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PubMed1983

Mechanical analysis of the human pelvis and its application to the artificial hip joint--by means of the three dimensional finite element method.

Mechanical analysis of the human pelvis and the hip joint was performed by means of a three-dimensional finite element method by ASKA program. Two models each standing on one leg were made, one was the pelvis with the physiological hip joint, in the other pelvis part of the cartilage and subchondral bone was replaced with Al2O3 ceramic materials. In this study, we obtained; (1) the various deformations and displacements of the whole pelvis, the pelvic ring and the acetabulum and (2) the principal stress, the maximum shear stress and the Von mises stress on the surface of the whole pelvis and in various horizontal sections of the whole pelvis.

Biomechanical Phenomena↗
PubMed1996

Angular movements of the lumbar spine and pelvis can be reliably measured after 4 minutes of treadmill walking.

OBJECTIVE: To determine the familiarization period required to obtain consistent measurements of the angular movements of the lumbar spine and pelvis during treadmill walking. DESIGN: An in vivo study with repeated measures every 2 min over 10 min. BACKGROUND: Walking on a treadmill can initially be an unfamiliar experience. No data were available to indicate the length of time required for treadmill familiarization prior to taking measurements of the angular movements of the lumbar spine and pelvis. The familiarization period has implications for the use of this technique in clinical testing. METHODS: The angular movements of the lumbar spine and pelvis were examined by thePEAK 3D motion measurement system in 16 untrained, normal subjects walking for 10 min on a treadmill at either self-selected or 60% of self-selected speed. RESULTS: The reliability of the angular measurements of the spine and pelvis were all greater than 0.83 (ICC) after 4 min of treadmill walking and did not appear to increase after 4 min. No changes in the amplitudes of the angular movements of the lumbar spine and pelvis could be detected after 4 min of treadmill walking, or of the absolute difference scores beyond 2 min of treadmill walking, in either normal or slow-speed walking groups. CONCLUSIONS: Angular movements of the lumbar spine and pelvis were consistent after 4 min of treadmill walking by normal subjects, both at self-selected and slow walking speeds, indicating that reliable measurements of these parameters could be taken at that time.

Journal Article↗
PubMed1999

Angular movements of the pelvis and lumbar spine during self-selected and slow walking speeds.

We studied the effect of walking at a self-selected and at a slower speed on the angular movements of the pelvis and lumbar spine. We also studied how interpretation of speed effects on lumbar spine movements was influenced by frame of reference, either relative to the pelvis or relative to a global reference frame. Twenty-seven subjects without pathology walked on a treadmill at either self-selected or 60% of self-selected speed. The movements of the pelvis and lumbar spine, as represented by surface markers, were recorded by videocameras and the three-dimensional angles computed by the PEAK motion measurement system. Results indicated that the amplitudes of pelvic list (P<0.05) and pelvic axial rotation (P<0. 05) were decreased at slow walking speed. Relative to the pelvis, the amplitude of lumbar lateral flexion was decreased with slower walking (P<0.01). In contrast, when lumbar spine movements were measured relative to a global reference frame, no differences were detected due to decreased walking speed. This suggests, firstly, that the effect of walking speed when evaluating the significance of decreased movements of the pelvis and of the lumbar spine (relative to the pelvis) of subjects walking at slower than self-selected speeds should be considered and secondly, that movement of the lumbar spine should be interpreted with respect to a frame of reference.

Adult↗
PubMed2005

Subject-specific finite element model of the pelvis: development, validation and sensitivity studies.

A better understanding of the three-dimensional mechanics of the pelvis, at the patient-specific level, may lead to improved treatment modalities. Although finite element (FE) models of the pelvis have been developed, validation by direct comparison with subject-specific strains has not been performed, and previous models used simplifying assumptions regarding geometry and material properties. The objectives of this study were to develop and validate a realistic FE model of the pelvis using subject-specific estimates of bone geometry, location-dependent cortical thickness and trabecular bone elastic modulus, and to assess the sensitivity of FE strain predictions to assumptions regarding cortical bone thickness as well as bone and cartilage material properties. A FE model of a cadaveric pelvis was created using subject-specific computed tomography image data. Acetabular loading was applied to the same pelvis using a prosthetic femoral stem in a fashion that could be easily duplicated in the computational model. Cortical bone strains were monitored with rosette strain gauges in ten locations on the left hemipelvis. FE strain predictions were compared directly with experimental results for validation. Overall, baseline FE predictions were strongly correlated with experimental results (r2=0.824), with a best-fit line that was not statistically different than the line y=x (experimental strains = FE predicted strains). Changes to cortical bone thickness and elastic modulus had the largest effect on cortical bone strains. The FE model was less sensitive to changes in all other parameters. The methods developed and validated in this study will be useful for creating and analyzing patient-specific FE models to better understand the biomechanics of the pelvis.

Aged↗
PubMed1999

[Significance of score systems in open complex trauma of the pelvis].

A quantitative analysis of the injury severity of 40 patients with open pelvic fractures was performed. Data were analyzed using the Statistical-Analysis-System (SAS Institute Inc., Cary, NC) with regard to patients' age, gender, trauma mechanism, classification and nature of the pelvic injury, associated lesions, and mortality. Trauma-scoring included the Hannover-Polytrauma-Score [11], the Pelvis-Fracture-Scale [2] and the Pelvis-Score [19]. Five patients died. The survivors had a mean Polytrauma-Score of 34.1, the nonsurvivors had a mean Polytrauma-Score of 44.6 (p = 0.7; Mann-Whitney-test). The nonsurvivors required highly significant more units of blood transfusions than the survivors (49.4 vs. 14.1; p = 0.003; Mann-Whitney-test). The loss of blood was related to the severity of the injury according to the Polytrauma-Score. There was no significant difference in the Pelvis-Fracture-Scale of survivors and nonsurvivors. Neither there was a significant correlation between the fracture type and the Polytrauma-Score nor between the fracture type and the mortality. The Pelvis-Score--with the variable "bleeding" defined as "major vessel lesion"--was significantly higher in the nonsurvivors than in the survivors (12.0 vs. 4.9; (p = 0.04; Mann-Whitney-test). In conclusion, in this retrospective study the Polytrauma-Score and the Pelvis-Score proved effective regarding some important aspects of the prognostic estimation of the general injury and the pelvic trauma, respectively. The Hannover-Pelvis-Fracture-Scale allows an exact documentation of the pelvic trauma as it pays proper attention not only to the fracture classification but especially to the soft tissue damage.

Adolescent↗
PubMed1992

[Treatment of the pelvis after total pelvic exenteration. Experience of the Regional Paul Strauss Cancer Center of Strasbourg].

Intestinal morbidity after total pelvic exenteration presents usually as fistulae. These appear particularly if irradiation has been carried out in the pelvis or the abdomen before surgery, and particularly as a result of the types of surgery carried out in the emptied pelvis. An analysis of 92 exenterations of the pelvis of which 52 were total exenterations led us to look at how treatments in the pelvis have evolved technically and to analyse the contribution they have made to reducing the number of fistulae and obstructions found as a result of this major surgery. Making a "sac" by packing the pelvis as suggested by the pioneer of this exceptionally extensive pelvic surgery gradually has been replaced by the use of endogenous material such as the omentum and more recently by the use of absorbable synthetic materials (vicryl) which give rise to progressive reperitonealisation. The authors approve of this last way of dealing with the emptied pelvic cavity because the synthetic material is very well tolerated clinically and the polyglactine 910 mesh is not predisposed to infection when it is used to make a hammock to prevent chronic radiation enteritis by holding the small intestines out of the pelvis.

Cancer Care Facilities↗
PubMed1991

[The prognostic importance of ultrasonic pelvimetry in anatomically contracted pelvis].

The lesser pelvis parameters measured by ultrasonic pelvimetry are characterized by different prognostic value for the functional assessment of various anatomic forms of contracted pelvis. Direct dimensions of the lesser pelvis, a difference of direct size of the orifice and fetal head biparietal size, and the pelviocranial index are prognostically the most valuable for patients with generally contracted pelvis. The same parameters are valuable for cases with Deventer's pelvis, and the sacrum flattening index value is also significant here. This latter characteristic is the only one prognostically valuable for cases with mesatipellic pelvis, permitting the prediction of possible labor complications.

Adult↗
PubMed1993

The misrepresentation of the human pelvis.

A representative series of illustrations of the human bony pelvis dating from the sixteenth century to the present is used to demonstrate the persistent misrepresentation in the orientation of the pelvis and in the nomenclature. Early erroneous concepts were probably strongly reinforced by publications of the Belgian anatomist Vesalius in the sixteenth century. In mounting the vertebrae on a vertical iron rod, he erased much of the sacral curvature and, as a consequence, the orientation of the rest of the pelvis was distorted. True versions of the pelvis were executed by Leonardo da Vinci before the time of Vesalius but these drawings were apparently among those that were lost for many years. A relatively small number of similarly accurate depictions of the bony pelvis have appeared down through the centuries and some of these are also included. A persistent error in many anatomical textbooks used today presents a modified inferior view of the pelvis as the "front view" and a nearly accurate front view as a "view from above." No definitive conclusion can be reached concerning the reason(s) for the remarkably long persistence of this error. The figures referenced are presented in the Gallery immediately following this article.

History, 15th Century↗
PubMed2004

Variability in dilatation of the fetal renal pelvis during a bladder filling cycle.

OBJECTIVE: To investigate the variation in the dimensions of the fetal renal pelvis in relation to the degree of bladder filling in fetuses with mild pyelectasis. METHODS: Eighteen third-trimester pregnant women with mild uni- or bilateral fetal pyelectasis, defined as an anteroposterior (A-P) diameter of the renal pelvis between 5 and 10 mm, were recruited for the study. The women were examined for 2-3 h by ultrasound. The A-P and transverse dilatation of the renal pelvis and the bladder dimensions (to calculate fetal bladder volume) were measured at 2-3-min intervals. Postnatally, all infants were investigated by ultrasound at 3-4 months. RESULTS: In 6/18 fetuses a consistent relationship between the size of the renal pelvis and bladder filling was found, with a mean difference in renal pelvic diameter before and after voiding of 6.7 mm and a largest observed difference of 14.3 mm. In 12/18 fetuses no such relationship was found. Postnatally, five infants were referred to a pediatric urologist. The investigations in these five infants could not confirm the hypothesis that variation in renal pelvic size in relation to bladder size may predict prenatal vesicoureteric reflux (VUR). CONCLUSIONS: In mild pyelectasis the size of the renal pelvis is highly variable in one-third of cases. The association with bladder volume and micturition suggests evidence of VUR, but this could not be proven. If cut-off values are used to differentiate between normal and abnormal renal pelvic size then not only gestational age but also the degree of bladder filling at the time of measurement should be taken into account. Caution should be expressed when the diagnosis of a possible urological anomaly is based on a single measurement during just one investigation.

Female↗
PubMed2005

Pelvi-calyceal height, a predictor of success when treating lower pole stones with extracorporeal shockwave lithotripsy.

Extra corporeal shockwave lithotripsy (ESWL) is the treatment of choice for the majority of renal stones, however, it has the lowest success rate in complete clearance of stones located in the lower pole. We assess whether pelvi-calyceal height is a useful measurement in predicting successful stone clearance from the lower pole. A total of 105 patients with a solitary lower pole calculus of less than 20 mm treated with ESWL were reviewed. Stone size, location and pelvi-calyceal height were measured by intravenous urogram. Success was defined as complete stone clearance. Fifty-four patients (51.4%) had successful treatments, with the remaining 51 (48.6%) having incomplete stone clearance (including two patients in whom treatment had no effect). There was a statistically significant difference (P<0.0001) in pelvi-calyceal height between the two groups. Mean pelvi-calyceal height in patients with complete stone clearance was 15.1 mm (SD=3.9) compared with 22.9 mm (SD=5.2) for those with incomplete clearance. Pelvi-calyceal height is a useful predictor of success when treating lower pole renal stones with ESWL.

Adult↗
PubMed2005

Aging affects coordination of rapid head motions with trunk and pelvis movements during standing and walking.

The head, containing the gravity sensors (vestibular system) and the visual system, must be stabilized in space to provide a steady reference. During walking, the head also needs to be free to move to allow scanning of surrounding objects and steering of locomotion. With aging, deteriorations in motor and sensory systems and their integration are commonly observed. Nevertheless, the strategies used by elderly subjects to complete challenging tasks that require precise sensorimotor integration, such as turning the head rapidly during gait, is not known. The objective of this study was to determine the effects of aging on the movement coordination of the head, trunk and pelvis when executing a rapid head motion in response to a visual signal. Elderly and young subjects turned their head rapidly (up, down, left, right or none) in response to a visual signal, during standing and walking. The 3-D positions of head, trunk and pelvis were recorded and analyzed. All subjects, young and old, successfully performed the task during both standing and walking without any loss of balance. Postural stability was maintained as large head motions were accompanied by relatively small trunk and pelvis movements. Horizontal plane movements associated with right and left head turns were significantly larger than sagittal plane movements associated with head up and down motions. Head motions were significantly slower and smaller in elderly subjects, and resulted in disrupted horizontal plane trunk-pelvis coordination during walking. We conclude that head, trunk and pelvis movements are coordinated in a task-dependent manner such that their movement amplitudes induced by rapid voluntary head motions are larger in walking than in standing. This task-dependent movement coordination is affected by aging.

Adult↗
PubMed2004

Pregnancy outcomes after abdominal irradiation that included or excluded the pelvis in childhood Wilms tumor survivors: a report from the National Wilms Tumor Study.

PURPOSE: This report describes the pregnancy outcomes among 7 survivors of childhood Wilms tumor, who were treated on one of the National Wilms Tumor Studies (NWTS) with radiation therapy (RT) portals that extended beyond the flank. METHODS AND MATERIALS: Pregnancy outcomes among female survivors of childhood Wilms tumor treated with abdominal irradiation in NWTS 1-4 were analyzed as part of the long-term follow-up study. Medical records and maternal questionnaires were used to gather information on pregnancy outcomes. RESULTS: A total of 130 patients received abdominal RT and survived to at least 15 years of age. Seven patients (5.4%) had at least 1 recorded pregnancy. The extent of RT fields was ascertained in 126 patients. For 4 patients, the extent of RT fields could not be determined. Twelve girls received RT using portals that included the upper abdomen but not the entire pelvis. Ten pregnancies were recorded in 5 of these patients; 9 resulted in live births, and 1 resulted in a miscarriage. One hundred fourteen girls received RT using portals that included the entire abdomen and pelvis. The abdominal RT dose distribution among these 114 patients was as follows: 9 received 0-10.49 Gy, 22 patients received 10.5-14.99 Gy, and 83 patients received 15+ Gy. Four pregnancies were recorded in 2 of these patients. After 21 Gy to the abdomen and pelvis in 1 patient, all 3 pregnancies resulted in miscarriages and fetal deaths. However, after 10.5 Gy, a normal live birth was reported in the other patient. Pregnancy-related complications were also more common if the RT portals included the pelvis. CONCLUSIONS: Fertility can be preserved in children with Wilms tumor after upper abdominal RT (10-20 Gy) that does not include the entire pelvis. In rare instances, fertility can be preserved after low-dose whole-abdominal RT (10.5 Gy). The indications and dosages for RT currently used have been greatly refined compared to NWTS-1 and NWTS-2. Childhood Wilms tumor survivors should be considered to be at a high risk for infertility and pregnancy-related complications during their reproductive years. Prompt obstetric evaluation is indicated for optimal prenatal, antenatal, and postnatal care.

Abortion, Spontaneous↗
PubMed1983

The echography of pelvi-ureteric junction obstruction in children.

The echographic appearances seen in 47 children with dilatation of the pelvi-calyceal system but not ureter, in whom the diagnosis of pelvi-ureteric junction obstruction was strong enough to lead to surgical correction, were classed into two categories. Those children in whom the antero-posterior diameter of the pelvi-calyceal system exceeded 10 mm were classed as being 'suspicious' (of pelvi-ureteric junction obstruction). When dilatation of the pelvis was accompanied by dilatation of the calyces this appearance was classed as 'definite'. There was a high false positive rate but a very low false negative rate. A simple water load stress test performed in 17 children helped to decrease the false positives from 16 to 10 but the high false positive rate in the 'definite' group stresses the need for subsequent functional studies. Ultrasound is concluded to be a worthwhile screening test to select children requiring functional studies.

Child↗
PubMedDate not supplied

Gait in patients with pregnancy-related pain in the pelvis: an emphasis on the coordination of transverse pelvic and thoracic rotations.

OBJECTIVE: To quantify gait impairments in women with pregnancy-related pain in the pelvis which persisted post-partum.Design. Nine patients and nine healthy subjects were studied during treadmill walking at different velocities. BACKGROUND: Walking problems in patients with pregnancy-related pain in the pelvis have been known to exist for a long time. To date, no quantitative gait studies have been conducted in this population. METHODS: Maximum attainable walking velocity was determined, amplitudes of pelvic and thoracic rotations were calculated, and spectral analysis was used to assess the harmonicity of these rotations. Coordination between pelvic and thoracic rotations was characterized as mean relative Fourier phase and weighted coherence. RESULTS: Maximum attainable walking velocity was highly variable between patients, but on average significantly lower than in healthy controls. Moreover, patients had a significantly lower mean relative Fourier phase (again, highly variable) and higher weighted coherence. The other parameters did not differ significantly between groups. CONCLUSIONS: Coordination between pelvic and thoracic rotations in the transverse plane was affected in patients with pregnancy-related pain in the pelvis. Individual patients may apply different strategies during walking to cope with the underlying problems. RELEVANCE: Pregnancy-related pain in the pelvis is poorly understood. Patients with this condition are known to have problems with locomotion. The present study reveals that gait coordination is altered. Theoretically, this underlines the importance of analysing coordination in pathological movement. Clinically, better understanding the gait problems of women with pregnancy-related pain in the pelvis may contribute to more appropriate treatments.

Adult↗
PubMed1997

Neurokinin A in rat renal afferent neurons and in nerve fibres within smooth muscle and epithelium of rat and guinea-pig renal pelvis.

Neurokinin A-like immunoreactivity of dorsal root ganglion neurons innervating the kidney were studied with retrograde tracing of FluoroGold dye applied to the cut renal nerves. The proportions and sizes of renal afferent neurons with neurokinin A-like immunoreactivity were quantified in T9-L2 dorsal root ganglia from five rats. Of 240 renal afferent neuronal somata examined, 26 +/- 3% (S.E.M.) showed neurokinin A-like immunoreactivity. Compared with the overall size distribution of renal afferent neurons, those staining for neurokinin A were mostly small-sized neurons with a few medium-sized neurons. All somata with neurokinin A-like immunoreactivity were neurofilament-poor as judged by labelling with an anti-neurofilament antibody, RT97, and it is therefore likely that they had unmyelinated fibres. To examine the sites to which the renal afferent fibres with neurokinin A might project, sections of rat and guinea-pig kidney and upper ureter were examined. Fibres with neurokinin A-like immunoreactivity were found beneath and within the transitional epithelium lining the inner surface of the pelvis, and within the smooth muscle layer beneath the transitional epithelium. Epithelial innervation was found only in regions with underlying smooth muscle and loose connective tissue, and not in sites where the epithelium was closely applied to the renal parenchyma. The network of fibres was most dense towards the pelvo-uretic junction. Fibres with neurokinin A-like immunoreactivity were not seen beneath or within the cuboidal/columnar epithelium covering the papilla within the renal pelvis. Furthermore, only very few fibres with neurokinin A were observed penetrating the transitional epithelium of the upper ureter in both rat and guinea-pig. The distribution of fibres labelled with antibodies to substance P and calcitonin gene-related peptide in the renal pelvis was similar to that for fibres with neurokinin A-like immuno-reactivity, although a few fibres penetrated further into the fornices than fibres with neurokinin-A-like immunoreactivity. Thus, many afferent fibres in the renal pelvis may contain neurokinin A as well as substance P and calcitonin gene-related peptide. These fibres may be the source of the neurokinin A, substance P and calcitonin gene-related peptide which can be released by topical capsaicin treatment. In addition they may be the mechano- and chemo-receptive fibres in the renal pelvis that are known to play important roles in renal haemodynamics. The intra-epithelial position of some of these fibres in the epithelial layer suggests a possible chemosensory or osmosensory role.

Animals↗
PubMed1998

Sports injuries in the pelvis and hip: diagnostic imaging.

We discuss the role of imaging techniques in examining the athletes with sports injuries involving the pelvis and the hip. Pelvis and hip pain is of difficult clinical clarification because of the various athletic injuries which may affect the bone or soft tissues at different anatomic sites. Moreover, the symptoms of pelvis and hip injuries are similar in most cases and they are often diffuse and atypical. Diagnostic imaging can play an essential role because treatment success depends on a correct diagnosis and these techniques can actually differentiate the most frequent causes of pelvis and hip sports injuries such as groin strain, osteitis pubis, ischial intersection syndrome, snapping hip, stress fractures, hernias and avulsion fractures. Finally, we discuss the role of magnetic resonance imaging in detecting the causes of hip pain other than sports injuries, such as avascular necrosis, reflex sympathetic dystrophy syndrome, herniation pit, acetabular labrum injuries. To conclude, diagnostic imaging techniques currently permit the direct and noninvasive depiction of pelvis and hip conditions. Particularly, magnetic resonance imaging is very helpful in detecting injury site, extent and characteristics; it can also predict the time period an athlete will be disabled and help define the best treatment planning.

Athletic Injuries↗
PubMed1983

Computed tomography of the pelvis in patients with multiple injuries.

The extent of osseous pelvic injury in patients suffering multiple organ trauma is difficult to assess. However, accurate information is essential in order to determine an acceptable treatment regimen, either operative (external or internal fixation), or nonoperative (bed rest and early ambulation). Twenty consecutive patients were treated for pelvic fractures from January 1981 through February 1982. All patients had multiple organ injuries, (average = 3.5 organ systems per patient). Each patient had an A-P X-ray projection of the pelvis in the emergency department (E.D.) as a part of the initial evaluation. Three patients (15%) required immediate laparotomy for associated abdominal injuries. Six patients (30%) required prolonged ventilatory support for pulmonary injuries. Computed tomography (CT) of the pelvis was performed on all patients within 4 days of admission. In seven patients, CT examination confirmed the findings of the routine X-rays obtained in the E.D. In 13 patients the CT examination demonstrated significant additional fractures of the pelvis which were not initially demonstrated in the E.D. A consistent pattern of either sacral fracture or injury to the sacroiliac joint which was not appreciated on the initial E.D. X-rays was demonstrated in these 13 patients. Six patients underwent operative intervention, four with Hoffmann frames (external fixation), and two with reduction and internal fixation. CT examination of the pelvis provides a rapid and thorough evaluation which is extremely useful in demonstrating all the fractures of the pelvis on the single examination, thereby allowing the early determination of the best treatment plan for patients with such major injuries.

Accidents, Occupational↗
PubMed2005

Elastin content of the renal pelvis and ureter determines post-pyeloplasty recovery.

PURPOSE: We evaluated the collagen-to-smooth muscle tissue matrix ratio and percentage of elastin in the renal pelvis, ureteropelvic junction (UPJ) and ureter, and compared these findings with the degree of obstruction, patient age and post-pyeloplasty renal recovery. MATERIALS AND METHODS: We analyzed histological sections from 75 patients with UPJ obstruction. Nine patients were excluded owing to bilateral UPJ obstruction and an improper specimen. We divided the specimen obtained from pyeloplasty into 3 parts, namely the renal pelvis above the obstruction, the obstructed UPJ portion and the ureter below the obstruction. To examine the collagen and smooth muscle, sections were stained using Masson's trichrome, and elastic van Giesson stain was used for elastin, smooth muscle and collagen. Collagen, smooth muscle and elastin populations were identified, and the tissue matrix ratio and percentage of elastin were calculated by color image analysis. RESULTS: In patients with lower ratios of collagen-to-smooth muscle in the UPJ proper hydronephrosis was more improved postoperatively (p = 0.049). In patients with a lower percentage of elastin in the renal pelvis, UPJ and ureter hydronephrosis was more improved postoperatively (p <0.0001). CONCLUSIONS: Because the UPJ portion was resected during pyeloplasty, the renal pelvis and the ureter remaining after pyeloplasty are likely to be related to improved hydronephrosis. A higher percentage of elastin in the renal pelvis and ureter contributes to inelasticity and low compliance, and results in a slower recovery from hydronephrosis after pyeloplasty.

Adolescent↗