Wild Aaron T, Sponseller Paul D, Stec Andrew A, Gearhart John P
Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA.
Semin Pediatr Surg. 2011 May;20(2):71-8. doi: 10.1053/j.sempedsurg.2010.12.002.
Classic bladder exstrophy (CBE) patients are born with a pubic diastasis that increases steadily with age from a mean value of 4 cm at birth to a mean of 8 cm at age 10, compared with a mean normal width of the pubic symphysis of 0.6 cm at all ages. The width of the sacrum and length of the posterior (iliac) segment of the pelvis in CBE patients are normal; however, the anterior (ischiopubic) segment of the pelvis is a mean 30% shorter and both the anterior and posterior segments are externally rotated compared to controls. The main role of osteotomy in treatment of CBE appears to be to relax tension on the bladder and repaired abdominal wall during wound-healing. Anterior innominate osteotomy with optional posterior vertical iliac osteotomy presents several advantages over the prior conventional technique of posterior iliac osteotomy. These include (a) less intraoperative blood loss, (b) better apposition and mobility of the pubic rami at the time of closure, (c) allowance for placement of an external fixator under direct vision, (d) allowance for secure external fixation in children over 6 months old, and (e) no requirement to turn the patient during the operation.
典型膀胱外翻（CBE）患者出生时耻骨分离，随着年龄增长，耻骨分离程度从出生时的平均4厘米稳步增加到10岁时的平均8厘米，而耻骨联合的正常平均宽度在各年龄段均为0.6厘米。CBE患者的骶骨宽度和骨盆后部（髂骨）段长度正常；然而，与对照组相比，骨盆前部（耻骨坐骨部）段平均短30%，且前后部段均向外旋转。截骨术在CBE治疗中的主要作用似乎是在伤口愈合期间减轻膀胱和修复腹壁的张力。与先前的传统髂后截骨术相比，前路无名骨截骨术加选择性后路垂直髂骨截骨术具有多个优点。这些优点包括：（a）术中失血较少；（b）闭合时耻骨支的对位和活动度更好；（c）允许在直视下放置外固定器；（d）允许对6个月以上儿童进行可靠的外固定；（e）手术过程中无需翻动患者。
