Abstract

引用本文

使用本文

图/表（结果） 2

参考文献

相关文章 15

引言

材料方法

讨论

文章快阅

延伸阅读

编辑推荐

Metrics

本文评价

[1]	蒲锐, 陈子扬, 袁凌燕. 不同细胞来源外泌体保护心脏的特点与效应[J]. 中国组织工程研究, 2021, 25(在线): 1-.
[2]	徐峰, 康辉, 魏坦军, 席金涛. 椎弓根螺钉不同固定方法治疗胸腰椎骨折的生物力学分析[J]. 中国组织工程研究, 2021, 25(9): 1313-1317.
[3]	张同同, 王中华, 文杰, 宋玉鑫, 刘林. 3D打印模型在颈椎肿瘤手术切除与重建中的应用[J]. 中国组织工程研究, 2021, 25(9): 1335-1339.
[4]	杜秀鹏, 杨朝晖. 65岁以下嵌插型股骨颈骨折初始畸形程度对颈缩短的影响[J]. 中国组织工程研究, 2021, 25(9): 1410-1416.
[5]	张尚普, 鞠晓东, 宋恒义, 董智, 王晨, 孙国栋. 关节镜下带线锚钉缝线桥缝合固定治疗肩锁关节脱位[J]. 中国组织工程研究, 2021, 25(9): 1417-1422.
[6]	张超, 吕欣. 髋臼骨折固定后的异位骨化：危险因素、预防及其治疗进展[J]. 中国组织工程研究, 2021, 25(9): 1434-1439.
[7]	周继辉, 李新志, 周游, 黄卫, 陈文瑶. 髌骨骨折修复内植物选择的多重问题[J]. 中国组织工程研究, 2021, 25(9): 1440-1445.
[8]	王德斌, 毕郑刚. 尺骨鹰嘴骨折-脱位解剖力学、损伤特点、固定修复及3D技术应用的相关问题[J]. 中国组织工程研究, 2021, 25(9): 1446-1451.
[9]	陈俊名, 岳辰, 何沛霖, 张俊涛, 孙墨渊, 刘又文. 髋关节置换与股骨近端防旋髓内钉内固定修复高龄股骨转子间骨折效果的Meta分析[J]. 中国组织工程研究, 2021, 25(9): 1452-1457.
[10]	胡凯, 乔晓红, 张永红, 王栋, 秦泗河. 空心螺钉和钢板内固定修复移位型跟骨关节内骨折：基于15篇随机对照试验的Meta分析[J]. 中国组织工程研究, 2021, 25(9): 1465-1470.
[11]	姬志祥, 蓝常贡. 尿酸盐转运蛋白在痛风中的多态性和治疗相关性[J]. 中国组织工程研究, 2021, 25(8): 1290-1298.
[12]	袁美, 张新新, 郭祎莎, 毕霞. 循环microRNA在血管性认知障碍诊断中的应用[J]. 中国组织工程研究, 2021, 25(8): 1299-1304.
[13]	汪显耀, 关亚琳, 刘忠山. 提高间充质干细胞治疗难愈性创面的策略[J]. 中国组织工程研究, 2021, 25(7): 1081-1087.
[14]	万然, 史旭, 刘京松, 王岩松. 间充质干细胞分泌组治疗脊髓损伤的研究进展[J]. 中国组织工程研究, 2021, 25(7): 1088-1095.
[15]	廖成成, 安家兴, 谭张雪, 王倩, 刘建国. 口腔鳞状细胞癌干细胞的治疗靶点及应用前景[J]. 中国组织工程研究, 2021, 25(7): 1096-1103.