骨盆骨折合并阴道损伤

报道１１例女性骨盆骨折合并阴道损伤６例痊愈，２例好转，３例死亡。其致伤机理多与会阴部骑跨伤时骨折暴力传导致阴道，使阴道上下受累而致伤有关。作者认为对女性不稳定性骨盆骨折应常规做泌尿生殖道检查。早期妥善处理可有效减少并发症。     

女性骨盆骨折的严重并发症——阴道损伤

报道87例女性骨盆骨折合并阴道损伤9例(10.3%),提示阴道伤在女性骨盆骨折中并非罕见.骨盆骨折合并阴道伤造成多样、复杂的伤情,致伤机理各异.重视阴道出血等症状,常规行生殖系统检查有利于及早诊断.正确的早期处理对于防止后遗症的发生至关重要,其原则是;抢救生命,治疗骨盆骨折,合理修复阴道及邻近器官伤.     

女性骨盆骨折的严重并发症—阴道损伤

报道８７例女性骨盆骨折合并阴道损伤９例（１０．３％），提示阴道伤在女性骨盆骨折中并非罕见。骨盆骨折合并阴道伤造成多样、复杂的伤情，致伤机理各异。重视阴道出血等症状，常规行生殖系统检查有利于及早诊断。正确的早期处理对于防止后遗症的发生至关重要，其原则是：抢救生命，治疗骨盆骨折，合理修复阴道及邻近器官伤。     

骨盆骨折合并阴道损伤的早期诊断和治疗

 目的 探讨骨盆骨折合并阴道损伤的早期诊断和治疗策略。方法 回顾性分析2000年1月至2010年7月收治的13例骨盆骨折合并阴道损伤患者的病历资料,年龄17～52岁,平均31.7岁。按Tile骨盆骨折分类系统分类：B1型4例、B2型1例(Tilt骨折)、B3型4例、C1型3例、C2型1例。3例急诊行阴道损伤修复、骨盆骨折切开复位内固定术;5例血流动力学不稳定者,积极抗休克治疗,病情稳定后急诊行阴道修复、骨盆骨折外固定支架固定术;2例延迟诊断阴道损伤,确诊后及时行阴道修复术,1例行骨盆骨折切开复位内固定术,另1例行外固定支架固定术;2例因外院漏诊阴道损伤,形成盆腔脓肿,行彻底清创、骨盆骨折外固定支架固定术,待感染控制后二期行阴道重建术。结果 12例存活,1例入院后6 h死亡。11例获得随访,平均随访17个月(8~36个月)。阴道损伤一期修复的9例患者中已婚者6例,5例性生活正常,1例存在性交时疼痛;未婚者3例,月经正常。阴道损伤二期重建的2例患者,均存在性交时疼痛。末次随访时Majeed骨盆骨折术后功能评分平均82.2分(56～96分),优6例、良3例、可2例。结论 女性骨盆骨折存在骨盆前环损伤,应高度怀疑阴道损伤的可能。早期诊断并修复阴道损伤是处理的关键,可获得较好的临床效果;延误诊断和治疗可导致严重的并发症,临床效果差。     

骨盆骨折合并会阴损伤的治疗

目的探讨骨盆骨折合并会阴损伤的治疗。方法13例会阴裂伤一期清创,骨盆环骨折内固定或外固定架临时固定、二期内固定。结果无一例死亡,会阴损伤愈合良好,无感染瘘道、大小便失禁、肛门和阴道狭窄等;骨盆骨折根据Majeed疗效评价标准:优10例,良3例。结论骨盆骨折合并会阴损伤,早期清创、止血、修复、固定骨盆能降低死亡率、减少并发症。     

肠损伤合并骨盆骨折的诊治探讨

目的探讨肠损伤合并骨盆骨折的早期诊断和治疗。方法回顾性分析成功诊治肠损伤合并骨盆骨折13例,其中回肠损伤2例,乙状结肠损伤5例,直肠损伤6例,均合并骨盆损伤。结果本组无病死率,未发生严重术后并发症,远期疗效良好。结论及时、早期诊断和及早手术、选择正确术式是肠损伤合并骨盆骨折治疗的关键。     

合并骨盆骨折的腹部损伤临床分析

是否合并腹腔脏器损伤是诊治腹部创伤的要点也是难点.尤其在合并骨盆骨折时,常伴有大量失血甚至失血性休克,腹膜后血肿可引起与腹膜炎难以鉴别的腹痛[1].我院2008年9月至2011年6月诊治45例合并骨盆骨折的腹部损伤病例,分析致伤原因与脏器损伤的关系,探讨脏器损伤的早期诊断及治疗原则,以期提高抢救成功率、降低死亡率.     

骨盆骨折合并女性生殖器损伤9例报告

骨盆骨折合并女性生殖器损伤较少见,误诊率高.1987年1月至2005年1月收治73例骨盆骨折,其中合并女性生殖器损伤10例,报告如下.     

经导管动脉栓塞术在泌尿生殖道损伤大出血中的应用

骨盆骨折常伴有严重合并症,而且常较骨折本身更为严重,当损伤盆腔内血管时常可导致患者死亡。因此早期快速、有效的止血措施及对其它脏器损伤的判断尤为重要。1999年1月至2002年12月,本院在数字减影血管造影(digitalsubstractionangiography,DSA)下,经导管动脉栓塞介入技术(transcatheterarterialembolization,TAE)治疗骨盆骨折合并生殖道损伤导致大出血休克患者5例,取得了满意临床效果。现报道如下。1临床资料1.1一般资料:本组5例,女性,年龄22～37岁。损伤原因:车祸3例,高空坠落2例。损伤类型:2例单纯耻骨联合分离、耻骨支骨折伴阴道尿…     

女性骨盆骨折致下泌尿生殖道损伤的治疗体会

1992年 2月～ 1998年 7月我院收治女性骨盆骨折下泌尿生殖道损伤患者6例 ,报告如下。资料与方法　本组 6例。年龄 12～ 37岁 ,平均 30岁。拖拉机轧伤 2例 ,汽车撞伤 4例。 1例有单纯耻骨联合分离和尿道阴道撕脱伤。 5例有创伤失血性休克、骨盆骨折、腹膜后血肿和不同程度的尿道阴道损伤。其中骑跨骨折尿道断裂阴道裂伤 2例 ;骑跨骨折一侧骶髂关节分离尿道阴道撕脱伤 2例者中 1例合并骶神经损伤 ;Ｍａｌｇａｉｇｎｅ骨折合并膀胱颈部多发性裂伤、阴道裂伤、髂血管损伤、内脏破裂 1例。 1例行膀胱造瘘术 ,5例行一期修补术 ,其中阴道修补膀胱肌…     

Traumatic rupture of female urethra

Complete avulsion of the female urethra secondary to blunt trauma is uncommon. It is associated with pelvic fractures, and because of the close association of the urethra and vagina a vaginal laceration also occurs. The paucity of lesions associated with pelvic fracture may be explained by the relative mobility and shortness of the urethra in the female. The treatment of urethral trauma in females has not been established. Vaginal, transpubic, or retropubic approaches have been used successfully. We report on 3 cases of urethral trauma with anterior vaginal lacerations treated by retropubic approach with good results.     

Pelvic fracture urethral injuries in girls

PURPOSE: Injuries to the female urethra associated with pelvic fracture are uncommon. They may vary from urethral contusion to partial or circumferential rupture. When disruption has occurred at the level of the proximal urethra, it is usually complete and often associated with vaginal laceration. We retrospectively reviewed the records of a series of girls with pelvic fracture urethral stricture and present surgical treatment to restore urethral continuity and the outcome. MATERIALS AND METHODS: Between 1984 and 1997, 8 girls 4 to 16 years old (median age 9.6) with urethral injuries associated with pelvic fracture were treated at our institutions. Immediate therapy involved suprapubic cystostomy in 4 cases, urethral catheter alignment and simultaneous suprapubic cystostomy in 3, and primary suturing of the urethra, bladder neck and vagina in 1. Delayed 1-stage anastomotic repair was performed in 1 patient with urethral avulsion at the level of the bladder neck and in 5 with a proximal urethral distraction defect, while a neourethra was constructed from the anterior vaginal wall in a 2-stage procedure in 1 with mid urethral avulsion. Concomitant vaginal rupture in 7 cases was treated at delayed urethral reconstruction in 5 and by primary repair in 2. The surgical approach was retropubic in 3 cases, vaginal-retropubic in 1 and vaginal-transpubic in 4. Associated injuries included rectal injury in 3 girls and bladder neck laceration in 4. Overall postoperative followup was 6 months to 6.3 years (median 3 years). RESULTS: Urethral obliteration developed in all patients treated with suprapubic cystostomy and simultaneous urethral realignment. The stricture-free rate for 1-stage anastomotic repair and substitution urethroplasty was 100%. In 1 girl complete urinary incontinence developed, while another has mild stress incontinence. Retrospectively the 2 incontinent girls had had an associated bladder neck injury at the initial trauma. Two recurrent vaginal strictures were treated successfully with additional transpositions of lateral labial flaps. CONCLUSIONS: This study emphasizes that combined vaginal-partial transpubic access is a reliable approach for resolving complex obliterative urethral strictures and associated urethrovaginal fistulas or severe bladder neck damage after traumatic pelvic fracture injury in female pediatric patients. Although our experience with the initial management of these injuries is limited, we advocate early cystostomy drainage and deferred surgical reconstruction when life threatening clinical conditions are present or extensive traumatized tissue in the affected area precludes immediate ideal surgical repair.     

Direction sensitive sensor probe for the evaluation of voluntary and reflex pelvic floor contractions

AIMS: The development of a vaginal probe for the evaluation of the dynamics of pelvic floor function is described. Fundamental criteria in the design of this probe involves the incorporation of a means of assessing whether the isotonic forces closing the vagina are equally distributed or whether they are greater in some directions than others. The aim of this study is to present the design of directionally sensitive multi-sensor probe, having circumferential spatial resolution, constructed to identify the distribution of anisotropic forces acting on the vagina following voluntary and reflex pelvic floor contractions. MATERIALS AND METHODS: Probe system consists of four pairs of force/displacement sensors mounted on leaf springs enabling isotonic measurements of voluntary and reflex contractions. Assembly is retractable to 23 mm for insertion, and expandable to 60 mm for measurement. Simultaneous measurements were made of force and displacement with the sensors oriented in the anterior/posterior and left/right orientation of the vagina. Using this probe, measurements were carried out to identify the temporal and spatial characteristic response of the vaginal wall. Data were analyzed with respect to voluntary pelvic floor and cough-induced contractions of nine subjects having a mean age of 64 years. RESULTS: A robust probe system was developed and measurements were successfully made. Initial results show that the maximum force and displacement occurs during reflex contractions in the anterior aspect of the vagina validating the anisotropic nature of the forces acting on the vaginal wall. The data also show that both the force and displacement produced by the cough-induced has a higher magnitude than voluntary pelvic floor contraction. CONCLUSIONS: A directional multi-sensor vaginal probe has been developed to evaluate the force and displacement produced during isotonic pelvic floor contractions. Analysis of the results provided new biomechanical data demonstrating the anisotropic nature of vaginal closure as a consequence of pelvic floor contractions.     

Diagnosis and treatment of rare complications of pelvic fractures

Purpose: To enhance the awareness of rare complications of pelvic fracture and describe the correct diagnosis and effective treatment. Methods: A total of 188 cases of pelvic fractures were retrospectively reviewed, and four patients who suffered from four types of rare pelvic fracture complications were described, namely ureteral obstruction caused by retroperitoneal hematoma-induced abdominal compartment syndrome (ACS), bowel entrapment, external iliac artery injury, and open scrotal sac injury. Results: We demonstrated that combined measures should be employed to prevent the occurrence of ACS following major pelvic fractures. Ureteral catheter support may be a good option at an early stage when ACS occurred. Contrasted computed tomography examination and sufficient awareness are keys to a correct diagnosis of bowel entrapment following pelvic fractures. Recognition of risk factors, early diagnosis, and prompt treatment of suspected injury of the external iliac artery are keys to patient survival and to avoid limb loss. Scrotal and/or testicular injury complicated by pelvic fractures should be carefully treated to maintain normal gonad function. Additionally, establishment of a sophisticated trauma care system and multi-disciplinary coordination are important for correct diagnosis and treatment of rare complications in pelvic fractures. Conclusions: Rare complications of pelvic fractures are difficult to diagnose and negatively impact outcome. Recognition of risk factors and sufficient awareness are essential for correct diagnosis and prompt treatment.     

Vaginal leiomyoma as a cause of pelvic pain and cystitis cystica

Leiomyoma of the vagina occurs extremely rarely and may be confused with a variety of benign vaginal tumors. A preoperative diagnosis is seldom made. The author reports a case of leiomyoma found in the anterior vaginal wall beneath the urethra and associated with pelvic pain and urinary symptoms.     

What are the risk factors of anal incontinence after vaginal delivery?

Fecal incontinence is one of the most feared complications of vaginal delivery. It may be the consequence of sphincter tears, of pudendal neuropathy, or of a combination of the two. Fecal incontinence occurs immediately following 13-54% of vaginal deliveries but its persistence in the mid and long term is poorly known. The incidence of perineal tear with anal sphincteric defect varies from 1-9% and the incidence of unrecognized sphincter injury may be as high as 18-35%. Half the women who undergo primary anal sphincter repair have short or long term continence problems. Pudendal neuropathy is caused by nerve stretch during pushing in the second stage of labor and descent of the fetal head; it may occur even with the first delivery. Risk factors for sphincter injury and pudendal neuropathy include forceps delivery, large neonatal size, and prolonged second stage of labor. The risk of fecal incontinence must be considered even during the first pregnancy. Routine episiotomy does not prevent sphincter injury and may even predispose to it. Pudendal neuropathy following delivery may lead to delayed fecal incontinence abetted by postmenopausal hormonal deficiency and tissue senescence. The possible benefit of early episiotomy for women at high risk of sphincter injury must be evaluated by prospective studies.     

Female urethral injuries associated with pelvic fracture: a systematic review of the literature

To review systematically the literature on female urethral injuries associated with pelvic fracture and to determine the optimum management of this rare injury. Using Meta‐analysis of Observational Studies in Epidemiology criteria, we searched the Cochrane, Pubmed and OVID databases for all articles available before 30 June 2016 using the terms ‘female pelvic fracture urethroplasty’, ‘female urethral distraction’, ‘female pelvic fracture urethral injury’ and ‘female pelvic fracture urethra girls.’ Two authors of this paper independently reviewed the titles, abstracts, and articles in duplicate. We identified 162 individual articles from the databases. Fifty‐one articles met our criteria for full review, including 158 female patients with urethral trauma. Of these injuries, 83 (53%) were managed with immediate repair; 17/83 (20%) via primary alignment and 66/83 (80%) via anastomotic repair. The remaining 75/158 (47%) were managed with delayed repair. Rates of urethral stenosis and fistula were highest after primary alignment. Urethral integrity appears to be similar after both primary anastomosis and delayed repair; however, patients experienced significantly more incontinence and vaginal stenosis after delayed repair. Patients who underwent delayed urethral repair were more likely to undergo more extensive reconstructive surgery than those who underwent primary repair. The optimum management of female urethral distraction defects is based on very‐low‐quality literature. Based on our review of the available literature, primary anastomotic repair of a female urethral distraction defect via a vaginal approach as soon as the patient is haemodynamically stable appears to be optimal.     

Posttraumatic complete and partial loss of urethra with pelvic fracture in girls: an appraisal of management

PURPOSE: Urethral injury in girls accompanying fracture of the pelvis is rare. We present our experience with 5 such complex cases and review the literature to define the types of problem and determine appropriate management. MATERIALS AND METHODS: We report on 5 girls with posttraumatic urethral injuries and pelvic fracture resulting in stricture as well as management based on the site and length of urethral stricture. Associated injuries and results are discussed. RESULTS: Of the 5 girls who presented with stricture 4 had undergone suprapubic cystostomy as initial treatment, whereas in 1 primary repair had failed. Urethral reconstruction using a bladder flap tube and distal urethrotomy into the vagina were performed in 3 and 1 cases, respectively. These 4 girls were continent although 1 required clean intermittent catheterization for a short period. The 3 patients with complete urethral loss had a more severe degree of pelvic fracture, including 1 treated with core through internal urethrotomy. CONCLUSIONS: Posttraumatic urethral injury accompanying pelvic fracture in young girls results in challenging management situations. More severely displaced pelvic fracture is associated with greater urethral loss and requires more complex repair. Cases of partial urethral injury or urethral transection without much displacement are better managed by primary repair of the transected urethra, which decreases morbidity. Primary repair may not be feasible in patients with extensive injury, who should be treated with secondary appropriate reconstruction after preliminary suprapubic cystostomy. Complete urethral loss may be managed by bladder flap tube neourethra creations with effective continence and excellent outcomes. Short segment distal urethral strictures may be treated with meatotomy or core through internal urethrotomy.