骨盆骨折致后尿道损伤的相关危险因素分析

The analysis of risk factors about urethral injury secondary to pelvic fracture

目的探讨骨盆骨折致后尿道损伤（pelvic fracture urethral injury，PFUI）的危险因素。方法回顾性分析2014年3月至2016年10月收治的120例骨盆骨折患者的临床资料。男87例，女33例。年龄11～78岁，平均（42．6±15．4）岁。骨折原因为车祸伤70例，坠落伤27例，重物砸伤23例。其中合并后尿道损伤患者43例，均为男性。年龄14—61岁，平均（40．4±14．5）岁。16例发生于膜部，17例发生于球膜部，10例发生于前列腺部。狭窄长度平均为（3．0±1．9）cm。后尿道损伤伴膀胱破裂1例、尿道直肠瘘1例、尿道皮肤瘘2例。按照骨盆骨折Tile分型分为：A1型10例，A2型10例，B1型14例，B2型31例，B3型42例，CI型2例，c2型11例，各型发生后尿道损伤的例数分别为1、2、2、7、29、0、2例。对患者进行危险度分析，对危险度分析提示的危险因素行Logistic回归分析并计算受试者工作特征（receiver operating characteristic，ROC）曲线下面积（the area under the CHIVe，AUC）。结果危险度分析结果显示，女性（X^2=25．419，P〈0．05，OR=0．571）和B3型骨盆骨折（X^2=31．002，P〈0．05，OR=10．198）对PFUI的发生有显著影响。Logistic回归分析结果显示，女性（Walds=16．528，P〈0．05，校正的OR=0．003）是PFUI的保护性因素，B3型骨盆骨折（Walds=10．853，P〈0．05，校正的OR=28．537）是PFUI的危险因素。ROC曲线的AUC=0．891（95％CI0．826～0．956），当把握度为0．60时，危险因素预测骨盆骨折致后尿道损伤的敏感性为67．4％，特异性为100．0％。结论女性患者发生后尿道损伤的情况非常少见，以男性居多。B3型骨盆骨折患者发生后尿道损伤的概率明显高于非B3型骨盆骨折患者。

Objective To investigate the risk factors of pelvic fracture related urethral injury （PFUI）. Methods We retrospectively reviewed 120 patients with pelvic fracture from March 2014 to October 2016 in our hospital. Of all the patients,87 were males and 33 were females. The average age was （42.6 ± 15.4 ）years old （ranging 11 -78 years old）. The etiology of pelvic fracture included traffic accident in 70 cases, fall injury in 27 case. Heavy crash in 23 cases. 43 male patients had an PFUI. Their average age was （40.4 ± 14.5 ）years old （ranging 14 -61 years old）. Of PFUI patients, the location of urethral injury included membranous part in 16 cases,bulbomembranous part in 17 and prostatic part in 10 cases. The average length of stricture was （ 3.0 ± 1.9 ） centimeter. One patient suffered the stricture, combined with bladder rupture. One patient had urethro-reetal fistula. Two patients had urethroeutaneous fistula. The pelvic fractures were categorized using Tile classification, including type A1 fractures in 10 cases, A2 in 10 cases, B1 in 14 cases, B2 in 31 cases, B3 in 42 cases, C1 in 2 cases and C2 in 11 cases. The patients＂ number of urethral injury in each type was 1,2,2,7,29,0,2, respectively. Hazard degree analysis and chi- square test were used to evaluate the risk factors. Variables with an association of P 〈 0. 05 were then tested using binary logistic regression and the area under the curve （AUC）. Results On hazard degree analysis, female （ X^2 = 25. 419,P 〈 0. 05, OR = 0. 571 ） and type B3 fracture （ X^2 = 31. 002, P 〈 0. 05, OR = 10. 198 ） have a significant impact on the occurrence of PFUI. On binary logistic regression, female （Walds = 16. 528, P 〈 0. 05, adjusted OR = 0. 003 ） is the protective factor of PFUI while type B3 fracture （ Walds = 10. 853, P 〈 0. 05 ,adjusted OR = 28. 537 ） is the risk factor. The area under the curve （ AUC = 0. 891 , 95% CI0. 826- 0. 956） illustrates the regression model has a high credibility. Conclusions Pelvic fracture urethral injury is much less likely to occur in females than men. Type B3 fracture is more likely to cause an PFUI than the others type.