Arner Justin W, Albers Marcio, Zuckerbraun Brian S, Mauro Craig S
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
Department of General Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
Arthrosc Tech. 2017 Dec 11;7(1):e23-e27. doi: 10.1016/j.eats.2017.08.045. eCollection 2018 Jan.
Patients with pubic symphysis instability who had failed nonoperative treatments may benefit from surgical repair. This disease process is rare, most commonly seen in postpartum women and athletes, and its surgical treatment is invasive and nonphysiological. Currently described surgical interventions, although limited, include plating, which provides an overly rigid construct with the risk of failure and possibly poor long-term outcomes particularly in athletes, and treatments such as curettage, more commonly used in the treatment of osteitis pubis. An emerging option is minimally invasive laparoscopic fixation using knotless anchors with a tape suture in a crisscross configuration. This possibly allows more physiological movement of the pubic symphysis in a less invasive manner. A detailed technical description and discussion of the technique are provided.
耻骨联合不稳定且非手术治疗失败的患者可能从手术修复中获益。这种疾病过程罕见,最常见于产后女性和运动员,其手术治疗具有侵入性且不符合生理状态。目前描述的手术干预措施虽然有限,但包括钢板固定,这会提供过于刚性的结构,存在失败风险,尤其在运动员中可能导致不良的长期预后,还有诸如刮除术等治疗方法,更常用于耻骨炎的治疗。一种新兴的选择是使用无结锚钉和带缝线以交叉配置进行微创腹腔镜固定。这可能以微创方式使耻骨联合实现更多的生理性活动。本文提供了该技术的详细技术描述和讨论。