耻骨联合分离.ppt

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1、APX-RAYDEMONSTRATINGAPCTYPE2SYMPHYSEALSEPARATIONINLETVIEWDEMONSTRATINGSEPARATIONOFTHESYMPHYSISOUTLETVIEWThepatientisprepped,suchthatthesymphysisisexposedinferiorly,theumbilicussuperiorlyandtheASISlaterally.Theincisionbeginstwofingerbreadthsabovethesymphysispubi

2、s.Theincisionbeginstwofingerbreadthsabovethesymphysispubis.Frequently,oneoftherectusheadsisavulsedfromoneofthesymphysealbodies.Occasionallythereisasplitintherectusfascia.RECTUSMUSCLEGelpiretractorsareplacedatthewoundedgestohelpidentifyScarpa’sfasciaandthentheex

3、ternalobliqueandrectusfascia.Thesofttissueiselevatedsuperiorlyandinferiorlyfromtheexternalobliqueandrectusfasciawiththeknifeheldessentiallyparallelwiththebody.EXTERNALOBLIQUEFASCIAThesofttissueiselevatedsuperiorlyandinferiorlyfromtheexternalobliqueandrectusfasc

4、iawiththeknifeheldessentiallyparallelwiththebody.Thelineaalbaiseasilyidentifiedbyobservingtheconfluenceofthefibersoftheexternalobliqueinthemidline.FOOTHEADThedottedlineisplacedonthelineaalba;thefasciabetweenthetworectusmusclesisdividedsharplybutonlythroughthefa

5、scia.HEADFOOTFOOTBluntdissectionbetweentherectusmuscleisperformed,allowingprotectionoftheperitoneumproximally,andbladderandbladderneckdistally.RECTUSMUSCLEHEADHEADFOOTTherectusisthendividedwithaBoviontopofthedigit.RECTUSMUSCLEHEADFOOTBLADDEROncetherectusissplit

6、,abluntretractorcanbeplaced,eventuallyholdingbackthebladder.Inthisfigure,thebladderregionisvisualizedjustproximaltothesymphysealregionunderneaththerectus.FOOTRECTUSByliftingtherectussuperiorlywiththefinger,aHohmannretractorcanbeplacedthroughtheperiosteumatthesu

7、periorandproximaledgeofthesuperiorramusjustlateraltothesymphysealbody.HEADFOOTHEADRECTUSThisisusedtoretracttherectuslaterally.Withtherectusbeingheldlaterally,abovicanbeusedtocleanthesuperiorsurfaceofthesuperiorramusintheareainwhichtheplatewillbeplaced.SUPERIORR

8、AMUSFOOTHEADSYMPHYSEALBODYRECTUSWiththelegsheldtogetherandtheretractorsinplace,thesymphysealseparationisalreadypartlyreduced.Thesuckeriswithinthesymphysealseparation.FOOTHEA