レ線骨盤形態の臨床的研究 主として骨盤峽出口について
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概要
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Morphological studies of pelvic shape were examined on 2250 cases of primi-and multigravid women by the X-ray film of pubic arch, lateral shape and inlet of pelvis. Also, course of delivery with regard to the pelvic contration and outlet were scrutinized statistically.<BR>Morphological findings.<BR>Findings of the pelvic arch were classified in 5 types, i. e. wide form, regular or standard form, moderately and extremely narrow and sharp triangle form, obtaining 16.7 %, 62.7 %, 15.1 % 4.0 % and 1.5 % in order.<BR>Shape of sacrum and pelvic inlet were classified by the methods of Guthmann and Martius.<BR>The wide form of pelvic arch is related to the platypelloid type of inlet statistically, regular form to gynecoid type and narrow formed to anthropoid type.<BR>High incidence of abnormality of sacral shape were found in the group of narrow typed pelvic arch. Increased pelvic depth were often observed in subjects with linear sacrum, second promontory pelvis and long pelvis.<BR>Mean and deviation of varying conjugation, angle and area of pelvic contraction and outlet were obtained by the measurement of pelvic arch on 796 cases of primigravid women and of lateral side of pelvis on 1123 cases.<BR>It seemed to be high in frequency in subjects with aged over 30 years old and with less than 150 cm of height.<BR>Following correlations were obtaind by the measurement, the height to intertuberous distance and subpubic angle, the intertuberous distance to the one between the great trochanters and also between the crista by external pelvinetry, intertuberous distance to obstetrical true conjugate, the sidest transverse diameter of the inlet, the anteroposterior diameter of the midplane and posterior sagittal contraction, the subpubic angle to the available anteroposterior diameter of the pelvic outlet and the latter one to the anteroposterior diameter of the pelvic contraction. The negative correlation was obtained between the subpubic angle and pelvic depth.<BR>Findings related to the clinical aspects.<BR>Studies on relationship between the shape of pelvic arch and course of labor were investigated in 1040 cases of primigravid vertex presentation.<BR>Caesarian section, vacuum delivery and forceps labor were found to be high in incidence in the group of narrow typed pelvic arch. In 72 cases with primigravid breech presentation, it seemed to be necessary to perform caesarian section generally, when those showed similar shape. Much longer time for second stage of delivery in above subjects were required than those with regular form.<BR>Lowest point for incidence as to occurrence of abnormal delivery was figured out upon measuring the varying conjugation, angle and area of pelvic contraction and outlet.<BR>It is rather significant to evaluate the process of delivery by the size of fetus in addition to the size and shape of pelvis. Therefore, pelvis-fetus index and pelvis uterine height index was figured out by the size of fetus and pelvis, and obtained the lowest point for incidence of abnormal delivery.<BR>Further more, morphological studies of pelvis were performed in subjects with abnormality of fetal attitude and rotation and with post -morten delivery.
- 学校法人 昭和大学・昭和医学会の論文