Research progress of pubic symphysis diastasis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Zhiguang ¹ , LI Qiang ² , LIU Rui ² , GUO Hao ^3,4 , TANG Peifu ³ ,  CHEN Hua ^1,3

1. First Clinical Medical College, Inner Mongolia Medical University, Hohhot Inner Mongolia, 010000, P. R. China;
2. Department of Orthopaedic Surgery, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot Inner Mongolia, 010000, P. R. China;
3. Department of Orthopaedic Surgery, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, P. R. China;
4. The Second Surgical Department, Beijing Municipal Corps Hospital of Chinese People’s Armed Police Force, Beijing, 100027, P. R. China;

Corresponding author：

CHEN Hua, Email: chenhua0270@126.com

Keywords：

Pubic symphysis diastasis; injury classification; pelvic fracture

DOI：

10.7507/1002-1892.202306093

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To review the research progress of pubic symphysis diastasis and provide effective reference for orthopedic surgeons in the diagnosis and treatment of pubic symphysis diastasis. Methods The anatomy, injury mechanism, treatment, and other aspects of pubic symphysis diastasis were summarized and analyzed by reviewing the relevant research literature at domestically and internationally in recent years. Results The incidence of pubic symphysis diastasis is high in pelvic fractures, which is caused by the injury of the ligaments and fibrocartilage disc around the pubic symphysis by external force. The treatment plan should be individualized according to the pelvic stability and the needs of patients, aiming to restore the stability and integrity of the pelvis and improve the quality of life of patients after surgery. Conclusion At present, the research on pubic symphysis diastasis still needs to be improved. In the future, high-quality, multi-center, and large-sample studies are of great significance for the selection of treatment methods and the evaluation of effectiveness for patients with pubic symphysis diastasis.

Citation： CHEN Zhiguang, LI Qiang, LIU Rui, GUO Hao, TANG Peifu, CHEN Hua. Research progress of pubic symphysis diastasis. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(12): 1541-1547. doi: 10.7507/1002-1892.202306093 Copy

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2.	Ghosh S, Aggarwal S, Kumar V, et al. Epidemiology of pelvic fractures in adults: Our experience at a tertiary hospital. Chin J Traumatol, 2019, 22(3): 138-141.
3.	Mi M, Kanakaris NK, Wu X, et al. Management and outcomes of open pelvic fractures: An update. Injury, 2021, 52(10): 2738-2745.
4.	Pohlemann T, Bosch U, Gänsslen A, et al. The Hannover experience in management of pelvic fractures. Clin Orthop Relat Res, 1994(305): 69-80.
5.	马坤龙, 朱磊, 方跃. 耻骨联合分离的治疗进展. 中国修复重建外科杂志, 2014, 28(2): 250-254.
6.	宫玉锁, 周君, 李盛华, 等. 耻骨联合区域相关解剖学进展及内固定治疗的生物力学特征. 中国组织工程研究, 2020, 24(27): 4371-4375.
7.	Pieroh P, Li ZL, Kawata S, et al. The arterial blood supply of the symphysis pubis-spatial orientated and highly variable. Ann Anat, 2021, 234: 151649.
8.	Hörlesberger N, Hohenberger G, Grechenig P, et al. Danger zone-the spermatic cord during anterior plating of the symphysis pubis. Injury, 2022, 53(2): 519-522.
9.	Meissner A, Fell M, Wilk R, et al. Biomechanics of the pubic symphysis. Which forces lead to mobility of the symphysis in physiological conditions? Unfallchirurg, 1996, 99(6): 415-421.
10.	石成弟, 郭晓山, 胡炜, 等. 经皮空心钉固定治疗创伤性耻骨联合分离. 中华骨科杂志, 2011, 31(11): 1218-1222.
11.	苑慧彤, 杨朝晖. “开书样”不稳定骨盆骨折的治疗进展. 实用骨科杂志, 2019, 25(9): 815-818.
12.	戚浩天. 应用Mimics软件探讨耻骨联合分离与骨盆容量改变相关性研究. 天津: 天津医科大学, 2014.
13.	胡小军, 杨伟, 郭永萍, 等. 损伤控制骨科技术治疗骨盆Tile B、C型骨折合并多发伤临床效果. 广西医科大学学报, 2020, 37(5): 939-943.
14.	Gray A, Chandler H, Sabri O. Pelvic ring injuries: classification and treatment. Pelvic and Acetabular Trauma, 2022, 36(2): 82-92.
15.	Burgess AR, Eastridge BJ, Young JW, et al. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma, 1990, 30(7): 848-856.
16.	Doro CJ, Forward DP, Kim H, et al. Does 2. 5 cm of symphyseal widening differentiate anteroposterior compression Ⅰ from anteroposterior compression Ⅱ pelvic ring injuries? J Orthop Trauma, 2010, 24(10): 610-615.
17.	Sagi HC, Coniglione FM, Stanford JH. Examination under anesthetic for occult pelvic ring instability. J Orthop Trauma, 2011, 25(9): 529-536.
18.	Wakefield SM, Giannoudis V, Messori M, et al. Atypical APC-1 pelvic fracture presenting with pelvic instability: successful management with pubic symphysis fusion. BMJ Case Rep, 2022, 15(12): e252473.
19.	李智惠, 葛江涛, 毕宝曰. 推拿复位手法治疗产后耻骨联合分离症临床效果. 深圳中西医结合杂志, 2023, 33(1): 59-62.
20.	匡乃峰, 闫平平, 陈悦霞, 等. 陈旧性耻骨联合分离综合保守治疗. 中国矫形外科杂志, 2022, 30(15): 1430-1433.
21.	王琰, 李勇强, 高伟鹏, 等. 骨盆环整体理论指导下产后耻骨联合分离的治疗效果. 中国康复理论与实践, 2021, 27(11): 1346-1350.
22.	Volpin G, Pfeifer R, Saveski J, et al. Damage control orthopaedics in polytraumatized patients-current concepts. J Clin Orthop Trauma, 2021, 12(1): 72-82.
23.	Yamamoto R, Udagawa K, Nishida Y, et al. Damage control orthopedics and decreased in-hospital mortality: A nationwide study. Injury, 2019, 50(12): 2240-2246.
24.	唐佩福, 王岩. 解放军总医院创伤骨科手术学. 北京: 人民军医出版社, 2013: 730-734.
25.	陈华, 唐佩福. 骨盆髋臼骨折微创治疗. 郑州: 河南科学技术出版社, 2016: 1-12, 101-118.
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28.	Stewart RG, Hammer N, Kieser DC. External fixation of unstable pelvic fractures: a systematic review and meta-analysis. ANZ J Surg, 2019, 89(9): 1022-1027.
29.	Chumchuen S, Lertpullpol W, Apivatgaroon A. Open technique for supra-acetabular pin placement in pelvic external fixation: a cadaveric study. J Orthop Traumatol, 2022, 23(1): 14.
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32.	武建超, 师政伟, 周建伟, 等. 骨盆前环骨折微创治疗研究进展. 中国修复重建外科杂志, 2020, 34(4): 529-535.
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35.	Liu S, Xiao B, Liu P, et al. New concealed-incision extrapelvic approach for pubic symphysis diastasis and parasymphyseal fractures: Preliminary results. J Bone Joint Surg (Am), 2020, 102(17): 1542-1550.
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38.	Sagi HC, Papp S. Comparative radiographic and clinical outcome of two-hole and multi-hole symphyseal plating. J Orthop Trauma, 2008, 22(6): 373-378.
39.	Gill JR, Murphy C, Quansah B, et al. Management of the open book APC Ⅱ pelvis: Survey results from pelvic and acetabular surgeons in the United Kingdom. J Orthop, 2017, 14(4): 530-536.
40.	Metz RM, Bledsoe JG, Moed BR. Does posterior fixation of partially unstable open-book pelvic ring injuries decrease symphyseal plate failure? A biomechanical study. J Orthop Trauma, 2018, 32 Suppl 1: S18-S24.
41.	Avilucea FR, Whiting PS, Mir H. Posterior fixation of APC-2 pelvic ring injuries decreases rates of anterior plate failure and malunion. J Bone Joint Surg (Am), 2016, 98(11): 944-951.
42.	Omid R, Trasolini NA, Stone MA, et al. Principles of locking plate fixation of proximal humerus fractures. J Am Acad Orthop Surg, 2021, 29(11): e523-e535.
43.	Kankanalu P, Orfanos G, Dwyer J, et al. Can locking plate fixation of symphyseal disruptions allow early weight bearing? Injury, 2021, 52(10): 2725-2729.
44.	Grimshaw CS, Bledsoe JG, Moed BR. Locked versus standard unlocked plating of the pubic symphysis: a cadaver biomechanical study. J Orthop Trauma, 2012, 26(7): 402-406.
45.	Moed BR, O’Boynick CP, Bledsoe JG. Locked versus standard unlocked plating of the symphysis pubis in a Type-C pelvic injury: a cadaver biomechanical study. Injury, 2014, 45(4): 748-751.
46.	Uliana CS, Nakahashi ER, Silva LHP, et al. No clinical advantage of locking over nonlocking plate fixation of symphyseal disruptions. Rev Col Bras Cir, 2021, 48: e20213122.
47.	MacAvoy MC, McClellan RT, Goodman SB, et al. Stability of open-book pelvic fractures using a new biomechanical model of single-limb stance. J Orthop Trauma, 1997, 11(8): 590-593.
48.	Zheng YQ, Chen LL, Shen JZ, et al. Biomechanical evaluation of seven fixation methods to treat pubic symphysis diastasis using finite element analysis. J Orthop Surg Res, 2022, 17(1): 189.
49.	Tseng KY, Lin KC, Yang SW. The radiographic outcome after plating for pubic symphysis diastasis: does it matter clinically? Arch Orthop Trauma Surg, 2023, 143(4): 1965-1972.
50.	Eakin JL, Grewal IS, Fene ES, et al. Percutaneous screw fixation of pubic symphysis disruption: A preliminary report. J Clin Orthop Trauma, 2022, 26: 101806.
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1. Hu S, Guo J, Zhu B, et al. Epidemiology and burden of pelvic fractures: Results from the Global Burden of Disease Study 2019. Injury, 2023, 54(2): 589-597.
2. Ghosh S, Aggarwal S, Kumar V, et al. Epidemiology of pelvic fractures in adults: Our experience at a tertiary hospital. Chin J Traumatol, 2019, 22(3): 138-141.
3. Mi M, Kanakaris NK, Wu X, et al. Management and outcomes of open pelvic fractures: An update. Injury, 2021, 52(10): 2738-2745.
4. Pohlemann T, Bosch U, Gänsslen A, et al. The Hannover experience in management of pelvic fractures. Clin Orthop Relat Res, 1994(305): 69-80.
5. 马坤龙, 朱磊, 方跃. 耻骨联合分离的治疗进展. 中国修复重建外科杂志, 2014, 28(2): 250-254.
6. 宫玉锁, 周君, 李盛华, 等. 耻骨联合区域相关解剖学进展及内固定治疗的生物力学特征. 中国组织工程研究, 2020, 24(27): 4371-4375.
7. Pieroh P, Li ZL, Kawata S, et al. The arterial blood supply of the symphysis pubis-spatial orientated and highly variable. Ann Anat, 2021, 234: 151649.
8. Hörlesberger N, Hohenberger G, Grechenig P, et al. Danger zone-the spermatic cord during anterior plating of the symphysis pubis. Injury, 2022, 53(2): 519-522.
9. Meissner A, Fell M, Wilk R, et al. Biomechanics of the pubic symphysis. Which forces lead to mobility of the symphysis in physiological conditions? Unfallchirurg, 1996, 99(6): 415-421.
10. 石成弟, 郭晓山, 胡炜, 等. 经皮空心钉固定治疗创伤性耻骨联合分离. 中华骨科杂志, 2011, 31(11): 1218-1222.
11. 苑慧彤, 杨朝晖. “开书样”不稳定骨盆骨折的治疗进展. 实用骨科杂志, 2019, 25(9): 815-818.
12. 戚浩天. 应用Mimics软件探讨耻骨联合分离与骨盆容量改变相关性研究. 天津: 天津医科大学, 2014.
13. 胡小军, 杨伟, 郭永萍, 等. 损伤控制骨科技术治疗骨盆Tile B、C型骨折合并多发伤临床效果. 广西医科大学学报, 2020, 37(5): 939-943.
14. Gray A, Chandler H, Sabri O. Pelvic ring injuries: classification and treatment. Pelvic and Acetabular Trauma, 2022, 36(2): 82-92.
15. Burgess AR, Eastridge BJ, Young JW, et al. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma, 1990, 30(7): 848-856.
16. Doro CJ, Forward DP, Kim H, et al. Does 2. 5 cm of symphyseal widening differentiate anteroposterior compression Ⅰ from anteroposterior compression Ⅱ pelvic ring injuries? J Orthop Trauma, 2010, 24(10): 610-615.
17. Sagi HC, Coniglione FM, Stanford JH. Examination under anesthetic for occult pelvic ring instability. J Orthop Trauma, 2011, 25(9): 529-536.
18. Wakefield SM, Giannoudis V, Messori M, et al. Atypical APC-1 pelvic fracture presenting with pelvic instability: successful management with pubic symphysis fusion. BMJ Case Rep, 2022, 15(12): e252473.
19. 李智惠, 葛江涛, 毕宝曰. 推拿复位手法治疗产后耻骨联合分离症临床效果. 深圳中西医结合杂志, 2023, 33(1): 59-62.
20. 匡乃峰, 闫平平, 陈悦霞, 等. 陈旧性耻骨联合分离综合保守治疗. 中国矫形外科杂志, 2022, 30(15): 1430-1433.
21. 王琰, 李勇强, 高伟鹏, 等. 骨盆环整体理论指导下产后耻骨联合分离的治疗效果. 中国康复理论与实践, 2021, 27(11): 1346-1350.
22. Volpin G, Pfeifer R, Saveski J, et al. Damage control orthopaedics in polytraumatized patients-current concepts. J Clin Orthop Trauma, 2021, 12(1): 72-82.
23. Yamamoto R, Udagawa K, Nishida Y, et al. Damage control orthopedics and decreased in-hospital mortality: A nationwide study. Injury, 2019, 50(12): 2240-2246.
24. 唐佩福, 王岩. 解放军总医院创伤骨科手术学. 北京: 人民军医出版社, 2013: 730-734.
25. 陈华, 唐佩福. 骨盆髋臼骨折微创治疗. 郑州: 河南科学技术出版社, 2016: 1-12, 101-118.
26. 夏羿凡, 陈路, 朱天亮, 等. 三种外固定置钉方法治疗骨盆骨折. 中国矫形外科杂志, 2017, 25(10): 879-883.
27. Chu X, Strage KE, Hadeed M, et al. Comparison of iliac crest versus supraacetabular external fixator in hemodynamically unstable patients with a pelvic ring injury. Int Orthop, 2021, 45(8): 2121-2127.
28. Stewart RG, Hammer N, Kieser DC. External fixation of unstable pelvic fractures: a systematic review and meta-analysis. ANZ J Surg, 2019, 89(9): 1022-1027.
29. Chumchuen S, Lertpullpol W, Apivatgaroon A. Open technique for supra-acetabular pin placement in pelvic external fixation: a cadaveric study. J Orthop Traumatol, 2022, 23(1): 14.
30. Cuervas-Mons M, Sánchez-Pérez C, Arnal-Burró J, et al. Ultrasound-guided supra-acetabular pelvic external fixator (US-SA FIX). Injury, 2019, 50 Suppl 1: S24-S29.
31. 唐成, 梁斌, 姚庆强, 等. 个体化经髂嵴植钉导板在骨盆外固定架深部植钉中的应用. 中国修复重建外科杂志, 2019, 33(9): 1133-1140.
32. 武建超, 师政伟, 周建伟, 等. 骨盆前环骨折微创治疗研究进展. 中国修复重建外科杂志, 2020, 34(4): 529-535.
33. 中华医学会骨科学分会创伤骨科学组, 中华医学会骨科学分会外固定与肢体重建学组, 中华医学会创伤学分会, 等. 中国骨盆骨折微创手术治疗指南(2021). 中华创伤骨科杂志, 2021, 23(1): 4-14.
34. Park MS, Yoon SJ, Choi SM, et al. Is there a clinical benefit of additional tension band wiring in plate fixation of the symphysis? BMC Musculoskelet Disord, 2017, 18(1): 40. doi: 10.1186/s12891-017-1418-3.
35. Liu S, Xiao B, Liu P, et al. New concealed-incision extrapelvic approach for pubic symphysis diastasis and parasymphyseal fractures: Preliminary results. J Bone Joint Surg (Am), 2020, 102(17): 1542-1550.
36. Rojas C, Ewertz E, Hormazábal JM. Fixation failure in patients with traumatic diastasis of pubic symphysis: impact of loss of reduction on early functional outcomes. J Orthop Surg Res, 2021, 16(1): 661.
37. Lange RH, Hansen ST Jr. Pelvic ring disruptions with symphysis pubis diastasis. Indications, technique, and limitations of anterior internal fixation. Clin Orthop Relat Res, 1985, (201): 130-137.
38. Sagi HC, Papp S. Comparative radiographic and clinical outcome of two-hole and multi-hole symphyseal plating. J Orthop Trauma, 2008, 22(6): 373-378.
39. Gill JR, Murphy C, Quansah B, et al. Management of the open book APC Ⅱ pelvis: Survey results from pelvic and acetabular surgeons in the United Kingdom. J Orthop, 2017, 14(4): 530-536.
40. Metz RM, Bledsoe JG, Moed BR. Does posterior fixation of partially unstable open-book pelvic ring injuries decrease symphyseal plate failure? A biomechanical study. J Orthop Trauma, 2018, 32 Suppl 1: S18-S24.
41. Avilucea FR, Whiting PS, Mir H. Posterior fixation of APC-2 pelvic ring injuries decreases rates of anterior plate failure and malunion. J Bone Joint Surg (Am), 2016, 98(11): 944-951.
42. Omid R, Trasolini NA, Stone MA, et al. Principles of locking plate fixation of proximal humerus fractures. J Am Acad Orthop Surg, 2021, 29(11): e523-e535.
43. Kankanalu P, Orfanos G, Dwyer J, et al. Can locking plate fixation of symphyseal disruptions allow early weight bearing? Injury, 2021, 52(10): 2725-2729.
44. Grimshaw CS, Bledsoe JG, Moed BR. Locked versus standard unlocked plating of the pubic symphysis: a cadaver biomechanical study. J Orthop Trauma, 2012, 26(7): 402-406.
45. Moed BR, O’Boynick CP, Bledsoe JG. Locked versus standard unlocked plating of the symphysis pubis in a Type-C pelvic injury: a cadaver biomechanical study. Injury, 2014, 45(4): 748-751.
46. Uliana CS, Nakahashi ER, Silva LHP, et al. No clinical advantage of locking over nonlocking plate fixation of symphyseal disruptions. Rev Col Bras Cir, 2021, 48: e20213122.
47. MacAvoy MC, McClellan RT, Goodman SB, et al. Stability of open-book pelvic fractures using a new biomechanical model of single-limb stance. J Orthop Trauma, 1997, 11(8): 590-593.
48. Zheng YQ, Chen LL, Shen JZ, et al. Biomechanical evaluation of seven fixation methods to treat pubic symphysis diastasis using finite element analysis. J Orthop Surg Res, 2022, 17(1): 189.
49. Tseng KY, Lin KC, Yang SW. The radiographic outcome after plating for pubic symphysis diastasis: does it matter clinically? Arch Orthop Trauma Surg, 2023, 143(4): 1965-1972.
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Chinese Journal of Reparative and Reconstructive Surgery

Research progress of pubic symphysis diastasis

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