耻骨联合分离.ppt

关于耻骨联合分离 第1页，共36页，编辑于2022年，星期一 AP X-RAY DEMONSTRATING APC TYPE 2 SYMPHYSEAL SEPARATION 第2页，共36页，编辑于2022年，星期一 INLET VIEW DEMONSTRATING SEPARATION OF THE SYMPHYSIS 第3页，共36页，编辑于2022年，星期一 OUTLET VIEW 第4页，共36页，编辑于2022年，星期一 The patient is prepped, such that the symphysis is exposed inferiorly, the umbilicus superiorly and the ASIS laterally. 第5页，共36页，编辑于2022年，星期一 The incision begins two finger breadths above the symphysis pubis. 第6页，共36页，编辑于2022年，星期一 The incision begins two finger breadths above the symphysis pubis. 第7页，共36页，编辑于2022年，星期一 Frequently, one of the rectus heads is avulsed from one of the symphyseal bodies. Occasionally there is a split in the rectus fascia. RECTUS MUSCLE 第8页，共36页，编辑于2022年，星期一 Gelpi retractors are placed at the wound edges to help identify Scarpa’s fascia and then the external oblique and rectus fascia. 第9页，共36页，编辑于2022年，星期一 The soft tissue is elevated superiorly and inferiorly from the external oblique and rectus fascia with the knife held essentially parallel with the body. EXTERNAL OBLIQUE FASCIA 第10页，共36页，编辑于2022年，星期一 The soft tissue is elevated superiorly and inferiorly from the external oblique and rectus fascia with the knife held essentially parallel with the body. 第11页，共36页，编辑于2022年，星期一 The linea alba is easily identified by observing the confluence of the fibers of the external oblique in the midline. FOOT HEAD 第12页，共36页，编辑于2022年，星期一 The dotted line is placed on the linea alba; the fascia between the two rectus muscles is divided sharply but only through the fascia. HEAD FOOT 第13页，共36页，编辑于2022年，星期一 FOOT Blunt dissection between the rectus muscle is performed, allowing protection of the peritoneum proximally, and bladder and bladder neck distally. RECTUS MUSCLE HEAD 第14页，共36页，编辑于2022年，星期一 HEAD FOOT The rectus is then divided with a Bovi on top of the digit. RECTUS MUSCLE 第15页，共36页，编辑于2022年，星期一 HEAD FOOT BLADDER Once the rectus is split, a blunt retractor can be placed, eventually holding back the bladder. In this figure