论文部分内容阅读
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 explore the early surgical treatment of pelvic fractures associated with urethral rupture and its therapeutic effect. Methods From January 1995 to January 2005, a total of 25 patients with pelvic fractures complicated by urethral rupture were treated. According to Tile classification method, pelvic stable injury in 1 case, unstable rotation injury in 17 cases, rotation and vertical unstable injury in 7 cases. Complete urethral rupture in 23 cases, partial rupture in 2 cases. Surgical methods include: (1) emergency urinary tract anastomosis, urethral part of the meeting anastomosis, urethra will division, urethral penetrating wound repair, open reduction and internal fixation of pelvic fracture in the same period in 9 cases. (2) emergency urethra will be division, postponed (7 ~ 21 d) pelvic fracture open reduction and internal fixation in 10 cases. (3) emergency cystostomy, deadline (3 ~ 21 d) urethral division and pelvic fracture open reduction and internal fixation in 6 cases. Results Postoperative follow-up 6 to 120 months, an average of 34 months. Pelvic injury according to Majeed’s efficacy criteria, excellent in 17 cases, good in 5 cases, 3 cases. Urine extubation was performed in 19 patients (76%). The maximum urinary flow rate was 18.6 ml / s on average. Urinary incontinence of the urethra was good and the average scar length was 0.51 cm. Five patients (20 %) Showed varying degrees of dysuria, urethra should regularly be expanded or diverted to other operations; 1 (4%) female patients can not control urination, to be further treated. Postoperative suprapubic soft tissue avulsion infection with puborectalis abscess formation in 1 case, posterior urethral stricture in 5 cases, impotence in 3 cases, urinary incontinence in 1 case. Conclusion The early reduction and effective fixation of pelvic fractures are the anatomic basis to achieve “tension-free urethral repair.”