INTRODUCTION: The goal of this study was to investigate prevalence and morphometric parameters of pubic ligaments and the interpubic disk and its cavity using imaging methods for use in clinical medicine. METHODS: Pubic symphysis morphology was investigated in 652 patients (348 women and 304 men), from which 449 CT scans and 203 MR scans were available. The average age of men was 48 years and women 39 years. Investigated parameters included dimensions of the interpubic disk, visibility and width of the reinforcing ligaments, and visibility, dimensions, and location of the symphysial cavity. The results were compared with MR scans of 20 healthy volunteers and 21 dissected anatomic specimens. RESULTS: The craniocaudal, ventrodorsal, and mediolateral diameters of the pubic disk were 36 to 37.7, 14.8 to 15.2, and 2.2 to 4.2 mm in women and 42 to 42.3, 18.6 to 19, and 2.4 to 4.5 mm in men, respectively. Higher age correlated with shorter mediolateral diameter and larger craniocaudal and ventrodorsal diameters. The superior pubic ligament was visible in 93.1% of men (1.44 mm thick) and in 100% of women (1.7 mm); the inferior pubic ligament in 89.7% of men (1.74 mm) and 88% of women (1.95 mm), the anterior pubic ligament in 96.6% of men (1.5 mm) and 82% of women (1.34 mm); and the posterior pubic ligament in 65.5% of men (1.18 mm) and 63.7% of women (0.83 mm). A symphysial cavity was found in 24% of men and 22.9% of women, with craniocaudal, ventrodorsal, and mediolateral dimensions of 13, 10.7, and 3.2 mm in men and 9.5, 10.7, and 3 mm in women, respectively. CONCLUSION: The presented morphologic parameters provide an anatomic reference for diagnostics of pathologic conditions of the pubic symphysis. The following anatomic structures should be added to the official anatomic terminology: symphysial cavity (cavitas symphysialis), retropubic eminence (eminentia retropubica), anterior pubic ligament (ligamentum pubicum anterius), and posterior pubic ligament (ligamentum pubicum posterius). LEVEL OF EVIDENCE: II-III.

From the Department of Anatomy 2nd Faculty of Medicine Charles University Prague 5 Czech Republic

Zobrazit více v PubMed

His W: Die anatomische Nomenklatur. Leipzig, Germany, Veit u. Co., 1895.

FCAT: Terminologia Anatomica. Stuttgart, Germany, Thieme Verlag, 1998.

Testut J, Latarjet A: Traite d´anatomie humaine, ed 8. Paris, France, Gaston Doin et Cie, 1928.

Putschar WGJ: The structure of the human symphysis pubis with special consideration of parturition and its sequelae. Am J Phys Anthrop 1976;45(3 pt 2):589-594.

Fridrich F, Báča V, Džupa V: Infectious inflammation of pubic symphysis (symphysitis pubis purulenta): Five case reports and literature view. Acta Chir Orthop Traumatol Cech 2016;83:411-417.

Vix VA, Ryu CY: The adult symphysis pubis: Normal and abnormal. Am J Roentgenol Radium Ther Nucl Med 1971;112:517-525.

Sgambati E, Stecco A, Capaccioli L, Brizzi E: Morphometric evaluation of the Symphysis pubis joint. Ital J Anat Embryol 1996;101:197-201.

Drake R, Vogl AW, Mitchell AWM: Gray's Anatomy, ed 39. Amsterdam, the Netherlands: Elsevier Books, 2019, pp 1439.

Bourgery JBM, Jacob NH: Traité complet de l'anatomie de l'homme: comprenant la médicine opératoire (Band 1, Text): Anatomie descriptive ou physiologique, appareil de relation, organes de locomotion: ostéologie, syndesmologie. Paris, France, Delaunay CA, 1832, pp 159.

Cruveilhier J: Anatomie descriptive, vol. 1. Paris, France, Imprimerie de Félix Loncquin, 1834, pp 449.

Luschka H: Die Halbgelenke des menschlichen Körpers. Berlin, Germany, Reimer, 1858.

Schilders E, Bharam S, Golan E, et al.: The pyramidalis-anterior pubic ligament-adductor longus complex (PLAC) and its role with adductor injuries: A new anatomical concept. Knee Surg Sports Traumatol Arthrosc 2017;25:3969-3977.

Matta JM, Tornetta P III: Internal fixation of unstable pelvic ring injuries. Clin Orthop Relat Res 1996;329:129-140.

Meissner A, Fell M, Wilk R, Boenick U, Rahmanzadeh R: Zur Biomechanik der Symphyse. Welche Kräfte führen zur Mobilität der Symphyse unter physiologischen Bedingungen? Unfallchirurgie 1996;99:415-421.

Pohlemann T, Bosch U, Gänsslen A, Tscherne H: The Hannover experience in management of pelvic fractures. Clin Orthop Relat Res 1994;305:69-80.

Routt ML Jr, Nork SE, Mills WJ: High-energy pelvic ring disruptions. Orthop Clin North Am 2002;33:59-72.

Becker I, Woodley SJ, Stringer MD: The adult human pubic symphysis: A systematic review. J Anat 2010;217:475-485.

Todd TW: The pubic symphysis of the guinea-pig in relation to pregnancy and parturition. Am J Anat 1923;31:345-357.

Wang J, Cao L, Wu J, Wang Q, Bi C: Clinical and radiological short-term outcomes of pubic symphysis diastasis treated with modified pedicle screw-rod fixation. Eur J Trauma Emerg Surg 2020;46:865-871.

Garras D, Carothers JT, Olson SA: Single-leg-stance (flamingo) radiographs to assess pelvic instability: How much motion is normal?. J Bone Joint Surg Am 2008;90:2114-2118.

Stover M, Eledstein AI, Matta JM: Chronic anterior pelvic instability: Diagnosis and management. J Am Acad Orthop Surg 2017;25:509-517.

Woerdeman MW: Nomina anatomica parisienssia (1955) et BNA (1895). Utrecht, the Netherlands, Ossthoek, 1957.

Yao F, He Y, Qian H, Zhou D, Li Q: Comparison of biomechanical characteristics and pelvic ring stability using different fixation methods to treat pubic symphysis diastasis: A finite element study. Medicine (Baltimore) 2015;94:e2207.

Alicioglu B, Kartal O, Gurbuz H, Sut N: Symphysis pubis distance in adults: A retrospective computed tomography study. Surg Radiol Anat 2008;301:153-157.

Agten CA, Megtzler C, Rosskopf AB, et al.: MR imaging of pubic symphysis after uncomplicated vaginal delivery and planned caesarean delivery in the first postpartum week. Clin Imaging 2019;56:58-62.

Gamble JG, Simmons SC, Freedman M: The symphysis pubis, anatomic and pathologic considerations. Clin Orthop Relat Res 1986;203:261-272.

Gibbon WW, Hession PR: Diseases of the pubis and pubic symphysis: MR imaging appearances. Am J Roentgenol 1997;169:849-853.

Kalenderer O, Turgut A, Bacaksız T, Bilgin E, Kumbaracı M, Akkan HA: Evaluation of symphysis pubis and sacroiliac joint distances in skeletally immature patients: A computerized tomography study of 1020 individuals. Acta Orthop Traumatol Turc 2017;51:150-154.

Kunduracioglu B, Yilmaz C, Yorubulut M, Kudas S: Magnetic resonance findings of osteitis pubis. J Magn Reson Imaging 2007;25:535-539.

Lewton KL, Dingwall HL: Morphological convergence in the pubis of slow-moving primates and xenarthrans. Am J Phys Anthropol 2016;161:381-397.

Wurdinger S, Humbsch S, Reichenbach JR, Peiker G, Seewald HJ, Kaiser WA: MRI of the pelvic ring joints postpartum: Normal and pathological findings. J Magn Reson Imaging 2002;15:324-329.

Fitzerald CM, Mallinson T: The association between pelvic girdle pain and pelvic floor muscle function in pregnancy. Int Urogynecol J 2012;23:893-898.

Lee SC, Endo Y, Potter HG: Imaging of groin pain: Magnetic resonance and ultrasound imaging features. Sports Health 2017;9:428-435.

Drężewska M, Śliwiński Z: Lumbosacral pain in ballet school students. Pilot study. Ortop Traumatol Rehabil 2013;1:149-158.

Sutro CJ: The pubic bones and their symphysis. Arch Surg 1936;32:823-841.

Kachlik D, Musil V, Baca V: Contribution to the anatomical nomenclature concerning lower limb anatomy. Surg Radiol Anat 2017;40:537-562.

Lenoir JCP: Mémoire sur les articulationes propres du bassin de la femme adulte, suivi d’une théorie nouvelle sur l’écartement des os de cette cavité pendant la grossesse et aprés l’accouchement. B Acad Nat Med Paris 1850-1851;16:655.

Zaglas: On the symphysis and its contained cavity. Moth Jour Med Sci 1851;13:489-491.

Henle J: Handbuch der Bänderlehre, ed 2. Braunschweig, Germany, Vieweg and Son, 1872, pp 121-125.

Wiliams JL: Gas in the symphysis pubis during and following pregnancy. Am J Roentgenol Radium Ther Nucl Med 1955;73:403-409.

Tenon. Sur les os du bassin de la femme. Mémoires de l’Institut des sciences, lettres et arts (Paris), 1806;6:149.