van Geffen H J A A, Simmermacher R K J, Bosscha K, van der Werken Chr, Hillen B
Department of Surgery, University Medical Centre, Utrecht, The Netherlands.
Hernia. 2004 May;8(2):93-7. doi: 10.1007/s10029-003-0191-4. Epub 2003 Nov 21.
Closure of large incisional hernias with the Components Separation Method (CSM) could be explained by medial-caudal rotation of the internal and transverse oblique muscles around their centres of origin. In eight human cadavers, the CSM was performed, and translation of the rectus abdominis muscle was measured. Mean unilateral translation of the rectus abdominis in the lateral-medial direction measured 2.2, 3.7, and 3.5 cm. This was 2.7, 4.5, and 4.0 cm after release of the posterior rectus sheath. Mean translation in a caudal direction was 0.5 cm, but seven cadavers showed a mean translation of 1 cm of the uppermost measuring point in a cranial direction. The hypothesis that rotation of separate tissue layers of the abdominal wall largely accounts for the translation effect of the CSM must be rejected. Release of the external oblique muscle produces more benefit to abdominal wall closure than release of the posterior rectus sheath.
采用成分分离法（CSM）关闭大型切口疝，可通过腹内斜肌和腹横肌围绕其起始中心向内侧 - 尾侧旋转来解释。在八具人体尸体上进行了CSM操作，并测量了腹直肌的移位情况。腹直肌在外侧 - 内侧方向的平均单侧移位分别为2.2、3.7和3.5厘米。在切开腹直肌后鞘后，这一数值分别为2.7、4.5和4.0厘米。在尾侧方向的平均移位为0.5厘米，但七具尸体显示最上方测量点在头侧方向的平均移位为1厘米。腹壁各独立组织层的旋转在很大程度上解释了CSM的移位效果这一假设必须被否定。切开腹外斜肌比切开腹直肌后鞘对腹壁关闭更有益。
