骨盆骨折合并尿道损伤的处理

Treatment of Pelvic Fracture with Posterior Urethral Injury

目的探讨骨盆骨折合并后尿道损伤的治疗方法和疗效。方法自2004年1月-2009年6月收治骨盆骨折合并后尿道损伤36例，尿道撕裂伤23例，断裂伤13例。骨盆骨折采用下肢牵引治疗9例，单纯骨盆前环外固定架固定13例，重建钢板内固定9例。骨盆前环内、外固定架＋骨盆后环内固定5例。结果36例均获得随访，随访时间10个月-4．5年。骨折愈合率为100％，继发骨盆畸形7例，25例拔除尿管后不能自行排尿，需行尿道扩张术。2例男性患者出现性功能不全，无一例发生尿失禁。结论骨盆骨折合并后尿道损伤恢复并维持有效的血液动力学指标后，应尽早修复损伤尿道，能提高救治成功率；通过骨盆环复位固定，减小尿道吻合处及周围组织张力，提高尿道损伤修复术后通畅率。

Objective To discuss the operative procedure and therapeutic effect for pelvic fracture with posterior wrethral injury. Methotis Thirty six eases of pelvic fracture with posterior urethra injury were treated from January in 2004 to June in 2009. Among of them, 23 cases were urethral laeerated wound and 13 eases were interrupt wound. Nine eases of pelvic fracture were treated by lower limb traction, 13 eases of front-loop pelvic fracture were treated by external fixation, 9 cases of pelvic fracture were treated by internal fixation of reconstruction plate and 5 cases of pelvie fracture were treated by internal and external fixator. Results Al/cases were followed up for 10 months to 4.5 years. The rate of fracture union was 100%. Seven cases proceeded to pelvic deformity, and 25 cases had to do dilation of urethra, because they could not urinate after pulling out urinary canal. Two cases （2 men） had sexual dysfunction without urinary incontinence. Conclusion The urethral canal＇s anatomic structure could be repaired when the pelvic fracture with posterior urethra injury is recovered by pelvic-loop fixing and effective haemodynamics maintained, which can prevent urethrostenosis effectively.