Nasrallah Khalil, Jammal Mahmoud, Khoury Amal, Liebergall Meir
Western Galilee Medical Center, 9 Nahariya-Cabri, Nahariya 22100, Israel.
Hadassah Medical Center of the Hebrew University, Kiryat Hadassah, POB 12000, Jerusalem 91120, Israel.
Trauma Case Rep. 2020 Oct 21;30:100357. doi: 10.1016/j.tcr.2020.100357. eCollection 2020 Dec.
Osteitis pubis (OP) is an inflammatory condition of the symphysis pubis (SP) characterized by focal pain and local tenderness. Pelvic instability (PI) is commonly associated with this condition. It is still not clear if OP leads to PI or it is PI that leads to OP. The exact cause of osteitis pubis is not yet known, although several predisposing factors have been suggested to contribute to this condition. In most cases, it is self-remitting and rarely needs surgical intervention.
A 63-year old woman presented with a 12-month history of persistent pain at the symphysis pubis and non-responsive to analgesics. The pain was aggravated by physical activity such as standing and walking. Physical examination showed focal tenderness at the symphysis pubis with no tenderness over the sacroiliac joints or lumbar region. The diagnosis was confirmed by characteristic findings on radiographs, CT and MRI. Surgery was considered after all conservative measures failed. The patient underwent a wedge-shaped resection of the symphysis pubis; the bone defect was filled autologous tri-cortical bone and fixed with dual plating. The outcome was satisfactory with radiologic union and symptom resolution postoperatively.
Osteitis pubis due to pelvic instability can cause chronic and persistent pain. In cases where conservative treatment fails, surgery should be considered. We recommend wide surgical resection of all non-viable bone at the symphysis pubis with the addition of tri-cortical iliac bone graft. Double plating should be considered in order to maximize the rate of fusion and further stabilize the fixation.
耻骨炎（OP）是耻骨联合（SP）的一种炎症性疾病，其特征为局部疼痛和压痛。骨盆不稳定（PI）通常与这种疾病相关。目前尚不清楚是OP导致PI还是PI导致OP。耻骨炎的确切病因尚不清楚，尽管有几种诱发因素被认为与这种疾病有关。在大多数情况下，它会自行缓解，很少需要手术干预。
一名63岁女性，耻骨联合处持续疼痛12个月，对镇痛药无反应。站立和行走等体力活动会加重疼痛。体格检查显示耻骨联合处有局部压痛，骶髂关节或腰椎区域无压痛。通过X线片、CT和MRI的特征性表现确诊。在所有保守治疗措施失败后考虑手术。患者接受了耻骨联合楔形切除术；骨缺损用自体三层皮质骨填充并用双钢板固定。术后影像学愈合且症状缓解，结果令人满意。
骨盆不稳定导致的耻骨炎可引起慢性持续性疼痛。在保守治疗失败的情况下，应考虑手术。我们建议广泛切除耻骨联合处所有失活的骨组织，并加用三层皮质髂骨移植。应考虑使用双钢板以最大化融合率并进一步稳定固定。
