Mehin Ramin, Meek Robert, O'Brien Peter, Blachut Piotr
University of British Columbia, Vancouver General Hospital, Vancouver, BC.
Can J Surg. 2006 Jun;49(3):170-6.
Osteitis pubis is a rare and self-limited condition. Surgery may be necessary in 5%-10% of cases. The outcome after surgery for osteitis pubis is not known.
To determine the success of surgical intervention for osteitis pubis, we used a computerized data registry to identify patients (10 women [mean age 40 yr]) who underwent surgery for osteitis pubis. A retrospective chart review was carried out. We also searched the literature for all cases of osteitis pubis managed surgically and identified 73 cases.
The 10 patients in our series had had symptoms for a mean of 4 years preoperatively. Onset of pain was insidious in 4 patients, it followed childbirth in 4 and it followed trauma in 2. Depending on the surgeon's preference, either a wedge resection of the symphysis pubis was performed or a symphysiodesis. At the latest follow-up (average 26 mo), although all patients had some improvement, only 6 of 10 patients were satisfied with the outcome. From the literature review, we identified 3 categories of patients with osteitis pubis: elite athletes, patients with postoperative or infectious osteitis pubis and the remainder, which would include the patients in our series.
Four types of surgical intervention are described: curettage, arthrodesis, wedge resection and wide resection. The elite athletes respond well to curettage. Patients with osteitis pubis following urologic or gynecologic procedures or have a proven infection require surgery in roughly 50% of cases. The third group has an unpredictable outcome.
耻骨炎是一种罕见的自限性疾病。5% - 10%的病例可能需要手术治疗。耻骨炎手术后的结果尚不清楚。
为了确定耻骨炎手术干预的成功率，我们使用计算机化数据登记系统识别接受耻骨炎手术的患者（10名女性，平均年龄40岁）。进行了回顾性病历审查。我们还在文献中搜索了所有接受手术治疗的耻骨炎病例，并确定了73例。
我们系列中的10名患者术前症状平均持续4年。4名患者疼痛起病隐匿，4名患者疼痛发生在分娩后，2名患者疼痛发生在创伤后。根据外科医生的偏好，要么进行耻骨联合楔形切除术，要么进行耻骨联合固定术。在最近的随访中（平均26个月），尽管所有患者都有一定程度的改善，但10名患者中只有6名对结果满意。通过文献综述，我们确定了耻骨炎患者的3类：精英运动员、术后或感染性耻骨炎患者以及其余患者，我们系列中的患者包括在其余患者中。
描述了四种手术干预类型：刮除术、关节固定术、楔形切除术和广泛切除术。精英运动员对刮除术反应良好。泌尿外科或妇科手术后患有耻骨炎或已证实感染的患者约50%需要手术。第三组患者的结果不可预测。
