Becker Ines, Stringer Mark D, Jeffery Ruth, Woodley Stephanie J
Department of Anatomy, Otago School of Medical Sciences, University of Otago, Dunedin, New Zealand.
Clin Anat. 2014 Oct;27(7):1058-67. doi: 10.1002/ca.22423. Epub 2014 Jun 5.
Pregnancy-related symphyseal pain is a condition commonly encountered by clinicians but its pathogenesis is poorly understood. The pubic symphysis is readily visualized with ultrasound, yet the normal sonographic anatomy of the joint has not been accurately documented. This study aimed to describe the anatomy of the pubic symphysis in healthy, nulliparous women using ultrasound. An experienced and inexperienced sonographer scanned the joint in 30 female volunteers (mean age 26 years). Interobserver and intraobserver reliability of ultrasound measurements were examined and the accuracy of these measurements was validated by ultrasound and dissection of six female cadaver pelves (mean age 75 years). In healthy young women, pubic symphysis morphology varied, and six categories of anterosuperior joint shape were defined. Mean values of several anatomic parameters were obtained in supine and standing positions: joint width (widest 10.1 mm, narrowest 2.6 mm); superior pubic ligament (SPL) length and depth (41.4 and 3.4 mm, respectively); and pubic crest length (left 24.4 mm, right 24.4 mm). Statistically significant relationships between SPL width and depth and anthropometric variables (body mass index, pelvic width, and body fat percentage) were established. Larger ultrasonographic measurements, such as wide joint width and SPL length, could be measured more reliably than smaller measurements, such as narrow joint width and SPL depth, in both healthy volunteers and cadavers. Findings from this study provide normative reference data for examination of the pubic symphysis in pregnant women and may therefore be relevant to understand pregnancy-related symphyseal pain.
妊娠相关的耻骨联合疼痛是临床医生常遇到的一种情况，但其发病机制尚不清楚。耻骨联合很容易通过超声显示，然而该关节正常的超声解剖结构尚未得到准确记录。本研究旨在使用超声描述健康未生育女性耻骨联合的解剖结构。一名经验丰富的超声检查医师和一名经验不足的超声检查医师对30名女性志愿者（平均年龄26岁）的耻骨联合进行了扫描。检查了超声测量的观察者间和观察者内可靠性，并通过对6具女性尸体骨盆（平均年龄75岁）进行超声检查和解剖来验证这些测量的准确性。在健康年轻女性中，耻骨联合形态各异，定义了六种类型的前上关节形状。在仰卧位和站立位获得了几个解剖参数的平均值：关节宽度（最宽10.1毫米，最窄2.6毫米）；耻骨上韧带（SPL）长度和深度（分别为41.4和3.4毫米）；以及耻骨嵴长度（左侧24.4毫米，右侧24.4毫米）。建立了耻骨上韧带宽度和深度与人体测量变量（体重指数、骨盆宽度和体脂百分比）之间的统计学显著关系。在健康志愿者和尸体中，较大的超声测量值，如宽关节宽度和耻骨上韧带长度，比较小的测量值，如窄关节宽度和耻骨上韧带深度，测量起来更可靠。本研究结果为孕妇耻骨联合检查提供了规范性参考数据，因此可能与理解妊娠相关的耻骨联合疼痛有关。
