Urethral and bladder neck injury associated with pelvic fracture in 25 female patients

PURPOSE: We describe the presentation, diagnostic evaluation, management and outcome of female urethral trauma. MATERIALS AND METHODS: All female patients treated at Harborview Medical Center between 1985 and 2001 with urethral injury were identified by International Classification of Diseases 9th revision code. Approval of the Human Subject Division was obtained and patient charts were reviewed. The Urogenital Distress Inventory Short Form, the Incontinence Impact Questionnaire Short Form and the Female Sexual Function Index were sent to the patients. RESULTS: A total of 25 patients (13 adults, 12 children) with a mean age of 22 years (range 4 to 67) met inclusion criteria. All had pelvic fracture related to blunt trauma. They represented 6% of all female patients treated in the same review period with pelvic fracture. Blood was seen at the introitus in 15 patients and 19 had gross hematuria. Of the injuries 9 were avulsions, 15 were longitudinal lacerations and 1 was not further specified. Primary repair was performed in 21 patients and 4 were treated nonoperatively. There were 5 patients who required secondary procedures including fistula repair in 4 and continent urinary diversion in 1. At a mean followup of 7.3 years (range 1.6 to 14.4) 9 of 21 patients (43%) had moderate or severe lower urinary tract symptoms and 8 of 13 (38%) had sexual dysfunction (FSFI score less than 26.55). CONCLUSIONS: Female urethral and bladder neck injury occurs with pelvic fracture, presents with gross hematuria and/or blood at the introitus, and requires operative repair for avulsions and longitudinal lacerations. These patients are at risk for significant sexual and lower urinary tract dysfunction.     

Open pelvic fracture: a lethal injury

Twenty-two of 604 patients (4%) with pelvic fracture (PF) had open fractures. Eight per cent of all pedestrian and motorcycle accidents resulted in open PF, compared to 0.8% of all vehicular accidents. With one exception, all patients sustained multiple injuries. The mortality rate for an open PF was 50%, in marked contrast to 10.5% for a closed PF. Of more importance, the pelvic fracture was the primary cause of death in 73% of those dying with an open PF and in 30% of those dying with a closed PF. The higher mortality is due to an increased risk of infection and to massive hemorrhage because of a high risk of concomitant major vessel injury, as well as increased diffuse retroperitoneal hemorrhage, in these open fractures. Therapy directed to restoring blood volume, identifying and repairing major vessel injury, and attempting to decrease the diffuse retroperitoneal hemorrhage is essential. If drainage is necessary, it should be accomplished with a closed system. Immediate colostomy and use of antibiotics should decrease the infectious complications.     

介绍一种骨盆骨折新的分类方法

随着骨盆骨折的外科技术和内固定物的发展，迫切要求有一个好的分类方法以判断伤情、指导治疗。多年来，许多学者提出了各自的分类方法，近年来的一些分类方法大都以Tile１９８０年提出的按骨折的病理形态结合损伤机制进行分类。目前国际上较流行的是Tile１９８８年提出的骨盆骨折分类法。１９９６年，瑞士医生Isler和Ganz在结合Tile分类法和１９９０提出的AO分类法的基础上，进行精练和发展，提出了骨盆骨折新的分类法。不同于Tile分类法，新的分类法以影像学为首要分类依据，以病理力学为次要依据。并且开创性的将骨盆后环与前环彻底…     

骨盆骨折与腰骶丛损伤

腰骶丛神经损伤临床较为少见,主要因其位于骨盆内,与臂丛神经易受到牵拉移位、撕裂撕脱损伤不同,其受到稳定的骨盆骨性结构保护,对一般外伤作用力的抵抗力较强。只有发生了威胁生命的高能量损伤———严重的骨盆骨折、后环断裂移位时才出现腰骶丛损伤。目前,腰骶丛损伤的诊断与处理仍是一个棘手的问题,应当予以高度重视。腰骶丛应用解剖一、腰丛及其主要分支腰丛来源于腰１、２、３神经根前支、一部分胸１２和一部分腰４。其位于腰大肌深面,脊椎横突前方（图１）。L１神经根前支向外延伸,主要构成髂腹下神经和髂腹股沟神经,尚有一…     

骨盆骨折尿道损伤的早期处理

骨盆骨折尿道损伤是泌尿外科最为棘手的难题之一,严重影响患者的生活质量。骨盆骨折尿道损伤的早期诊断和及时正确的处理至关重要。逆行尿道造影不仅可以了解有无尿道损伤,还可以明确尿道损伤的类型,是目前推荐使用的诊断方式。骨盆骨折尿道损伤早期处理方式较多,目前耻骨上膀胱造瘘术、二期尿道修复术是首选治疗方式。本文就骨盆骨折尿道损伤的早期处理方式及要点综述如下。     

骨盆骨折后尿道损伤的处理与预后(附84例报告)

目的探索骨盆骨折合并后尿道损伤的安全、有效治疗方法。方法对８４例骨盆骨折伴后尿道损伤患者采用食指引导下，直接放置带有铁芯的双腔导尿管行简化的尿道会师加牵引术，术后适时尿扩。结果全组随访８１例，其中６９例可正常排尿，治愈率为８５．２％；阳萎３例。结论在多脏器伤合并后尿道损伤中，正确应用尿道会师加牵引术，拔管后及时尿道扩张可作为首选方法。     

Open pelvic fracture: an injury for trauma centers.

Twenty-seven blunt trauma patients with open pelvic fracture who were seen in a trauma center over a 10-year period were characterized for treatment and resource consumption. Age, injury severity score, mortality, mechanism of injury, associated injuries, blood requirement, length of stay (LOS), surgical procedures, and complications were analyzed. There was a mean of 26 units of blood transfused, 9 operative procedures, and LOS of 43 days. Associated injuries were common. Aggressive hemorrhage and sepsis control, including 2 hemipelvectomies, resulted in an overall survival rate of 85%, with no mortality occurring in the last 20 patients. The reduced mortality obtained in the treatment of this highly resource consumptive injury suggests that open pelvic fracture should be managed at a trauma center, where these resources are immediately available.     

Voiding dysfunction secondary to penetrating bony fragment 20 years after pelvic fracture

We report a case of persistent voiding dysfunction caused by an unsuspected penetrating bony spicule 20 years after extraperitoneal bladder rupture and pelvic fracture.     

骨盆骨折后尿道损伤和阳萎

目的：探讨骨盆骨折后尿道并发阳萎的机制及如何避免阳萎的发生。方法：随访骨盆的后尿道损伤１８例与狭窄２５例的治疗效果。结果：后尿道损伤１８例,采用会师牵引复位术治疗,２例发生阳萎（１１．１％）;陈旧性后尿道狭窄２５例,经各种手术修复尿道后,５例发生阳萎（２０．０％）。结论：阳萎主要由骨盆骨折损伤勃起神经与血管及阴茎海绵体引起,伤后的手术操作及多次尿道复位或成形术,亦增加阳萎的发生率。     

骨盆骨折合并直肠肛管损伤的诊治

目的探讨提高骨盆骨折合并直肠肛管损伤的救治水平。方法回顾性总结１９６６～１９９６年骨盆骨折合并直肠肛管损伤１６例,采用转流性结肠造瘘与骶前引流;对合并大出血休克的病人８例在抗休克治疗的同时,早期开腹手术,结扎髂内动脉,填塞止血。结果本组治愈１３例;死亡３例,其中死于多器官衰竭（ＭＳＯＦ）２例,死于败血症１例。结论正确的早期诊断和有效的早期治疗是提高骨盆骨折合并直肠肛管损伤疗效的关键