- 期刊
使用骨盆電腦斷層掃描暨三度空間骨型重組作爲恥骨聯合輕微錯位之臨床診斷依據：病例報告
Clinical Diagnosis of Mild Misalignment of Symphysis Pubis Using CT Scan with Three-dimensional Reconstruction of Pelvis: A Case Report
摘要
恥骨聯合(symphysis pubis)處受傷偶見於產科或外傷科，產科以自然生產之產婦在陰道分娩過程中受傷較常見，外傷科則以駕駛人遭側面撞擊，其外側骨盆嚴重受創而波及恥骨聯合處爲主。至於一般跌倒而導致恥骨聯合處受傷則極爲罕見。本病例即是一般性跌倒，患者在數個月內發生多次外側骨盆著地撞擊後，逐漸感覺下腹部疼痛，行走困難，且日漸嚴重。經門診理學檢查後發現患者之右側髂薦關節鬆弛(hypermobility of sacroiliac joint)，右側骨盆前旋(anterior rotation)，恥骨聯合處有明顯壓痛，疑似恥骨聯合處扭傷變形(deformation)。骨盆X 光檢查呈現骨盆傾斜(pelvis tilting)以及恥骨聯合處輕微錯位(misalignment)，由於此例X光影像之判讀並不容易，故安排電腦斷層掃描暨三度空間骨型重組，針對恥骨聯合處，取得正面觀以及後面觀之影像，因而得見微小卻清晰可辨之錯位變化，使得臨床之診斷更有依據。
並列摘要
The patients who suffered from symphysis pubis injury would normally be treated in two clinical departments. Symphysis pubis diastasis is an uncommon intrapartum complication which may occur in women with some associative factors such as macrosomic fetus, small pelvis, and rapid descent of presenting part during spontaneous vaginal delivery. The automotive side impacts are a leading cause of injuries to the pubic symphysis which might be combined with major pelvic trauma. Other factors that might contribute to this type of injury is general fall events, although very rare, which would induce minor symphysis pubis injury. Recently, we presented with a case of mild misalignment of symphysis pubis following multiple falls within several months. The patient suffered impact on her lateral pelvis during every fall. She felt hypogastric discomfort and difficulty in walking, resulting in that the condition of the patient gradually deteriotated. On examination, there were hypermobility of the right sacroiliac joint, anterior rotation of the right pelvis, and severe local tenderness on symphysis pubis. The misalignment of symphysis pubis could not be shown clearly by pelvic X-ray. However the injury could clearly be seen with CT scan with 3-D reconstruction.