Tratamiento de la diástasis de rectos asociada a hernias de línea media vía TESuR (Trans-umbilical Endoscopic Sublay Repair) / Management of diastasis recti associated with midline hernias using TESuR (Trans-umbilical Endoscopic Sublay Repair)

RESUMEN Antecedentes: Las hernias de línea media asociadas a diástasis de los músculos rectos anteriores (DRA) son frecuentes y se ha propuesto el tratamiento de ambas patologías simultáneamente para reducir la recurrencia. Las técnicas mínimamente invasivas permiten el tratamiento adecuado con reducción de complicaciones asociadas a la herida quirúrgica; sin embargo, aún no hay consenso acerca de cuál es la mejor técnica. Objetivo: Evaluar los resultados posoperatorios a corto y mediano plazo de una serie de pacientes con defectos de línea media y DRA tratados con la técnica Trans-umbilical Endoscopic Sublay Repair (TESuR). Material y método: Se realizó un estudio observacional descriptivo retrospectivo de pacientes a quienes se les aplicó técnica TESuR entre diciembre de 2020 y marzo de 2023, con un seguimiento posoperatorio mínimo de 6 meses. Se analizaron variables demográficas y perioperatorias. Resultados: En el período de estudio se realizaron 24 reparaciones. Todos los pacientes fueron varones. La edad promedio fue de 57 años (rango 41-81) y el índice de masa corporal (IMC) de 28,9 (21,7- 36,1) kg/m². El área del defecto fue de 8,8 (4-25) cm2, con una DRA de 5,1 (3-9) cm. La tasa de complicaciones a 30 días posoperatorios alcanzó el 17% (4/24); todas fueron Clavien-Dindo I. Con un promedio de seguimiento de 18,6 meses (rango 6-25) no se detectaron recidivas herniarias, aunque dos pacientes (8%) presentaron recidiva de la DRA. Conclusiones: La técnica TESuR presentó una baja morbilidad sin recidivas, por lo que la consideramos una alternativa segura y eficaz para el tratamiento de la DRA asociada a defectos de la línea media.

ABSTRACT Background: Midline hernias associated with diastasis recti abdominis (DRA) are common. Simultaneous treatment of both conditions has been recommended to reduce recurrence. Minimally invasive techniques allow adequate treatment while reducing surgical site complications. However, there is still no consensus regarding the optimal technique. Objective: The aim of this study was to evaluate the short and mid-term outcomes of Trans-umbilical Endoscopic Sublay Repair (TESuR) in patients with midline defects and DRA. Material and methods: We conducted a retrospective descriptive observational study of patients undergoing TESuR between December 2020 and May 2023, with a minimum postoperative follow-up of 6 months. The demographic and perioperative variables were analyzed. Results: A total of 24 procedures were performed during the study period. All the patients were men. Mean age was 57 years (range 41-81) and body mass index (BMI) was 28.9 (21.7- 36.1) kg/m². Mean size of the defect was 8.8 cm2 (4-25) with a mean diastasis width of 5 cm (3-9). The rate of complications at 30 days was 17% (4/24) and were all are grade 1 of the Clavien-Dindo classification. After a mean follow-up of 18.6 months (range 6-25), there were no hernia recurrences, although 2 patients (8%) had a recurrence of DRA. Conclusions: TESuR showed low morbidity rate and absence of recurrences, constituting a safe and effective option for the management of DRA associated with midline defects.

Minimally invasive lipoabdominoplasty (MILA) tactic / Lipoabdominoplastia minimamente invasiva - Tática MILA

ABSTRACT While diastasis recti (DR) was long neglected by general surgeons, plastic surgeons considered conventional abdominoplasty as the only repair option. However, this scenario has changed recently, either due to a better understanding of the correlation between DR and abdominal wall function and greater risk of recurrence in abdominal hernia repairs, or due to the development of new minimally invasive techniques for repairing DR. One of these surgical procedures consists of the concept of an abdominoplasty, that is, supra-aponeurotic dissection and plication of the DR (with or without abdominal hernia) but performed through three small supra-pubic incisions by laparoscopy or robotic approach. More recently, this procedure has gained new stages. Liposuction and skin retraction technology have been associated with MIS plication of DR, which increases the indications for the technique and potentially improves results. For the first time in the literature, we describe these steps and the synergy between them.

RESUMO Embora a diástase de reto abdominal (DR) tenha sido negligenciada por muito tempo pelos cirurgiões gerais, os cirurgiões plásticos consideravam a abdominoplastia convencional como a única opção de reparo. No entanto, esse cenário mudou recentemente, seja pelo melhor entendimento da correlação entre DR e a função da parede abdominal e o maior risco de recorrência na correção de hérnias abdominais, seja pelo desenvolvimento de novas técnicas minimamente invasivas (MIS) para reparo da DR. Um desses procedimentos cirúrgicos consiste no conceito de abdominoplastia, ou seja, dissecção supra-aponeurótica e plicatura da DR (com ou sem hérnia abdominal), mas realizada através de três pequenas incisões suprapúbicas por laparoscopia ou abordagem robótica. Mais recentemente, esse procedimento ganhou novas etapas. A lipoaspiração e a tecnologia de retração da pele têm sido associadas à plicatura MIS da DR, o que aumenta as indicações da técnica e potencialmente melhora os resultados. Pela primeira vez na literatura, descrevemos essas etapas e a sinergia entre elas.

Reparacion endoscopica preaponeurotica (repa) una alternativa en la diastasis de rectos abdominales / Pre-aponeurotic endoscopic repair (r.e.p.a.): an alternative in diastasis recti abdominis

La diástasis de recto abdominales (DR) es la disyunción de sus bordes internos. Nuestro objetivo es exponer una serie de casos intervenidos quirúrgicamente con la técnica R.E.P.A. en el tratamiento de la diástasis de rectos asociado a defectos de la línea media. Es un estudio prospectivo observacional intervencionista, de abril 2018 a diciembre 2019, se operaron 15 paciente 73% mujeres y 27% varones, edad media 48 años, el diagnóstico de ingreso frecuente fue DR primaria 9 pacientes (60%), la medición ecográfica de DR fue <59mm con 10 casos (66,6%). El tiempo quirúrgico promedio fue 130 min, 1 conversión a cirugía abierta, la estancia hospitalaria fue 1,5 días y los eventos locales postoperatorios fueron 2 casos de seroma (50%). En conclusión, R.E.P.A. es factible y segura de realizar, no requiere muchos insumos, permite instalar material protésico, cumple los beneficios de la cirugía videoendoscopica, es una técnica endoscópica básica y la curva de aprendizaje no es dificultosa.

Diastasis rectus abdominis (RD) is the disjunction of inner edges. Our objective is to present a series of cases surgically operated employing R.E.P.A. technique in the treatment of rectal diastasis associated to midline defects. A prospective observational interventional study, from April 2018 to December 2019 was conducted. 15 patients (73% women and 27% men) with a mean age of 48 years were operated, the diagnosis of frequent admission was primary RD (n=9, 60%), the ultrasound measurement of RD was <59mm (10 cases, 66.6%). The mean surgical time was 130 min, 1 conversion to open surgery, hospital staying was 1.5 days and local postoperative events were 2 cases of seroma (50%). In conclusion, R.E.P.A. is feasible and safe to perform, does not require many supplies, allows to install prosthetic material, meets the benefits of video endoscopic surgery, it is a basic endoscopic technique and the learning curve is not difficult.

Embarazo y ortopedia / Pregnancy and Orthopaedics

Introducción: Son múltiples las afecciones ortopédicas que sufre una mujer embarazada, por ello las demandas de atención por esta causa van en ascenso. Objetivo: Actualizar el tratamiento de las lesiones traumáticas y ortopédicas en la paciente embarazada y coordinar las indicaciones de la cesárea. Métodos: Se utilizan métodos teóricos y empíricos para realizar análisis del conocimiento actualizado sobre estas. Resultados: Se determinó que el parto normal es posible después de una fractura pélvica, siempre que no existan secuelas que dañen el canal del parto. El dolor de espalda fue un síntoma común en las mujeres embarazadas, pero en las que presentaron escoliosis las molestias fueron más frecuentes. La diastasis de la sínfisis del pubis se asoció con la maniobra de McRoberts; y la indicación de cesárea se sugirió a partir de criterios puramente obstétricos, aunque se respetaron las afecciones ortopédicas y traumáticas presentes en las pacientes. Conclusiones: Incrementar los conocimientos del personal que trabaja con la embarazada, a partir de sus factores de riesgo y las posibilidades de mitigación de daño por estas causas.

Introduction: pregnant women suffer from multiple orthopaedic conditions; therefore, care demands for this cause are on the rise. Objective: to update the treatment of traumatic and orthopaedic injuries in pregnant patients and coordinate the indications for cesarean section. Methods: theoretical and empirical methods were used to carry out the analysis of updated knowledge regarding these affections. Results: we determined that normal delivery is possible after a pelvic fracture, as long as there are no sequelae that damage the birth canal. Back pain was a common symptom in pregnant women but in those with scoliosis the discomfort was more frequent. Symphysis pubis diastasis was associated with the McRobert's maneuver; and the indication for cesarean section was suggested based on purely obstetric criteria, although the orthopaedic and traumatic conditions present in the patients were respected. Conclusions: to increase the knowledge of the personnel, who work with the pregnant women, based on their risk factors and the possibilities of mitigating damage due to these causes.

Asociación entre distancia de los bordes mediales del recto abdominal y dolor lumbar en estudiantes universitarios

Introducción: El dolor lumbar crónico en los universitarios oscila entre un 12,4 y 75 %. Se evidenció inicialmente que la alteración de la musculatura del recto abdominal puede estar asociada al dolor lumbar. Objetivo: Evaluar la asociación entre la distancia de los bordes mediales del músculo recto abdominal y la presencia de dolor lumbar. Métodos: Se realizó un estudio de casos y controles en estudiantes de una universidad privada de la ciudad de Lima. Se valoraron el dolor lumbar y la distancia entre los bordes mediales del músculo recto abdominal mediante la escala numérica de dolor, índice cintura cadera, el cuestionario nórdico y la escala de Oswestry. Se midió la distancia los bordes mediales del músculo recto abdominal con un Caliper digital. Resultados: La media y desviación estándar de la distancia de los bordes mediales del músculo recto abdominal fue 21,9 ± 3,5. Esta y la diástasis abdominal se asociaron con el dolor lumbar. Conclusiones: Se demostró que la distancia de los rectos abdominales y el dolor lumbar en los estudiantes universitarios guardan relación.

Introduction: Chronic low back pain in university students ranges between 12.4 and 75 %. It was initially evidenced that the alteration of the musculature of the rectus abdominis may be associated with low back pain. Objective: To evaluate the association between the distance from the medial edges of the rectus abdominis muscle and the presence of low back pain. Methods: A case-control study was conducted in students of a private university in the city of Lima. Low back pain and the distance between the medial edges of the rectus abdominis muscle were assessed using the numerical pain scale, the waist-hip index, the Nordic questionnaire and the Oswestry scale. The distance between the medial edges of the rectus abdominis muscle was measured with a digital Caliper. Results: The mean and standard deviation of the distance from the rectus abdominis was 21.9 ± 3.5. This and abdominal diastasis were associated with low back pain. Conclusions: The distance between the medial edges of the rectus abdominis muscle and low back pain in university students was shown to be related.

Application evaluation of interactive group management in puerpera with diastasis recti abdominis / 中国实用护理杂志

Objective:To explore the application effect of interactive group management mode in puerpera with postpartum diastasis recti abdominis, and to provide reference for optimizing the health management of puerpera with rectus abdominis separation.Methods:This study was a randomized controlled trial. Convenience sampling method was used to select 114 puerpera with postpartum diastasis recti abdominis who were treated in Maternal and Child Health Hospital of Zhenjiang City from January to June 2022 as the research objects. According to the random number table method, the postpartum women were divided into an intervention group and a control group with 57 cases each. The intervention group received interactive group management for 12 weeks, while the control group received routine health guidance. Before and after the intervention, the two groups were evaluated by diastasis recti abdominis, rehabilitation knowledge-attitude-practice, general self-efficacy, and the duration of the first-level test results of the eight-level abdominal bridge.Results:The 55 cases were included in the final intervention group, while 56 cases were included in the control group. After intervention, the separation distance of rectus abdominis of the intervention group was (2.27 ± 0.47) cm, and that of the control group was (2.48 ± 0.39) cm. The difference between the two groups was statistically significant ( t = 2.53, P<0.05). The knowledge-attitude-practice total score and each item score of diastasis recti abdominis rehabilitation in the intervention group were (106.84 ± 5.78), (61.53 ± 4.29), (25.42 ± 2.26), (19.89 ± 1.89) points respectively while in the control group were (73.77 ± 8.33), (38.48 ± 7.56), (20.73 ± 3.07), (13.55 ± 1.99) points. The differences between the two groups were statistically significant ( t values were 9.16 -24.28, all P<0.01). The general self-efficacy score of the intervention group was (27.47 ± 3.16) points, and that of the control group was (26.05 ± 3.43) points. The difference between the two groups was statistically significant ( t = 2.26, P<0.05). The first-level test time of eight-level abdominal bridge in the intervention group was (80.29 ± 11.50) s, which was significantly higher than (29.39 ± 6.09) s in the control group, and the difference was statistically significant ( t = 29.20, P<0.01). The completion rate of exercise in the intervention group was (90.20 ± 1.83)%. Higher than (69.52 ± 8.04)% in the control group, with a statistically significant difference ( t = 13.73, P<0.01). Conclusions:Interactive group management can significantly ameliorate the separation distance of diastasis recti abdominis, increase the level of knowledge-attitude-practice of diastasis recti abdominis rehabilitation and the compliance of rehabilitation exercise, improve the self-efficacy, prolong the first-level test time of eight-level abdominal bridge, and improve the abdominal core muscle strength for puerpera.

The pubic symphysis orthotic compression anatomic plate for treatment of fractures and dislocations around the pubic symphysis / 中华创伤骨科杂志

Objective:To evaluate our self-designed pubic symphysis orthotic compression anatomic plate (PSOCAP) in the treatment of fractures and dislocations around the pubic symphysis.Methods:A retrospective study was conducted to analyze the 16 patients with fracture or dislocation around the pubic symphysis who had been treated by our self-designed PSOCAP at Department of Traumatic Surgery, Center for Orthopaedic Surgery, The Third Hospital Affiliated to Southern Medical University from January 2021 to June 2022. There were 8 males and 8 females with an age of (41±19) years. According to the Tile classification for pelvic fractures, there were 3 cases of type B1, 2 cases of type B3, 1 case of type C1.2, 4 cases of type C1.3, 3 cases of type C2, and 3 cases of type C3. There were 8 cases of pubic symphysis separation and 8 fractures of the pubic ramus (2 ones at Nakatani zone Ⅰ and 6 ones at Nakatani zone Ⅱ). Time from injury to surgery was 16 (11, 53) days, ranging from 4 to 348 days. The fractures or dislocations around the pubic symphysis were exposed by the modified Stoppa approach, reduced with the assistance of PSOCAP and fixated with PSOCAP; the posterior pelvic ring was reduced and fixated by corresponding surgical methods. Recorded were the surgical time, intraoperative bleeding, postoperative quality of fracture reduction, surgical complications, and functional recovery at the last follow-up concerning the pelvic anterior ring.Results:Surgery went on successfully in the 16 patients. Their surgical time was (58±15) min, ranging from 40 to 90 min, and their intraoperative bleeding 85 (63, 150) mL, ranging from 50 to 250 mL. According to the Matta scoring, the fracture reduction was evaluated as excellent in 10 cases, as good in 3 cases and as fair in 3 cases. The (10±3)-month follow-up for the 16 patients revealed complete fracture union for all after (12±2) weeks. According to the Majeed scoring at the last follow-up, the pelvic function was evaluated as excellent in 5 cases, as good in 7 cases, and as fair in 4 cases. No such postoperative complications as fracture displacement or internal fixation failure occurred.Conclusion:Owing to the biplane and integrated structure, our self-designed PSOCAP can help reduce the fractures or dislocations around the pubic symphysis to achieve anatomical reduction and strong internal fixation, leading to good clinical efficacy.

Value of ultrasonic measurement of pubic symphysis distance during labor / 中华超声影像学杂志

Objective:To explore the application value of ultrasonic measurement of the pubic symphysis distance in predicting pubic symphysis diastasis(PSD) during delivery.Methods:A total of 262 pregnant women from June 2021 to July 2022 who delivered at Suzhou Wuzhong People′s Hospital and Jiangyin People′s Hospital were retrospectively analyzed. The patients were divided into PSD group of 26 cases and normal pregnant women group (control group) of 234 cases according to whether or not PSD was confirmed during postpartum follow-up. Relevant data of the two groups were collected, including the biparietal diameter and femoral length of the fetus within 7 days before delivery, the pubic symphysis distance of pregnant women when the cervix was not dilated, pubic symphysis distance when the cervix dilated to 5 cm during the first stage of delivery, and the pubic symphysis distance after delivery, the age of the pregnant woman, the gestational week, the number of pregnancies, and the birth weight of the fetus. The differences of the above relevant data between the two groups were compared.Spearman correlation analysis was used to analyze the correlation between various parameters. The occurrence of postpartum PSD, and Logistic regression was used to analyze the predictive value of various parameters on the occurrence of postpartum PSD. ROC curve was used to analyze the diagnostic efficacy of each parameters to predict PSD.Results:The fetal birth weight, number of pregnancies, pubic symphysis distance in three time points in the PSD group were significantly higher than those in the control group (all P<0.05). The age of the pregnant women was negatively correlated with the occurrence of postpartum PSD ( rs=-0.152, P=0.014). The fetal birth weight, the number of pregnancies, the pubic symphysis distance in the cervix no-dilated and the first stage of labor were positively correlated with the occurrence of postpartum PSD( rs=0.160, 0.166, 0.678, 0.581, all P<0.05). Logistic regression analysis showed that the increase of pubic symphysis distance before labor would increase the risk of postpartum PSD, and the difference was statistically significant ( OR=2 506.028, 95% CI=14.293-439 402.630, P=0.003). The increase of pubic symphysis distance at the first stage of labor increased the risk of postpartum PSD, with a statistically significant difference ( OR=10 704.027, 95% CI=33.830-3 386 803.429, P=0.002). The ROC curve analysis showed that the area under the curve of the pubic symphysis distance in the cervix no-dilated and the first stage of labor for the diagnosis of PSD were 0.896 and 0.917 respectively, the sensitivity were 0.731 and 0.885, the specificity were 0.940 and 0.829, and the corresponding critical values were 0.87 cm and 1.06 cm respectively. The area under the curve of the combination of the two parameters for the diagnosis of PSD was 0.930, the sensitivity was 0.885, and the specificity was 0.876. Conclusions:Ultrasonic measurement of pubic symphysis distance during delivery can predict the occurrence of postpartum PSD in pregnant women and can provide a basis for the occurrence and treatment of postpartum pubic symphysis separation in pregnant women.

Research progress of pubic symphysis diastasis / 中国修复重建外科杂志

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.

Effect of core muscle motor control training on postpartum diastasis recti abdominis / 中国康复理论与实践

ObjectiveTo explore the clinical effect of core muscle motor control training on postpartum diastasis recti abdominis. MethodsFrom January, 2021 to January, 2022, 30 outpatients with postpartum diastasis recti abdominis were randomly divided into control group (n = 15) and experimental group (n = 15). Manipulative therapy and breathing training were performed simultaneously in both groups. Besides, the control group received conventional core strength training, and the experimental group received core muscle motor control training, for four weeks. Their distance of diastasis recti abdominis, abdominal circumference and waist circumference were compared before and after treatment. ResultsAfter treatment, the distance of diastasis recti abdominis, abdominal circumference and waist circumference reduced in both groups (Z = 3.408, t > 5.927, P < 0.05). The reduction value of diastasis recti abdominis distance was more in the experimental group than in the control group (t = 2.328, P < 0.05). ConclusionCore muscle motor control training can effectively relieve postpartum diastasis recti abdominis, and the effect is better than conventional core strength training.

Contribution of the practice of resistance exercises and the type of delivery to the diastasis of the rectus abdominis muscles in primiparous women / Contribución de la práctica de ejercicios de resistencia y el tipo de parto a la diástasis de los músculos rectos abdominales en mujeres primíparas / Contribuição da prática de exercício resistido e do tipo de parto para a diástase dos músculos retos do abdome em primíparas

ABSTRACT Maternal organism suffers physiological and biomechanical changes during pregnancy, including the separation of rectus abdominis muscles (RAM). This cross-sectional study aimed to compare the distance between the RAM among sedentary and active primiparous women who had vaginal childbirth and cesarean section, to correlate RAM separation with maternal and child variables and to compare these variables between primiparous women with and without RAM diastasis. In total, 56 women were evaluated in their ninth postpartum week, divided into four groups according to the mode of delivery and the practice of resistance exercises. RAM distance was calipered in the supraumbilical, umbilical, and infraumbilical regions. The values obtained were verified via analysis of variance (ANOVA), Pearson's correlation, and independent t-test. We found no main effect between mode of delivery and practice of resistance exercises or interaction between mode of delivery and practice of resistance exercises (p≥0.118) for RAM distance. We found significant correlation between body weight before pregnancy and RAM distance (p<0.001). There was no association between body weight gain during pregnancy and the newborn's weight with RAM distance (p≥0.132). We observed significant difference in body weight before pregnancy between primiparous women with and without RAM diastasis (p<0.005). We found no differences between groups regarding body weight gain during pregnancy and the newborn's weight (p≥0.122). It was concluded that the practice of resistance exercises and the mode of delivery have no impact on the separation of supraumbilical, umbilical, and infraumbilical regions of RAM in primiparous women.

RESUMEN El cuerpo materno sufre cambios fisiológicos y biomecánicos durante el embarazo, entre los cuales se destaca el alejamiento de los músculos rectos abdominales (MRA). Los objetivos de este estudio transversal fueron: comparar la distancia entre los MRA entre mujeres primíparas que realizaban entrenamiento y las sedentarias que se sometieron a parto vaginal y cesárea; correlacionar el alejamiento de los MRA con las variables materno-infantiles; y comparar estas variables entre mujeres primíparas con y sin diástasis de los MRA. Se evaluaron a 56 mujeres en la novena semana posparto, quienes fueron divididas en cuatro grupos según el tipo de parto y la práctica de ejercicios de resistencia. La distancia entre los MRA se midió con un calibre en las regiones supraumbilical, umbilical e infraumbilical. En los datos se aplicaron el análisis de varianza (Anova), la correlación de Pearson y la prueba t independiente. No hubo efecto del tipo de parto, la práctica de ejercicios de resistencia o la interacción del tipo de parto y la práctica de ejercicios de resistencia (p≥0,118) en la distancia entre los MRA. Hubo una correlación significativa entre el peso antes del embarazo y la distancia entre los MRA (p<0,001). No hubo asociación entre el aumento de peso durante el embarazo y el peso del bebé con la distancia entre los MRA (p≥0,132). Hubo una diferencia significativa en el peso antes del embarazo entre mujeres primíparas con y sin diástasis de los MRA (p<0,005). No hubo diferencia entre los grupos en el aumento de peso durante el embarazo y el peso del bebé (p≥0,122). Se concluye que la práctica de ejercicios de resistencia y el tipo de parto no tienen impacto en el alejamiento de los MRA en las regiones supraumbilical, umbilical e infraumbilical en mujeres primíparas.

RESUMO O organismo materno sofre alterações fisiológicas e biomecânicas durante a gestação, dentre elas o afastamento dos músculos retos do abdome (MRAs). Os objetivos deste estudo transversal foram: comparar a distância entre os MRAs entre primíparas treinadas e sedentárias que realizaram parto vaginal e cesárea; correlacionar o afastamento dos MRAs com variáveis materno-infantis; e comparar essas variáveis entre primíparas com e sem diástase dos MRAs. Foram avaliadas 56 mulheres na nona semana pós-parto, divididas em quatro grupos de acordo com o tipo de parto e a prática de exercício resistido. A distância entre os MRAs foi mensurada com paquímetro nas regiões supraumbilical, umbilical e infraumbilical. Os dados foram submetidos à análise de variância (Anova), correlação de Pearson e teste t independente. Não houve efeito do tipo de parto, da prática de exercício resistido ou da interação tipo de parto e prática de exercício resistido (p≥0,118) para a distância entre os MRAs. Houve correlação significativa entre peso antes da gestação e distância entre os MRAs (p<0,001). Não houve associação entre ganho de peso na gestação e peso do bebê com a distância entre os MRAs (p≥0,132). Houve diferença significativa no peso antes da gestação entre primíparas com e sem diástase dos MRAs (p<0,005). Não houve diferença entre grupos no ganho de peso na gestação e no peso do bebê (p≥0,122). Conclui-se que a prática de exercício resistido e o tipo de parto não têm impacto no afastamento entre os MRAs nas regiões supraumbilical, umbilical e infraumbilical em primíparas.

Efectividad de la Terapia Física en el Manejo de la Diástasis de los Rectos Abdominales en el Postparto: Scoping Review / Effectiveness of Physical Therapy in the Management of Diastasis Rectus Abdominis in Postpartum: A Scoping Review

Introducción. La diástasis de los rectos abdominales es una patología frecuente en el postparto. Aunque se puede resolver de forma espontánea y natural, la mayoría requiere tratamiento basado en la terapia física. Dentro de las principales modalidades se encuentran ejercicios de activación del transverso del abdomen, ejercicios abdominales, entrenamiento de piso pélvico y vendaje abdominal. Al ser estrategias ampliamente utilizadas, se requiere estudiar su efectividad. Objetivo. Describir los reportes de la literatura científica acerca de la efectividad de la terapia física en el manejo de la diástasis de los rectos abdominales en el periodo postparto. Metodología. Se realizó una scoping review según la metodología propuesta por Arksey y O´Malley y PRISMA-ScR. Se efectuó una búsqueda en las bases de datos PubMed, Lilacs, ScienceDirect, Scielo, Scopus y Scholar Google incluyendo artículos en inglés y español publicados entre 2012 y 2022, seleccionados acorde al tema de investigación. Resultados. Se incluyeron 22 artículos en la síntesis cualitativa y se resume la evidencia seleccionada en 5 dimensiones: participantes, evaluación, intervención, resultados de la efectividad de la terapia física en la disminución de la distancia inter-rectos y otros resultados. Conclusión. Existe variada evidencia científica y de poca calidad metodológica respecto a la modalidad y efectividad de la terapia física en el tratamiento de la diástasis de los rectos abdominales. Se sugieren programas individualizados que consideren los nuevos paradigmas de evaluación, enfocando en la funcionalidad de la pared abdominal.

Background. Diastasis recti abdominis is a common pathology in the postpartum period. Although it can be resolved spontaneously and naturally, most require treatment based on physical therapy. Transverse abdominis exercises, abdominal exercises, pelvic floor training, and abdominal binder are among the primary modalities. Thus, it is necessary to study their effectiveness as widely used strategies. Objective. Describe the reports in the scientific literature about the effectiveness of physical therapy in the management of diastasis recti abdominis in the postpartum period. Methods. This scoping review was carried out according to the methodology proposed by Arksey and O'Malley and PRISMA- ScR. Besides, a quest was developed in the PubMed, Lilacs, ScienceDirect, Scielo, Scopus and Scholar Google databases, including articles in English and Spanish published between 2012 and 2022, selected according to the research topic. Results. Twenty-two articles were included in the qualitative synthesis, and the chosen evidence was summarized in five dimensions: participants, evaluation, intervention, results of the effectiveness of physical therapy in reducing the inter-rectus distance, and other results. Conclusion. There is diverse scientific evidence and poor methodological quality regarding to the modality and effectiveness of physical therapy in the treatment of diastasis recti abdominis. Individualized programs are suggested, that consider new evaluation paradigms, focusing on the functionality of the abdominal wall.

Alternativa de manejo miniinvasivo para el tratamiento de pacientes con diástasis abdominal y colgajo dermograso mediante la táctica VER: Vaser® + endoscopia + Renuvion® / Minimally invasive management alternative for the treatment of patients with abdominal diastasis and dermo-fat flap using the VER tactic: Vaser® + endoscopy + Renuvion®

El tratamiento de la diástasis abdominal en pacientes con colgajo dermograso no está estandarizado y puede realizarse mediante diferentes técnicas. Presentamos una alternativa para el manejo miniinvasivo de pacientes con diástasis abdominal asociada a colgajo dermograso mediante la combinación de tres procedimientos que denominamos "táctica VER": Vaser® + endoscopia + Renuvion®. Según nuestra experiencia preliminar, la combinación de los 3 procedimientos es segura y efectiva en los casos seleccionados

The treatment of abdominal diastasis in patients with a dermo-fat flap is not standardized and can be performed using different techniques. We present an alternative for the minimally invasive management of patients with abdominal diastasis associated with dermo-fat flap through the combination of three procedures that we call "VER tactic": Vaser® + Endoscopy + Renuvion®. Based on our preliminary experience, the combination of the 3 procedures is safe and effective in selected cases

Study on the status and influencing factors of rectus abdominis muscle separation in postpartum women / 中国综合临床

Objective:To analyze the current situation and influencing factors of rectus abdominis muscle separation in postpartum women.Methods:The clinical data of 3 368 postpartum women who underwent postpartum physical examination in Shenzhen Longgang maternal and child health hospital from June to October 2020 were retrospectively analyzed. The general data, rectus abdominis separation and pelvic organ prolapse were collected for cross-sectional investigation.Results:The incidence of rectus abdominis separation in postpartum women was 60.7% (2 045/3 368). <30 years old, ≥30 years old (56.8% (856/1 507) and 63.9% (1 189/1 861), χ2=17.54)). The increase of body mass during pregnancy was <16 kg, ≥16 kg (59.1% (1 351/2 285) and 64.1% (694/1 083), χ2=7.57)). Spontaneous labor and cesarean section (55.7% (1 262/2 266) and 71.7% (790/1 102), χ2=77.87)). Pregnancy 1, 2, ≥3 times (53.9% (645/1 196), 62.1% (702/1 131) and 67.1% (698/1 041), χ2=41.48). Production for 1, 2, ≥3 times (53.9% (877/1 628), 67.0% (1 016/1 517) and 68.2% (151/223), χ2=62.09)). History of macrosomia (68.7% (160/233) and 60.1% (1 885/3 135), χ2=6.64)). Prolapse of anterior vaginal wall (75.2% (1 559/2 072) and 37.5% (486/1 296), χ2=476.15), there were significant differences in the incidence of rectus abdominis separation (all P<0.05). Logistic regression analysis showed that ≥ 3 times pregnancies ( OR=1.572,95% CI=1.270-1.945),cesarean section ( OR=2.440,95% CI=2.050-2.905),macrosomia ( OR=1.660,95% CI=1.213-2.273), anterior vaginal prolapse( OR=7.324,95% CI=6.083-8.819) were risk factors of diastasis recti abdominis (all P<0.05). Conclusions:The incidence of rectus abdominis separation in postpartum women is high. Three or more pregnancies, cesarean section, history of macrosomia and prolapse of anterior vaginal wall play an important role in the occurrence of rectus abdominis separation.

Infix plus cannulated screws for the treatment of pelvic injuries caused by pubic symphysis separation in middle-aged and elderly patients / 中华老年医学杂志

Objective:To investigate the clinical effect of Infix combined with hollow screws for the treatment of pelvic injuries with pubic symphysis separation in middle-aged and elderly patients.Methods:Data of 8 middle-aged and elderly patients with pelvic injuries due to pubic symphysis separation undergone treatment from January 2017 to December 2020 were retrospectively analyzed.Results:The average operating time of 8 patients was (46.0±6.2)min(range: 40-62min); the average intraoperative blood loss was (32.0±5.6)ml(range: 25-50 ml); the average length of incisions at the iliac screw was(2.6±0.4)cm(range: 2.0-3.5 cm); the average length of incisions at the hollow screw was (1.1±0.3)cm(range: 0.8-1.5 cm); and the average times of fluoroscopy were (36.0±6.0)times(range: 28-52 times). Postoperative X-ray and CT examinations showed that the reduction of the pubic symphysis was good, the inserted iliac screws and cannulated screws were positioned accurately, and the incision healed well.Based on Matta's criteria, postoperative radiological outcomes were evaluated, with 7 cases rated as excellent and 1 as good, giving an excellent to good rate of 100%(8/8). The average followed up time for all 8 patients was (15.0±4.2)months(range: 6-24 months). Pelvic X-ray and CT examinations at the last follow-up showed that the fractures healed well and the pubic symphysis reduction did not fail.Infix and cannulated screws in the pubic symphysis were removed 10-12 weeks after surgery[average: (10.5±0.5)weeks]. According to the Majeed Pelvic Score, 5 cases were rated as excellent, 2 cases as good and 1 as fair, with an excellent to good rate of 87.5%(7/8). One patient had symptoms related to the lateral femoral cutaneous nerve that disappeared after 3 months.One patient developed deep venous thrombosis after surgery, and the filter was placed and removed 10 weeks later.Conclusions:Using Infix plus cannulated screws for the treatment of pelvic injuries in middle-aged and elderly patients with pubic symphysis separation has the advantages of limited trauma and intraoperative blood loss, good fixation and few complications.

Analysis on the level of knowledge, attitude and practice of rehabilitationfor postpartum diastasis recti abdominisinpuerperaeand the influencing factors of behavior / 中国实用护理杂志

Objective:To explore the current level of knowledge, attitude and practice of rehabilitation for postpartum diastasis recti abdominis inpuerperae, and analysis the influencing factors of behavior, in order to provide a reference frame for nursing staff to formulate effective health education programs.Methods:From November 2020 to April 2021, a self-designed questionnaire was used to investigate 522 puerperae from 4 tertiary hospitals in Guangdong province, Jiangsu province and Zhejiang province, to explore their level of knowledge, attitude and behavior of rehabilitation for postpartum diastasis recti abdominis. Mann-Whitney Utest or Kruskal-Wallis Htest was used for univariate analysis, Binary Logistic regression analysis was used to analysis the influencing factors of rehabilitative behavior.Results:The median score of knowledgedimension, attitude dimension and behavior dimension of rehabilitation for postpartum diastaisis recti abdominis in puerperae respectively were 47.0 (36.0, 55.0), 26.0 (24.0, 31.0), 15.0 (10.0, 18.0) points. The results show that the main factors influencing of rehabilitation behaviorfor postpartum diastaisis recti abdominis in puerperae were knowledge ( χ2 = 87.78, P<0.05), attitude ( χ2 = 4.77, P<0.05), number of deliveries ( χ2 = 3.94, P<0.05) and family personal monthly income ( χ2 = 4.88, P<0.05). Conclusions:At present, puerperae have a positive attitude towards rehabilitation for postpartum diastasis recti abdominis, but the level of knowledge and practice of rehabilitation for postpartum diastasis recti abdominisneed to be improved.Nursing staff should focus on puerperae with incomplete knowledge, negative attitude, multiple deliveries and low family personal monthly income.

Holistic Pelvic Ring Concept in Treatment of Postpartum Pubic Symphysis Diastasis / 中国康复理论与实践

Objective:To observe the effect of pelvic band fixation with three-dimensional adjustment of suspended pelvis on patients with pubic symphysis diastasis under the holistic pelvic ring concept. Methods:From February, 2018 to February, 2020, 30 parturients with pubic symphysis diastasis were evaluated pelvic ring. They accepted three-dimensional adjustment of pelvis with suspension to restore the anatomical reduction of sacroiliac joint and the symphysis pubis according to the evaluation, and were fixed with pelvic band for six to eight weeks. The pubic symphysis union was monitored with color ultrasonography. They were reviewed with pelvic X-ray two weeks after removal of pelvic band, and assessed with Visual Analogue Scale (VAS) for pain and modified Barthel Index (MBI) before treatment, immediately after removal of the pelvic band and two weeks after removal of the pelvic band, while the pelvic ring structure was measured. Results:The scores of VAS and MBI improved two weeks after pelvic band removal compared with those before treatment, as well as distance of pubic symphysis separation, upper margin difference of pubic symphysis, width difference of iliac wings, transverse and longitudinal diameter difference of obturator foramens (t > 2.509, P < 0.05). However, the scores of VAS and MBI improved two weeks after pelvic band removal compared with those immediately after removal of the pelvic band (|t| > 2.854, P < 0.05), while the distance of pubic symphysis separation increased (t = 2.319, P < 0.05), still in the normal reference value. Conclusion:Correcting the post-partum pubic symphysis diastasis under the holistic pelvic ring concept can restore the anatomical structure of the pelvis, avoid the compensatory movement pattern, and improve the daily living in the later time.

Diagnosis and treatment of abdominal rectus diastasis / 中华消化外科杂志

Abdominal rectus diastasis is common in postpartum women and obese people, with clinical manifestations of midline abdominal bulge and lower back pain. Severe cases may affect the function of abdominal wall muscle groups, which cause a series of physiological dysfunction. There are few studies on the diagnosis and optimal management of abdominal rectus diastasis, especially on its surgical indications, and no uniform conclusion is achieved. The authors comprehensively analyze the research progress at home and abroad, exploring the etiology, diagnosis, treatment options and surgical indications of abdominal rectus diastasis, in order to provide references for clinical practice.

Atuação fisioterapêutica na redução da diástase abdominal no puerpério imediato / Physiotherapy in the reduction of diastasis of the recti abdominis in inmediate pospartum / Fisioterapia para reducir la diástasis abdominal en el posparto inmediato

Objetivo: verificar se a intervenção fisioterapêutica no puerpério imediato contribui para a redução da diástase. Métodos: estudo de intervenção com randomização de dois grupos de 25 puérperas recrutadas em uma maternidade de Vitória-ES. Ambos foram submetidos à avaliação e mensuração da diástase através de um paquímetro, e no grupo de tratamento além da avaliação foi aplicado um protocolo de tratamento fisioterápico às 06 e 18 horas após o parto. Os dados foram analisados através dos testes de Wilcoxon, Mann-Whitney e teste t pareado. Resultados: houve diminuição da diástase abdominal entre a primeira e a última avaliação em ambos os grupos, no entanto, a análise entre grupos identificou uma redução mais acentuada no grupo de tratamento (p<0,001). Conclusão: os achados deste estudo mostram que o atendimento fisioterápico no puerpério imediato é capaz de influenciar positivamente na redução da diástase abdominal, proporcionando às puérperas uma recuperação mais rápida

Objective: to verify if the physiotherapeutic intervention in the immediate puerperium contributes to the reduction of the diastasis. Methods: randomized intervention study of two groups of 25 mothers recruited at a maternity hospital in Vitória-ES. Both were submitted to diastasis evaluation and measurement using a caliper, and in the treatment group, in addition to the evaluation, a physical therapy protocol was applied at 06 and 18 hours after delivery. Data were analyzed by Wilcoxon, Mann-Whitney and paired t-tests. Results: there was a decrease in the abdominal diastasis between the first and last evaluation in both groups and the variables studied, however, the analysis between groups identified a sharper decline in the treatment group (p <0.001). Conclusion: the findings of this study show that the physiotherapeutic care in the immediate puerperium is able to positively influence the reduction of the abdominal diastasis, providing a faster recovery to the puerperal women

Objetivo: verificar si la intervención de fisioterapia en el período posparto inmediato contribuye a la reducción de la diástasis. Métodos: estudio de intervención aleatorizado de dos grupos de 25 madres reclutadas en un hospital de maternidad en Vitória-ES. Ambos fueron sometidos a evaluación y medición de la diástasis utilizando un calibrador, y en el grupo de tratamiento, además de la evaluación, se aplicó un protocolo de fisioterapia a las 06 y 18 horas después del parto. Los datos fueron analizados por Wilcoxon, Mann-Whitney y pruebas t pareadas. Resultados: hubo una disminución en la diástasis abdominal entre la primera y la última evaluación en ambos grupos y las variables estudiadas, sin embargo, el análisis entre los grupos identificó una reducción más marcada en el grupo de tratamiento (p <0.001). Conclusión: los resultados de este estudio muestran que la atención de fisioterapia en el período posparto inmediato puede influir positivamente en la reducción de la diástasis abdominal, proporcionando a las mujeres puerperales una recuperación más rápida

No clinical advantage of locking over nonlocking plate fixation of symphyseal disruptions / Nenhuma vantagem clínica do uso de placas bloqueadas sobre não bloqueadas na disjunção da sínfise púbica

ABSTRACT Purpose: although locking plates have led to important changes in fracture management, becoming important tools in the orthopedic surgeon's arsenal, the benefits of locking plates for traumatic diastasis of the pubic symphysis have not been established. This study was conducted to assess the quality of life in its different domains among patients with traumatic diastasis of the pubic symphysis managed either with locking or nonlocking plate. Methods: a prospective cohort study was undertaken at 3 level 1 trauma centres in Brazil. Patients presenting traumatic diastasis of the pubic symphysis treated with plate fixation with a minimum follow-up of 12 months were eligible for inclusion. Through a Pfannenstiel approach, the pubic symphysis was reduced and fixed with a superiorly positioned 4.5mm four to six hole reconstruction locked plate or 3.5mm four to six hole reconstruction nonlocked plate. Posterior injury was managed during the same procedure. Outcome measures were adequate healing of the pelvic injuries, return to pre-injury level on daily activities, and quality of life at the last follow-up visit. Complications and modes of failure were summarized and reviewed. Bivariate linear regression was used to assess individual factors affecting patients' health-related quality of life. A p value of <5% was considered significant. Results: a total of 31 adult patients (29 males and 2 females) were eligible for the study. Thirteen patients were managed with a reconstruction locked plate and 18 patients with a nonlocked reconstruction plate. Average postoperative follow-up time was 24 months. Adequate healing of the pelvic injuries was achieved in 61.5% of patients treated with locking plates and 94.4% of patients treated with nonlocking plates (p=0.003). Radiographic failure of fixation with minor complications occurred in 46.1% of patients after locked plating versus 11.1% of patients in the nonlocking plate group (p=0.0003). In bivariate analysis, abnormal gait (p=0.007) was associated with a reduced long-term quality of life as measured with the EQ-5D-3L. Conclusion: internal fixation of traumatic diastasis of the pubic symphysis with locking plates has no clinical advantage when compared to nonlocked plating. Mechanical failure and inadequate healing are significantly increased after locked plating of the pubic symphysis. Therefore, we do not recommend routine use of locking plates for managing patients presenting traumatic diastasis of the pubic symphysis. Level of evidence: II (prospective, cohort study).

RESUMO Justificativa e Objetivo: embora as placas bloqueadas tenham levado a mudanças importantes no tratamento de fraturas, tornando-se ferramentas importantes no arsenal do cirurgião ortopédico, os benefícios para a fixação da lesão da sínfise púbica não foram adequadamente estabelecidos. Este estudo foi realizado para avaliar a qualidade de vida em diferentes domínios de pacientes com disjunção traumática da sínfise púbica tratados com placas bloqueadas e não bloqueadas. Métodos: trata-se de estudo de coorte prospectivo, realizado em três centros de trauma nível 1, no Brasil. Foram elegíveis para inclusão no estudo pacientes com disjunção traumática da sínfise púbica tratados com redução aberta e fixação interna com placa, com seguimento mínimo de 12 meses. Por meio de abordagem de Pfannenstiel, a sínfise púbica foi reduzida e fixada com uma placa bloqueada de reconstrução de 4,5mm de quatro a seis orifícios posicionada superiormente ou com uma placa não bloqueada de reconstrução de 3,5mm de quatro a seis orifícios. A lesão pélvica posterior foi tratada durante o mesmo procedimento. Os desfechos analisados na última visita de acompanhamento foram cicatrização da lesão pélvica, retorno às atividades diárias para nível pré-lesional e qualidade de vida. Complicações e modos de falha foram observados e descritos. Foi utilizada regressão linear bivariada na avaliação dos fatores individuais que afetaram a qualidade de vida relacionada à saúde dos pacientes, com valor p <5% considerado significativo. Resultados: foram incluídos no estudo 31 pacientes adultos (29 homens e 2 mulheres). Treze pacientes foram tratados com placa de reconstrução bloqueada e 18 com placa de reconstrução não bloqueada. O tempo médio de seguimento pós-operatório foi de 24 meses. A cicatrização adequada da lesão do anel pélvico foi alcançada em 61,5% dos pacientes tratados com placas bloqueadas e em 94,4% dos pacientes tratados com placas não bloqueadas (p=0,003). Falha radiográfica de fixação com complicações menores ocorreu em 46,1% dos pacientes tratados com placa bloqueada contra 11,1% dos pacientes no grupo de placas não bloqueadas (p=0,0003). Na análise bivariada, marcha anormal (p=0,007) foi associada à redução da qualidade de vida em longo prazo, medida com o EQ-5D-3L, embora não tenha sido observada relação direta destas com os implantes utilizados. Conclusão: a fixação interna da disjunção traumática da sínfise púbica com placas bloqueadas não apresenta vantagem clínica quando comparada com placas não bloqueadas. Falha mecânica e cicatrização inadequada aumentam significativamente após o uso de placas bloqueadas na sínfise púbica. Portanto, não recomendamos o uso rotineiro de placas bloqueadas para o tratamento de pacientes com disjunção traumática da sínfise púbica. Nível de evidência: II (estudo de coorte prospectivo).