Lima Ewerton Borges de Souza, Janco Marco Antonio Rojas, Saturnino Ubiratan Stefani de Oliveira, Leal Tarcísio Alves, Reis Fernando Baldy Dos, Cocco Luiz Fernando
Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
Rev Bras Ortop (Sao Paulo). 2024 Apr 22;59(Suppl 2):e251-e254. doi: 10.1055/s-0043-1776023. eCollection 2024 Nov.
During the gestational period, the pubic symphysis dilates for vaginal delivery. However, exacerbated widening may indicate ligament injury and pelvic instability, resulting in significant pain complaints. This uncommon condition is called peripartum pubic symphysis disjunction (PPSD). We herein report the case of a patient with a gestational age of 38 weeks who complained of severe pain in the lumbar and pelvic region, radiating to the right hip and knee, after vaginal delivery of a single pregnancy with no obstetric complications. The patient had extensive edema and vulvar ecchymosis, and radiographic examinations showed a pubic symphysis disjunction of 7 cm and a right sacroiliac joint opening. The literature is controversial regarding the indication of treatment for these cases, but the clinical and radiographic findings motivated the surgical treatment. We closed the pubic symphysis with orthogonal plates and stabilized the sacroiliac joint with a percutaneous screw. The patient underwent outpatient follow-up for six months, with good progression and no intercurrences, and returned to work with minimal pain, good function, and satisfied with the treatment.
在妊娠期，耻骨联合为经阴道分娩而扩张。然而，过度增宽可能提示韧带损伤和骨盆不稳定，从而导致严重的疼痛主诉。这种罕见情况称为围产期耻骨联合分离（PPSD）。我们在此报告一例孕38周的患者，其在单胎妊娠无产科并发症经阴道分娩后，主诉腰骶部和骨盆区域剧痛，并放射至右髋部和膝部。患者有广泛水肿和外阴瘀斑，影像学检查显示耻骨联合分离7厘米，右侧骶髂关节开口。关于这些病例的治疗指征，文献存在争议，但临床和影像学表现促使我们进行手术治疗。我们用正交钢板闭合耻骨联合，并用经皮螺钉稳定骶髂关节。患者接受了为期6个月的门诊随访，病情进展良好，无并发症，恢复工作时疼痛轻微，功能良好，对治疗满意。
