Wischnik A, Lehmann K J, Busch H P, Englmeier K H, Sterescu D, Georgi M, Melchert F
Frauenklinik Universität Heidelberg.
Z Geburtshilfe Perinatol. 1989 May-Jun;193(3):145-51.
Within 1 year with 1325 births 54 cases necessitated operative obstetric intervention due to a disproportion between fetal head and maternal pelvis. In 40 cases radiologic pelvimetry was performed, using the conventional technique. 75% of cases turned out to be due to a midplane or outlet contraction. As, on the one hand, this type of pelvic disproportion seems to be of increasing importance, on the other hand generously adoperated radiologic diagnosis is not well accepted by the patients due to X-ray burden, Digital Image Intensifier Radiography (DIR) has been introduced for pelvimetry. X-ray burden amounts to only 5% of that of the conventional technique. Enhanced postprocessing and interactive measurement possibilities are further advantages of DIR. Using the appropriate softwear, interactive measurement results are characterized by the lack of mistakes due to X-ray divergence, if only the distance between measurement level and desk surface is known. By analyzing 30 computer tomograms measurement levels of the most important pelvic distances could be calculated in relation to the position of the anterior iliac spine. These relations show a very low interindividual variation. Thus, possible errors in measurement amount to a maximum of only 3.5%. The evaluation of our cases reveals the necessity to reassess the normal ranges for pelvic parameters, for the use of those deriving from conventional pelvimetry failed to describe correctly the anatomy of birth channel. For this sake, additional measurements, esp. of sacral and pelvic outlet anatomy have to be performed. Based upon these measurements, a computer aided modelling of the birth channel and a simulation of the birth could be achieved.(ABSTRACT TRUNCATED AT 250 WORDS)
在1年时间里,共分娩1325例,其中54例因胎头与母体骨盆不相称而需要进行产科手术干预。40例采用传统技术进行了放射学骨盆测量。结果发现75%的病例是由于中骨盆或骨盆出口狭窄。一方面,这种类型的骨盆不相称似乎越来越重要,另一方面,由于X线负担,患者对广泛采用的放射学诊断接受度不高,因此引入了数字图像增强X线摄影(DIR)进行骨盆测量。X线负担仅为传统技术的5%。DIR的进一步优势在于增强的后处理和交互式测量可能性。使用适当的软件,只要知道测量平面与桌面之间的距离,交互式测量结果就不会因X线发散而出现错误。通过分析30例计算机断层扫描,可计算出最重要的骨盆距离测量平面与髂前上棘位置的关系。这些关系显示个体间差异非常小。因此,测量误差最大仅为3.5%。对我们病例的评估表明,有必要重新评估骨盆参数的正常范围,因为使用传统骨盆测量得出的参数未能正确描述产道的解剖结构。为此,必须进行额外的测量,尤其是骶骨和骨盆出口解剖结构的测量。基于这些测量,可以实现产道的计算机辅助建模和分娩模拟。(摘要截断于250字)