骨盆骨折合并后尿道损伤继发性功能障碍临床诊断及治疗随访

连俊锋+邓志荣+刘建勋

[摘要] 目的 回顾性分析骨盆骨折合并后尿道损伤继发性功能障碍的致病原因，并总结治疗经验。 方法 对2010年1月～2016年1月梅州市大埔县人民医院收治的60例骨盆骨折患者的病历档案进行调阅，通过不同的骨折程度将60例患者分为A组（稳定骨折，移位轻微），患者行尿道会师牵引固定术；B组（旋转不稳定、垂直稳定骨折，累及前后环），患者行尿道端端吻合术；C组（旋转及垂直均不稳定，稳直剪力），患者行盆骨复位内固定术。通过国际勃起功能指数和夜间阴茎胀大试验对患者阴茎勃起情况进行评价。 结果 A、B、C三组损伤前和损伤后的IIEF评分以及手术治疗后和治疗6个月后的IIEF评分存在统计学意义（P<0.05）。A、B、C三组NPT结果显示三组的强度、时间、次数，三组比较差异有统计学意义（P<0.05）。在对三组术后3、6、12个月的性功能状态及生育情况进行随访，均具有统计学意义。 结论 盆骨骨折合并后尿道损伤继发性功能障碍与骨折的类型及部位有关。

[关键词] 骨盆骨折；后尿道损伤；性功能障碍；诊断治疗

[中图分类号] R683 [文献标识码] A [文章编号] 2095-0616（2017）08-199-04

[Abstract] Objective To retrospectively analyze pathogeny of pelvic fracture complicated with secondary dysfunction after urethral injury and to summarize treatment experience. Methods Medical records of 60 patients with pelvic fracture who were admitted to Dapu People's Hospital from January 2010 to January 2016 were looked into.According to different degrees of fractures，they were divided into group A （stable fracture， slight displacement），group B （rotatory instability， vertically stable fracture，involving anterior and the posterior rings） and group C （rotatory and vertical instability，stable and direct shear）.Group A was given urethral traction and fixation，group B was given urethral end-to-end anastomosis and group C was given pelvic reduction and internal fixation.Penile erection of patients was evaluated by international index of erectile function and nocturnal penile tumescence. Results IIEF scores before and after injury of group A，group B and group C were significantly different.In addition，IIEF scores before operation and 6 months after treatment were also significantly different.Differences had statistical significance （P<0.05）.NPT showed that strength，duration and times of three groups has significant difference （P<0.05）.Differences had statistical significance.During follow-up， sexual function and fertility condition of 3，6 and 12 months after operation of three groups all had statistical significance. Conclusion Pelvic fracture complicated with secondary dysfunction after urethral injury is related to type and position of fracture.

[Key words] Pelvic fracture；Posterior urethral injury；Sexual dysfunction；Diagnosis and treatment

伴隨着现代社会生活的快节奏发展，骨盆骨折合并后尿道损伤继发性功能障碍的患者也日益增加。骨盆骨折后尿道损伤是泌尿外科常见的急症之一，其包括直接损伤和医源性创伤。两者都会造成勃起功能障碍（erectile dysfunction，ED）[1]。在临床诊断中因盆骨骨折导致勃起功能障碍的发生率为54%～62%，因此勃起功能障碍也是盆骨骨折合并后尿道损伤后的常见并发症之一[2]。同样因其无确切的致病原因，进而无法准确地进行诊断，导致治疗后会对往后的生育功能造成一定的影响，对患者及患者家属造成心理创伤[3]。对此本次研究旨在对骨盆骨折合并后尿道损伤继发性功能障碍进行科学的回顾性分析，分析其致病原因。……