developmental pelvic abnormalities
Introduction
Introduction to developmental pelvic abnormalities The front half of the pelvic inlet plane is narrow, not suitable for the connection of the fetal head occipital part, the latter half is wider, and the fetal head is easy to connect with the posterior or occipital position. The pelvis is the birth canal. The birth canal is the passage of the fetus, which plays an important role in the three major factors of childbirth. In particular, whether the size and shape of the bone canal can adapt to the fetus is the key to determining the success of childbirth. A certain line of the pelvis or a few lines Too short, abnormal pelvic shape, congenital malformation, pelvic fractures or tumors, and pelvic lesions caused by metabolic diseases can cause abnormal bone birth canal, leading to dystocia. basic knowledge The proportion of illness: 0.002% Susceptible people: women Mode of infection: non-infectious Complications: dystocia, abnormal birth dysplasia
Cause
Developmental pelvic abnormalities
First, developmental pelvic abnormalities:
The pelvis is affected by ethnic, genetic, and nutritional factors during its development. Its shape and size vary from person to person. Shapiro is divided into four types according to pelvic morphology: female, male, flat, and sputum. In fact, the pelvis that fully conforms to these four forms are rare, and most of them are mixed types.
Second, pelvic disease or injury:
1, vitamin D deficiency disease pelvis: due to insufficient supply of vitamin D in childhood or long-term not sun, the formation of vitamin D deficiency pelvis is mainly due to the patient's weight and the mechanical effects of muscle ligament on the pelvic traction, followed by Pathological changes in the development of pelvic bones are now rare.
2, osteomalacia pelvis: Vitamin D deficiency occurs in adults with osteophytes have been called osteomalacia.
3, pelvic fractures: more often after a car accident or falls.
4, pelvic tumor: rare. Pelvic chondroma, osteoma, chondrosarcoma have been reported.
Prevention
Developmental pelvic abnormality prevention
Once the diagnosis is confirmed, it should be treated early.
1, surgical indications:
The age of 2 years or older, acetabular dysplasia, acetabular angle greater than 45 °, the proportion of head lice is not suitable for acetabular can not accommodate the femoral head; after surgery or surgery, after a certain period of time, the acetabulum is still poorly developed or Undeveloped, the femoral head is still in a subluxation or total dislocation; the age of more than 7 years old, the pubic symphysis cartilage has healed, although the acetabular index does not exceed 45 ° also adapt to this procedure.
2, preoperative preparation: with Salter pelvic osteotomy.
3, surgical steps:
4, postoperative treatment:
Abduction internal rotation position single hip herringbone plaster fixation;
Folding line 14 days after surgery, and plastering after 6-8 weeks;
Walk down the ground 3-6 months after surgery.
Complication
Developmental pelvic abnormalities Complications, dystocia, abnormal birth dystocia
May be combined with dystocia, abnormal bone birth canal dystocia.
Symptom
Developmental pelvic abnormalities common symptoms stenotic pelvis male pelvic pelvic injury skewed pelvic bone birth canal abnormalities
Classified according to the pelvic stenosis plane: the pelvis can be narrowed simultaneously in one or more of the three planes of the entrance, the middle pelvis, and the exit.
1. The pelvic inlet plane is narrow: the diagonal diameter is less than 11.5 cm, and the flat pelvis is diagnosed. X-ray measurement: the anteroposterior diameter of the entrance is less than 1 lcm, and the outer diameter of the pubic symphysis measured outside the pelvis is less than 18 cm. The performance of the fetal head is blocked, can not enter the basin, the former sheep water bladder is unevenly stressed, easy to cause premature rupture of membranes, secondary uterine weakness, prolonged incubation period and active period.
2, the middle pelvic plane stenosis: the two important diameters of the middle pelvis are the ischial spine diameter and the posterior sagittal diameter. Pelvic measurement, bilateral ischial spine prominently protruded, lateral wall cohesion; X-ray measurement, ischial spine diameter less than 10cm (middle pelvic transverse diameter), posterior sagittal diameter less than 4cm, the sum of the two is less than 13.5cm. Middle pelvic stenosis Usually manifested as prolonged labor, difficulty in rotation in the fetal head, resulting in persistent posterior occipital position.
3. The pelvic outlet plane is narrow: the transverse diameter of the pelvic outlet (the diameter of the ischial tuberosity) is less than 7.5 cm and the outlet is narrow. The stenosis of the outlet can measure the sagittal diameter after the pelvic outlet, and the sum of the transverse diameter of the pelvic outlet and the sagittal diameter of the pelvic outlet is less than 15cm. If the fetus is difficult to pass the medium, the general exit is not suitable for trial production, so the fetus should be fully estimated. Fetus>; 3500g, vaginal delivery may be difficult, close observation of the progress of labor, relaxation of surgical indications.
Examine
Developmental pelvic abnormalities
First, clinical symptoms:
Appearance: thigh, calf and contralateral asymmetry (1-1, 1-2), can be expressed as thickening or shortening or thinning, external rotation (one side); hip widening (both sides).
Skin texture: increased buttocks, groin and thigh skin, asymmetry (1-3, 1-4).
Physical activity: less limb activity, most easily found when changing diapers.
Second, the signs:
The femoral artery of the affected limb is weakened or disappeared, and the adductor muscle is tense.
Barlow test positive (only for neonatal examination), because hip instability is reduced with increasing age, and abduction limitation increases with age.
The Ortolani sign or the abduction test is positive and this method is reliable. The Nelaton line is destroyed.
Third, X-ray inspection.
Diagnosis
Developmental diagnosis of developmental pelvic abnormalities
X-ray examination can be diagnosed.
Funnel-type pelvis: The diameter of the pelvic inlet plane is normal, but the middle pelvis and the exit plane are narrow, and the sides of the pelvis are inclined inward like a funnel. Pelvic measurements and diagnosis can be performed by means of CT and related means.
The entrance of the humanoid pelvis is long oval, and the anteroposterior diameter of the entrance is larger than the transverse diameter. The two sides of the pelvis are slightly cohesive, and the ischial spine is more prominent. The sciatic notch is wider, the pubic arch is narrower, and the tibia is inclined backwards, so the anterior part of the pelvis is narrower and the posterior part of the pelvis is wider. The tibia often has 6 knots, and the apes-like pelvis is deeper than other types. Women in China account for about 15%.
Spinal lesional pelvic deformity is one of the types of pelvic deformities. Also called the hunchback pelvis. Spinal lesion pelvic deformity refers to the shape of the pelvis caused by the disease of the spine, and the size is inconsistent with the normal pelvis. The pelvic deformity of the female is mainly caused by the delivery of the fetus during pregnancy and delivery, which is a cause of dystocia.
Flat pelvis: refers to the narrow entrance plane of the pelvis, shortened anteroposterior diameter, flat shape, hence the name. Due to childhood rickets, the bones are softened, the pelvis is deformed, the tendon is pressed forward and the appendix bone protrudes forward in the exit plane, and the ischial tuberosity is everted, so the transverse diameter of the outlet is widened except for the shortening of the anteroposterior diameter of the entrance. A preliminary diagnosis can be made by pelvic measurements. At the end of pregnancy or after labor, the sagittal suture of the fetal head can only be connected to the entrance.
