围产期耻骨联合分离的诊断与治疗

目的：研究围产期耻骨联合分离发生的特点、发病原因、早期诊断、治疗技术和预防要点。方法对2005年1月到2012年12月治疗的31例围产期耻骨联合分离患者的临床和随访资料进行回顾性分析。结果31例患者中2例手术治疗，29例保守治疗，均随访4～6个月，平均4．5个月。患者局部症状均好转或消失，耻骨联合处无压痛，骨盆挤压分离试验阴性，产后1．5个月时分离距离和局部疼痛程度都恢复至正常水平，与治疗前相比具有显著性差异（ t值分别为1．975、2．376，均P＜0．05）。结论产前发生耻骨联合分离且胎儿较大者应首选剖宫产，以避免加重耻骨联合分离。产后型可根据临床表现及拍片检查早期诊断，积极保守治疗可获得满意效果，对于耻骨联合分离合并骶髂韧带损伤的不稳定性重度患者内固定治疗可及早进行。

Diagnosis and treatment of perinatal pubic symphysis separation

Objective To study the characteristics , pathogenesis , early diagnosis , treatment and prevention of perinatal pubic symphysis separation （PPSS）.Methods Retrospective analysis was conducted on the clinical and follow-up information of 31 patients with PPSS treated in the period of January 2005 to December 2012.Results There were 2 cases undergoing operation of internal fixation , and the other 29 received conservative treatment .They were followed up after discharge for 4-6 months with average period of 4.5 months.Local symptoms relieved or disappeared , and there was no tenderness pain .Pelvic compression and separation test were negative .The separation distance and local pain degree recovered to normal 1.5 months after delivery, which were significantly different from preoperative condition （t value was 1.975 and 2.376, respectively, both P〈0.05）.Conclusion Prenatal occurrence of pubic symphysis separation with large fetus should choose cesarean section to avoid the aggravation of separation of symphysis pubis .Postpartum type can be diagnosed early according to clinical manifestations and X-ray examination , and active conservative treatment can obtain satisfactory effect .For patients with pubic symphysis separation combined with sacroiliac ligament injury , internal fixation can be carried out as soon as possible .