Traumatology and Orthopedics of RussiaTraumatology and Orthopedics of RussiaТравматология и ортопедия России2311-29052542-0933Vreden National Medical Research Center of Traumatology and Orthopedics105410.21823/2311-2905-2018-24-3-145-156ReviewsОбзорыReviewsPUBIC SYMPHYSIS DIASTASIS IN PREGNANCY AND DELIVERY (REVIEW)РАСХОЖДЕНИЕ ЛОННОГО СОЧЛЕНЕНИЯ ПРИ БЕРЕМЕННОСТИ И РОДАХ (ОБЗОР ЛИТЕРАТУРЫ)PetrushinA. L.ПетрушинА. Л.
Russian Federation

Alexander L. Petrushin — Cand. Sci. (Med.), head of the Surgical Department.

47, ul. Lenina, 164600, Karpogory, Archangelsk Oblast.

Петрушин Александр Леонидович — канд. мед. наук, заведующий хирургическим отделением.

Ул. Ленина, д. 47, 164600, п. Карпогоры, Архангельская обл.

PryaluchinaA. V.ПрялухинаА. В.
Russian Federation

Anastasia V. Pryaluchina — obstetrician-gynecologist.

47, ul. Lenina, 164600, Karpogory, Archangelsk Oblast.

Прялухина Анастасия Владимировна — врач акушер-гинеколог.

Ул. Ленина, д. 47, 164600, п. Карпогоры, Архангельская обл.

Karpogorsky Central District Hospital .ГБУЗ АО «Карпогорская центральная районная больница».071020182431451560710201807102018https://journal.rniito.org/jour/article/view/1054

Purpose of the study — to generalize and arrange the data published in scientific literature and to present current views on epidemiology, diagnostics and treatment options for pubic symphysis diastasis during pregnancy and delivery.

 Semeiotic separation wider than 10 mm is considered pubic symphysis diastasis during pregnancy and delivery. Diastasis above 14-25 mm might be associated with ruptures of sacroiliac joints. Frequency of such pathology is reported in the range from 0,03 to 2,8%. Key risk factors of this pathology include multiparity and repeated labor. Symptoms of pubic separation include pain and signs of pelvic instability manifesting immediately after delivery or within a short period of time after the delivery. AP roentgenography is the principal diagnostics method however lately ultrasound exam is done more frequently. Conservative option prevails in treatment of pubic symphysis diastasis. Surgical procedures are recommended in case of separation above 30-50 mm, ruptures of sacroiliac joints, open lesions, failed conservative treatment and urological dysfunction. In such cases preferred option is the internal fixation by plate and screws. Some authors use external fixation. Late-term outcomes of both methods do not demonstrate significant differences.

 Pain regress after the surgery is observed within 3 weeks to 6 months postoperatively, walking with partial load is restored in 5-14 days, full load on the lower limbs is possible 6 months postoperatively. Indications for removal of implants after internal fixation are not clearly defined. Following surgical treatment of pubic symphysis diastasis the majority of authors incline to subsequent operative delivery.

Цель исследования — обобщить и систематизировать опубликованную в научной литературе информацию и  представить современные взгляды на эпидемиологию, диагностику и лечебную тактику при расхождении лонного сочленения во время беременности и родов.

Расхождением лонного сочленения во время беременности и родов считается наличие симптомного диас­ таза шириной более 10 мм. Диастаз шириной более 14–25 мм может сочетаться с разрывами крестцово-под-вздошных сочленений. Распространенность этой патологии составляет от 0,03 до 2,8%. Среди основных фак-торов риска отмечают многоплодные и повторные роды. Симптоматика лонных расхождений складывается из болевого синдрома и признаков нестабильности таза, появляющихся сразу после родов или через корот-кий промежуток времени. Основным методом диагностики является рентгенография в прямой проекции, однако все чаще используется УЗИ. Лечение расхождений лонного сочленения в основном консервативное. Оперативное лечение лонных расхождений показано при ширине диастаза более 30–50 мм, наличии раз-рывов крестцово-подвздошных сочленений, открытых повреждений, отсутствии эффекта от консервативной терапии, наличии урологических расстройств. Предпочтение отдается внутренней фиксации с использовани-ем пластин и винтов. Ряд авторов используют наружную фиксацию, отдаленные результаты использования этих методов значительно не отличаются. Регресс болевого синдрома после операции происходит в сроки от 3 нед. до 6 мес., ходьба с частичной нагрузкой восстанавливается через 5–14 дней, полная нагрузка на ноги возможна через 6 мес. Показания к удалению имплантатов после внутренней фиксации четко не опре-делены. После оперативного лечения расхождения лонного сочленения большинство авторов склоняются к последующим оперативным родам.

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