背景:在膀胱外翻初始修复期间,腹部和骨盆闭合仍然是一个挑战。我们旨在报告一种新的双侧闭孔截骨术的可行性和结果。
方法:回顾性研究2017年12月至2021年5月期间,同一团队在不同机构接受单阶段延迟膀胱外翻封堵术联合膀胱外翻术(根治性软组织动员术)治疗BEEC(膀胱外翻)的儿童的前瞻性数据。当耻骨近似在手术结束时不可行时,通过相同的方法进行双侧闭孔截骨术,包括伊利奥-公共拉米的双边分裂,Iskio-pubicrami,闭塞膜,和内部闭孔肌肉的脱离。耻骨碎片在中线近似在一起。需要在热成型后夹板中固定3周。主要结果标准是6个月时的膀胱裂开率,通过物理检查进行评估。次要结果标准包括神经血管闭孔椎弓根损伤,在骨科体检期间进行分析,伤口或骨感染,步态采集,由父母报告并在体检期间进行评估,和血管阴茎损伤,通过阴茎和龟头着色来判断。
结果:17名儿童(11名男性,包括6名女性),中位年龄为2个月[1-33];在研究期间接受相同手术入路的膀胱外翻患儿中,占29%(17/58)。术后无膀胱裂开,中位随访时间为34个月[6-47]。未观察到并发症。盆腔X线显示双侧骨化过程正常。既没有步态异常,随访期间未观察到闭孔神经缺乏的临床指征。
结论:当耻骨无法逼近时,双侧闭孔截骨术是膀胱外翻闭合的有用辅助手段,儿科泌尿科医生通过同样的方法是可行的,并且不需要外部固定器。
方法:IV.
BACKGROUND: Abdominal and pelvic closure remains a challenge during bladder exstrophy initial repair. We aimed to report on the feasibility and results of a novel technique of bilateral obturator osteotomy.
METHODS: Retrospective study of prospective collected data of children who underwent single-stage delayed bladder exstrophy closure combined with RSTM (Radical Soft Tissue Mobilization) for BEEC (Bladder Exstrophy Epispadias Complex) by the same team at different institutions between December 2017 and May 2021. When pubic approximation was not feasible at the end of the procedure, bilateral obturator osteotomy was performed through the same approach, consisting in bilateral divisions of the ilio-pubic rami, ischio-pubic rami, obturator membrane, and detachment of the internal obturator muscle. Pubic bone fragments were approximated together on the midline. Immobilization in a thermoformed posterior splint was indicated for 3 weeks. The main outcome criterion was the bladder dehiscence rate at 6 months, assessed by physical inspection. Secondary outcome criteria included neurovascular obturator pedicle injury, analyzed during orthopedic physical examination, wound or bone infections, gait acquisition, reported by parents and evaluated during medical examination, and vascular penile impairment, judged by penile and glans coloration.
RESULTS: 17 children (11 males, 6 females) were included, at a median age of 2 months [1-33]; and representing 29% (17/58) of the children with bladder exstrophy who underwent the same surgical approach during the time of study. There was no postoperative bladder dehiscence with a median follow-up of 34 months [6-47]. No complication was observed. Pelvic X-rays showed bilateral normal ossification process. Neither gait abnormality, nor clinical indication of obturator nerve deficiency was observed during follow-up.
CONCLUSIONS: When pubic bones approximation is not possible, bilateral obturator osteotomy is a useful adjunct in bladder exstrophy closure, feasible by the pediatric urologist through the same approach, and not requiring external fixator.
METHODS: IV.