摘要
目的探讨骨盆骨折合并尿道断裂的早期手术方法及其治疗效果。方法自1995年1月至2005年1月,共收治骨盆骨折合并尿道断裂患者25例。根据 Tile 的分型方法,骨盆稳定型损伤1例,旋转不稳定型损伤17例,旋转及垂直均不稳定型损伤7例。尿道完全断裂23例、部分断裂2例。手术方法包括:(1)急诊尿道吻合、尿道会师部分吻合、尿道会师、尿道阴道贯通伤修补,同期行骨盆骨折开放复位内固定术9例。(2)急诊尿道会师,延期(7～21 d)行骨盆骨折切开复位内固定术10例。(3)急诊膀胱造瘘,限期(3～21 d)行尿道会师及骨盆骨折切开复位内固定术6例。结果术后随访6～120个月,平均34个月。骨盆损伤根据 Majeed 的疗效标准,优17例,良5例,可3例。尿管拔除后,19例(76%)患者排尿通畅,最大尿流率平均为18.6 ml/s,排泄性尿路造影示尿道断端对位良好,瘢痕平均长度为0.51cm;5例(20%)出现不同程度的排尿困难,须定期扩张尿道或改行其他手术;1例(4%)女性患者不能控制排尿,须进一步治疗。术后耻骨上原发软组织撕脱伤感染伴耻骨后脓肿形成1例,后尿道狭窄5例,阳痿3例,尿失禁1例。结论骨盆骨折的早期复位和有效固定是实现"无张力尿道修复"的解剖基础。
Objective To evaluate the early operative treatment and clinical results of pelvic fractures associated with urethra disruption. Methods From January 1995 to January 2005, 25 patients suffered from pelvic fractures combined urethra disruption treated by operation were retrospectively analyzed. According to Tile＇s classification, 1 case was stable pelvic fracture, 17 rotational unstable fractures, and 7 rotational combined vertical unstable fractures. The complete urethra rupture were in 23 cases and incomplete in 2 cases. The operative methods included： （ 1 ） emergency open reduction and internal fixation of the pelvis combined primary urethra suturing in 2 cases, partial suturing after realignment in 4 cases, realignment in 2 cases, and urethrovaginal penetrating wound repairing in 1 case; （2） primary urethra realignment only and ddayed （range, 7 to 21 days） pelvic internal fixation in 10 cases; （3） early cystostomy and ddayed （range, 3 to 21 days） urethra realignment and pelvic internal fixation in 6 cases. Results The mean follow-up time of all patients was 34 months （ range from 6 to 120 months）. According to Majeed＇s evaluation, 17 cases of pelvic injury showed excellent results, 5 good, and 3 fare. After urinary catheter removed, the mean maximal urine flow rate of 19 （76%） patients was 18.6 ml/s and the mean scar length between both disrupted ends on the film of excretion urethrugraphy was O. 51 cm. Five （20%） cases suffered in dysuria needed urethreurynte or further surgery. One （4%） female could not control urination who need a second-look operation. The primary suprapubic soft tissue avulsion wound infection secondary to posteropubic abscess was found in 1 case, posterior urethra-stenosis in 5 cases, sexual impotence in 3 cases, and incontinence in 1 case. Conclusions The satisfactory reduction and effective fixation of the pelvic fractures is an anatomical basis for receiving ＂tension-free urethral anastomosis＂.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2007年第4期249-253,共5页
Chinese Journal of Surgery
关键词
骨盆骨折
尿道断裂
外科手术
Pelvic fracture
Urethra disruption
Surgical procedures,operative
