《耻骨联合分离》PPT课件

《《耻骨联合分离》PPT课件》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、APX-RAYDEMONSTRATINGAPCTYPE2SYMPHYSEALSEPARATIONINLETVIEWDEMONSTRATINGSEPARATIONOFTHESYMPHYSISOUTLETVIEWThepatientisprepped,suchthatthesymphysisisexposedinferiorly,theumbilicussuperiorlyandtheASISlaterally.Theincisionbeginstwofingerbreadthsabovethesymphysispubis.Theinci

2、sionbeginstwofingerbreadthsabovethesymphysispubis.Frequently,oneoftherectusheadsisavulsedfromoneofthesymphysealbodies.Occasionallythereisasplitintherectusfascia.RECTUSMUSCLEGelpiretractorsareplacedatthewoundedgestohelpidentifyScarpa’sfasciaandthentheexternalobliqueandre

3、ctusfascia.Thesofttissueiselevatedsuperiorlyandinferiorlyfromtheexternalobliqueandrectusfasciawiththeknifeheldessentiallyparallelwiththebody.EXTERNALOBLIQUEFASCIAThesofttissueiselevatedsuperiorlyandinferiorlyfromtheexternalobliqueandrectusfasciawiththeknifeheldessential

4、lyparallelwiththebody.Thelineaalbaiseasilyidentifiedbyobservingtheconfluenceofthefibersoftheexternalobliqueinthemidline.FOOTHEADThedottedlineisplacedonthelineaalba;thefasciabetweenthetworectusmusclesisdividedsharplybutonlythroughthefascia.HEADFOOTFOOTBluntdissectionbetw

5、eentherectusmuscleisperformed,allowingprotectionoftheperitoneumproximally,andbladderandbladderneckdistally.RECTUSMUSCLEHEADHEADFOOTTherectusisthendividedwithaBoviontopofthedigit.RECTUSMUSCLEHEADFOOTBLADDEROncetherectusissplit,abluntretractorcanbeplaced,eventuallyholding

6、backthebladder.Inthisfigure,thebladderregionisvisualizedjustproximaltothesymphysealregionunderneaththerectus.FOOTRECTUSByliftingtherectussuperiorlywiththefinger,aHohmannretractorcanbeplacedthroughtheperiosteumatthesuperiorandproximaledgeofthesuperiorramusjustlateraltoth

7、esymphysealbody.HEADFOOTHEADRECTUSThisisusedtoretracttherectuslaterally.Withtherectusbeingheldlaterally,abovicanbeusedtocleanthesuperiorsurfaceofthesuperiorramusintheareainwhichtheplatewillbeplaced.SUPERIORRAMUSFOOTHEADSYMPHYSEALBODYRECTUSWiththelegsheldtogetherandthere

8、tractorsinplace,thesymphysealseparationisalreadypartlyreduced.Thesuckeriswithinthesymphysealseparation.FOOTHEA