CAJ | 학술논문

目的探讨尿道会师同期骨盆骨折复位内固定治疗骨盆骨折合并后尿道断裂的疗效.方法自2003年12月至2009年8月,采用尿道会师同期骨盆骨折复位内固定治疗骨盆骨折合并后尿道断裂33例.全部为后尿道完全断裂.骨盆骨折按AO分类:A2型2例,B1型6例,B2型7例,B3型5例,C1型6例,C2型4例,C3型3例.12例急诊同期行尿道会师术和骨盆骨折切开复位内固定术,21例因病情危重急诊先行耻骨上膀胱造瘘、骨盆骨折外固定,病情稳定后,在早期行尿道会师术同时行骨盆骨折切开复位内固定术.结果术后随访3～63个月,平均37个月.术后76%(25/33)的患者无须尿道扩张或仅需短期尿道扩张,24%(8/33)需要进一步复杂的尿道手术治疗,尿失禁和勃起障碍发生率仅为6%(2/33)和18%(6/33),其中33%(2/6)勃起障碍者与骶神经损伤有关.末次随访骨盆骨折根据Majeed功能评分平均90.3分(66～100分),其中优24例,良8例,可1例.结论尿道会师术同期骨盆骨折复位内固定是治疗骨盆骨折合并后尿道断裂的一种创伤小、治疗周期短、疗效切实可靠、并发症低的方法.
목적 탐토뇨도회사동기골분골절복위내고정치료골분골절합병후뇨도단렬적료효.방법 자2003년12월지2009년8월,채용뇨도회사동기골분골절복위내고정치료골분골절합병후뇨도단렬33례.전부위후뇨도완전단렬.골분골절안AO분류:A2형2례,B1형6례,B2형7례,B3형5례,C1형6례,C2형4례,C3형3례.12례급진동기행뇨도회사술화골분골절절개복위내고정술,21례인병정위중급진선행치골상방광조루、골분골절외고정,병정은정후,재조기행뇨도회사술동시행골분골절절개복위내고정술.결과 술후수방3～63개월,평균37개월.술후76%(25/33)적환자무수뇨도확장혹부수단기뇨도확장,24%(8/33)수요진일보복잡적뇨도수술치료,뇨실금화발기장애발생솔부위6%(2/33)화18%(6/33),기중33%(2/6)발기장애자여저신경손상유관.말차수방골분골절근거Majeed공능평분평균90.3분(66～100분),기중우24례,량8례,가1례.결론 뇨도회사술동기골분골절복위내고정시치료골분골절합병후뇨도단렬적일충창상소、치료주기단、료효절실가고、병발증저적방법.
Objective To investigate the outcome of the urethral realignment simultaneous internal fixation in treatment of pelvic fracture associated with posterior urethral disruption. Methods The study included 33 patients with pelvic fracture associated with posterior urethral disruption treated simultaneously by urethral realignment and internal fixation from December 2003 to August 2009. According to AO classification, two patients were with type A2 fracture, six with type B1 ,seven with type B2,five with type B3 ,six with type C1 ,four with type C2 and three with type C3. All the patients were found with complete posterior urethral disruption. Primary urethral realignment combined with emergency open reduction and internal fixation of pelvic fracture were performed in 12 patients. Due to unstable condition, 21 patients underwent primary suprapubic cystostomy and external fixation, sequentially delayed urethral realignment and internal fixation.Results The mean follow-up time of all patients was 37 months ( range, 3-63 months). Of all the patients, 25 patients (76%) regained good without urethral dialation or needed only short term urethral dilatation, and eight patients (24%) suffered from urethral stricture and needed further complex surgery. The incidences of urinary incontinence and erectile dysfunction were 6%(2/33) and 18% (6/33). The erectile dysfunction of two patients was ascribed to sacral nerve injury.At the final follow-up, the mean score was 90.3 points (range, 66-100) according to the Majeed' s scoring system, which showed that the result was excellent in 24 patients, good in eight and fair in one.Conclusions Urethral realignment and simultaneous internal fixation can attain good clinical results for pelvic fracture associated with posterior urethral disruption. It takes advantages of minor surgical trauma,short treatment cycle, good outcome and low complication rate.