李雨洁 李倩 李俊

[摘要]先天性腹直肌分离症非常少见，多见于怀孕或体重剧增人群，尤以产后人群较为高发。腹直肌分离症的特征主要为腹腔内压力增加引起的中线突出，肌筋膜仍保留连续性。目前，腹直肌分离症的临床治疗手段根据程度不同有物理治疗与手术治疗，重度患者以手术治疗为主。手术治疗指征为双侧腹直肌分离宽度超过3cm并伴有腹壁外观改变、腰背疼痛症状及腹腔内脏器官膨出引起腹胀等不适。手术治疗有多种选择，包括外科手术、整形外科手术及机器人辅助手术等，其中整形外科手术凭借良好的外形修复效果而受到欢迎。不同手术方法在腹直肌分离症中的应用各有其优势与不足，且适用范围也不同。本文围绕腹直肌分离症的整形外科手术治疗进行分析，以期为腹直肌分离症的整形外科治疗提供理论参考，现综述如下。

[关键词]腹直肌分离症;外科治疗;整形技术;开放手术;腹腔镜手术

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2021）04-0169-03

Advances in Orthopedic Treatment of Rectus Separation

LI  Yu-jie，LI Qian，LI Jun

（Department of Plastic Surgery，Nanjing Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University，Nanjing 210004，Jiangsu，China）

Abstract： Congenital separation of rectus abdominis is very rare. It is more common in people with pregnancy or rapid weight gain， especially in postpartum people.The main feature of rectus separation is the midline protrusion caused by an increase in intraperitoneal pressure and the continuity of the myofascial.At present， the clinical treatment of rectus separation includes physical therapy and surgical treatment according to the degree， and surgical treatment is the main treatment for severe patients.Surgical treatment was indicated by discomfort of bilateral rectus abdominis muscle separation width exceeding 3cm， appearance change of abdominal wall， symptoms of low back pain， abdominal distension caused by abdominal viscera and organs， etc.There are many options for surgical treatment， including surgery， plastic surgery， robot-assisted surgery， etc.， among which plastic surgery is popular because of its good appearance repair effect.Different surgical methods in the separation of rectus abdominis have their own advantages and disadvantages， and the scope of application is also different.In order to provide theoretical reference for the orthopedic treatment of rectus separation， this paper focuses on the analysis of the orthopedic treatment of rectus separation. The review is as follows.

Key words： rectus abdominis dissociation;surgical treatment;open surgery;laparosc-opic surgery; plastic technology

腹直肌分離症主要表现为腹壁肌肉异常分开，腹白线增宽，腹内容物膨出。妊娠期女性随着孕周的增加，子宫逐渐增大，造成腹壁扩张延伸，使两侧腹直肌由腹中线向两侧偏移。正常情况下，腹直肌会在产后逐渐向中线靠拢，腹壁慢慢恢复。但部分女性因双胞胎、羊水过多、胎儿过大、多次生产及腹壁本身薄弱等因素出现产后腹直肌无法回到原先位置的症状，造成腹直肌分离。报道称[1]，腹直肌分离症在妊娠晚期和分娩后妇女中十分常见，妊娠35周左右发生率为100%，产后4d约62.5%产妇的腹直肌分离超过2cm，至产后6个月仍有39%～70%的女性腹直肌不能复原。……