The diagnostic value of active inflammatory changes of the symphysis pubis on magnetic resonance imaging scans in patients with axial spondyloarthritis and clinical factors analysis / 中华风湿病学杂志

Objective:To evaluate the correlation of active inflammatory changes of the symphysis pubis on magnetic resonance imaging (MRI) scans with clinical factors in patients with axial spondyloarthritis.Methods:We retrospectively evaluated 112 patients with axial spondyloarthritis (ax-SpA) in our hospital from February 2014 to November 2020. Patients were divided into 4 groups: symphysis pubis + sacroiliac arthritis, symphysis pubis + non-sacroiliac arthritis, non-symphysis pubis + sacroiliac arthritis, and non symphysis pubis + non-sacroiliac arthritis group. Intra-group correlation coefficient ( ICC) was used to analyze the correlation between MRI active inflammation of the symphysis pubis and the sacroilioarthritis. Age, sex, symptom duration, smoking, body mass index, human leukocyte antigen (HLA)-B27 positive rate, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) among the four groups were compared by one-way analysis of variance (ANOVA) and Chi-square test. Results:The proportion of active inflammation of the symphysis pubis was 35.7% (40/112). There was no correlation between active inflammation of the symphysis pubis and sacroilioarthritis ( r=-0.06, P=0.559). Twenty-four patients of the 69 patients with sacroilioarthritis had active inflammation of the symphysis pubis, 16 patients of the 43 patients without sacroilioarthritis had active inflammation of the symphysis pubis. In patients without active inflammation of the sacroiliac joint, the CRP and ESR of the active inflammation of the symphysis pubis group was (49±60) mg/L, (40±19) mm/1 h, statistically higher than that of the non-active inflammation group (19±22) mg/L, (22±37) mm/1 h ( t=2.36, P=0.023; t=2.88, P=0.006). In patients who had active inflammation of the symphysis pubis, the symptom duration of the non-active inflammation of the sacroiliac joint, was (14±9) years, which was significantly longer than that of the active inflammation group (5±4) years ( t=4.07, P=0.001). Conclusion:There is no correlation between active inflammatory changes of the symphysis pubis and bone marrow edema of the sacroiliac joint. Therefore, in ax-SpA patients with inflammatory low back pain and/or hip/groin pain, and also with high levels of CRP, ESR, but no active inflammatory changes of the sacroiliac joint on MRI scans, active inflammation of the symphysis pubis should be considered.

Three Cases of Separation of Symphysis Pubis during Vaginal Delivery / 대한주산의학회잡지

Spontaneous separation of symphysis pubis during vaginal delivery is reported to be a rare complication with the incidence ranging from 1:521 to 1:30,000 deliveries. This injury is associated with sharp pain, swelling, tenderness over the symphysis pubis, and difficult in walking. Diagnosis of spontaneous separation of the symphysis is mostly based on clinical findings and confirmed radiographically. Complete recovery might be achieved after conservative treatment and the prognosis is excellent. We have experienced three cases of separation of the symphysisis during vaginal delivery, so we present these cases with a brief review of the literature.

A case of diastasis of the symphysis pubis accompanying gait disturbance developed before labor pain / 대한산부인과학회지

We experienced a case of diastasis of the symphysis pubis accompanying severe pubic pain and serious gait disturbance, which was developed at 34 weeks gestation before labor pain in 36-year-old primiparous woman, who has experienced previous cesarean section at her first pregnancy due to pelvic pain before onset of labor, so we report a case with a review of the literature.

Separation of the Symphysis Pubis during Childbirth

PURPOSE: To evaluate the clinical features and incidence of separation of the symphysis pubis during childbirth, and to evaluate the risk factors of the lesion and the outcome of treatment. MATERIALS AND METHODS: Seventy two cases of separation of symphysis pubis among 66,721 delivery between January 1992 and December 2004 was selected. The control group was composed of 498 cases without separation of symphysis pubis during childbirth. Several factors increasing the risk of this lesion were assessed using χ

Clinical analysis of the perinatal pubic bone separation / 대한산부인과학회지

OBJECTIVE: To raise recognition and find out clinical characteristics about pubic bone separation relatively rarely reported. METHODS: Among the total of 40,475 mothers who had delivered livebirths of over 25 weeks gestation between January 1995 and December 2002, we assigned 40,401 mothers without pubic bone separation to control group I and 74 mothers with pubic bone separation to sample group I. We compared maternal age, gestational age, birth weight and parity between the two groups. To conduct subgroup analysis on mothers who had undergone normal vaginal delivery, we randomly selected 37 out of sample group I and assigned them to sample group II. We selected 1,073 out of control group I with a ratio of nullipara-to-multipara and assigned them to control group II. In subgroup analysis, we compared several risk factors between control group II and sample group II. Lastly, clinical characteristics of sample group I were analyzed by Student's T-test, chi-square test. RESULTS: There were no significant differences in maternal age, gestational age, birth weight and parity between control group I and sample group I. Moreover, there were no significant differences in maternal age, gestational age, parity, weight gain, duration of oxytocin use, BPD and labor duration between control group II and sample group II. But, the history of vacuum delivery, macrosomia and long second-stage labor duration were more notable in sample group II than control group II. The severity and distance of pubic bone separation were severe in cases of normal vaginal delivery than those of Cesarean section. CONCLUSION: In conclusion, it will enhance the diagnostic rate for pubic bone separation in perinatal period to widen the understanding of it's clinical characteristics.

Three Cases of Separation of Symphysis Pubis During Vaginal Delivery / 대한주산의학회잡지

Separation of symphysis pubis during vaginal delivery is rare condition with incidence ranging from 1/500 to 1/30000 deliveries. The injury is caused by fetal head exerting pressure on pelvic ligaments that have been relaxed by progesterone and relaxin. The separation might be associated with considerable pain, swelling and tenderness over the pubic area. Diagnosis is based on clinical findings and X-ray findings. The condition is treated conservatively with bed rest, analgesics and physical therapy. Prognosis is exellent. We experienced 3cases of separation of symphysis pubis during vaginal delivery and report these cases with a brief review of literature.

A Case of Rupture of the Symphysis Pubis during Labor / 대한산부인과학회잡지

Spontaneous rupture of symphysis pubis during delivery is rare condition. The overall incidence is 1/600~1/30000 deliveries. The Separation was associated with considerable pain, swelling and tenderness over the symphysis pubis and confirmed roentgenographically. The condition was treated conservatively with bed rest, mostly in the lateral decubitus position, aided by a restrictive pelvic binder. Mobilization was initiated after pain relieved. Recovery can be expected to be complete. We present a case of spontaneous rupture of symphysis pubis during delivery with a brief review of the literature.

Unusual Dislocation of the Symphysis Pubis: A Case Report / 대한정형외과학회잡지

The lateral compression injury of the pelvis is common in high-speed vehicle accidents, and symphysis pubis disruption can occur with external rotation or anterior compression injury. The most common injury of the symphysis pubis is diastasis. So far, four cases of the locked symphysis pubis have been reported, and two of these were treated by closed reduction. The current case involves a 26-year-old man who experienced a lateral compression force to his pelvis and knees, and suffered a symphysis pubis disruption (locked symphysis pubis, i.e., creeping of the left pubic body below the right pubic body), urethral rupture and bilateral knee dislocation. The locked symphysis pubis was successfully reduced with a closed maneuver.

A case of disruption of symphysis pubis diagnosed after delivery of a primigravida / 대한산부인과학회잡지

Peripartum pubic symphysis separation is a recognized complication of delivery with incidence ranging 1:300 to 1:30,0002,4-6. The underlying etiology of symptomatic symphyseal separation has not fully elucidated. Diagnosis is mostly based on clinical findings. Complete recovery was made only by analgesics and physical therapy. The occurrence of symphyseal separation does not necessitate an alteration in the management of subsequent pregnancy7. We have experienced a case of disruption of symphysis pubis during labor supposed to be caused by too rapid labor course. Details regarding this case and a review of the literature are presented.

Diastasis of the Symphysis Pubis after Delivery / 대한정형외과학회잡지

PURPOSE: The objectives of this study are to observe the clinical characteristics, outcome of treatment and incidence of diastasis of the symphysis pubis after delivery and to evaluate the risk factors of the lesion. MATERIALS AND METHODS: Seventy-six patients diagnosed with diastasis of the symphysis pubis were reviewed. The diagnostic criteria of diastasis were; 1) positive signs and symptoms of pelvic instability, 2) radiological evidence of widening of the symphysis pubis by more than 6 mm and/or vertical mobility of more than 3 mm, or widening of the sacroiliac joint by more than 4 mm. Several factors that increase the risk of this lesion during delivery were reviewed and analyzed using the chi-square test, t-test, and by logistic regression. RESULTS: Seventy-six diastasis of the symphysis pubis were diagnosed in 24,089 deliveries during the study period. Joint widening ranged from 3 mm to 34 mm. Twenty-three cases had accompanying vertical mobility. Pain in the pelvic joint and walking difficulty were most common clinical characteristics. History of pelvic girdle relaxation during pregnancy was found to increase the risk of the lesion (P=0.0028). CONCLUSION: We found that a history of pelvic girdle relaxation during pregnancy was a risk factor of diastasis of the symphysis pubis after delivery. Early detection and satisfying results by optimal treatment are associated with recognizing the lesion's characteristic clinical findings.

Separation of the Symphysis Pubis during Childbirth / 대한정형외과학회잡지

PURPOSE: To describe our experience concerning clinical features, methods of treatment and outcomes of separation of the symphysis pubis during childbirth. MATERIALS AND METHODS: We experienced 26 cases during a period of 6 years from March 1992 to January 1998. Retrospectively, we analysed 23 cases which could be followed up for more than a year, each with separation of the symphysis pubis associated with childbirth. Method of treatment was pelvic sling and absolute bed rest in 18 cases of 23 cases, the others were treated with bed rest and early mobilization. RESULTS: Clinical symptoms and physical findings were similar in all cases. The duration of symptom was from 3 weeks to a year (mean=3.2 months), the size of the gap on simple X-ray ranged from 6 mm to 28 mm (mean=16 mm) initially and from 3 mm to 11 mm (mean=4.7 mm) finally. Outcomes were good in all cases with conservative treatment, although final radiologic fingings were normalized, widening, sclerosis, erosion or osteophytes. CONCLUSION: Separation of the symphysis pubis during childbirth was treated well with conservative treatments, although variable radiologic findings were noted in final X-ray finding.

Osteomyelitis of the Symphysis Pubis: A case Report / 대한정형외과학회잡지

Osteomyelitis of the symphysis pubis is rare and it has signs and symptoms similar to those of osteitis pubis: distal anterior thigh pain, spasm of the adductor and rectus abdominis muscle and waddling gait. Unlike ostetitis pubis, the clinical course of osteomyelitis is progressive, with increasing bone destruction and widening of the symphysis on plain radiographs, and is curable by surgical treatment. We report a case of osteomyelitis of the symphysis pubis diagnosed by MRI and treated by debridement and curettage with appropriate antibiotics.

Separation of the Symphysis Pubis: Report of 5 Cases / 대한정형외과학회잡지

The symphysis pubis is a nonsynovial amphiarthrosis in which the bodies of the two pubic bones are united by a fibrocartilaginous disk. This forms subsidiary tie arches that augment femorsacral arch in the erect position, ischiosacral arch in the sitting position. In normal state the symphysis is strong enough not to be separated. We experienced 5 cases of separated symphysis pubis developed during labor at the Catholic Hospital from January 1987 to December 1988. The duration of follow-up was between 12 and 19 months without any residual symptom after conservative treatment.

Traumatic Separation of the Symphysis Pubis / 대한정형외과학회잡지

Symphyseal injury is increasing in number together with today's speed of development of car industry in Korea. However, this injury is not common in practice. Some authors reported that symphyseal injury is only 4 to 6% of all pelvic fractures. Symphysis pubis has characteristicsl anatomy to maintain mechanical integrity of the pe1vis with circumferential ligament. The pelvis is a ring structure with strong ligaments. This support include the symphysis pubis, the anterior and posterior sacroiliac ligaments, and the strong sacrotuberous ligaments. According to Peltier(1964), when symphysis is separated more than 1.0cm, pubic instability will be developed. However, Wild(1982) reported that pelvic instability develops when separation of the symphysis exceeds more than 2.5cm. Tile(1984) reported that anterior pubic rami acts as a strut to prevent anterior collapse of the pelvic ring during weight bearing. However, in the presence of intact posterior structures, it gives little effect on pelvic stability. In addition to trauma, pelvic instability develops congenitally or by pregnancy. During pregnancy, pregnancy-related hormones relsx the ligameritous stuctures of the pelvic girdle. In most instances, the major pelvic ring returns to normal when the effect of the relaxin hormones disappear. However, in rare instances, a major symphysis disruption may continuously persist. To evaluste the trauma-induced separation of the symphysis pubis, we analyzed the 19 cases with 15 months follow-up on an average, who were treated at the Orthopaedic Department, Kang-Nam St. Marys Hospital, from June 1981 to June 1986. The results were as follows 1. Among 19 cases, 9 cases(47.4%) were male, 10 cases(52.6%) were female. And average age of the patients was 30.2 years. 2. The main cause of the fracture was traffic accident in 18 out of 19 cases. 3. In cases of symphyseal separation more than 3.4cm, fracture-separation of both sacroiliac joint was certainly occured. However, in cases with separation more than 2.2cm, unilalateral fracture-dislocation of sacroiliac joint occurred. 4. Open reduction and interal fixatiopn including external fixation was performed in 9 og cases. As an indication of surgery, separation of the symphysis, which exceeds more than 2.2cm and which associated (1) with sacroiliac fracture-dislocation, (2) failed conservative treatment, and (3) when simultaneously emergency urological operation is indicated.

A Case of Separation of the Symphysis Pubis and 2 Cases of Sacroiliac Strain During and After Spontaneous Labor / 대한정형외과학회잡지

Mechanically the symphysis pubis serves to anchor the ends of the two weight bearing arches of the pubis-the femorosacral and ischiosacral arches. Under normal conditions it has been found to exceedingly resistant to separation. Sacroiliac strain is also uncommon because the sacroiliac ligaments are very strong and the movement which produce a torsion strain upon the joint is more likely to cause a strain of thinner capsular ligaments surrounding the small lumbosacral joints. We experienced a case of separation of the symphysis pubis and 2 cases of sacroiliac strain during and after spontaneous labor.