闭合性骨盆骨折继发勃起功能障碍的危险因素分析

Risk factors for secondary erectile dysfunction in closed pelvic fractures*

背景:勃起功能障碍是男性骨盆骨折患者常见的并发症,目前骨盆骨折继发勃起功能障碍的影响因素及机制尚不明确。目的:分析闭合性骨盆骨折患者继发勃起功能障碍的危险因素。方法:回顾性分析2013年1月至2018年6月收治的符合纳入与排除标准的96例男性骨盆骨折患者的临床资料,年龄20~60岁,平均(37.5±9.5)岁。采用单因素分析和多因素Logistic回归分析方法,对受伤年龄、致伤原因、是否合并耻骨联合分离,骨盆骨折类型、是否合并尿道损伤、骨折后评估时间、手术入路共7个因素与闭合性骨盆骨折继发勃起功能障碍的关系进行分析。结果:单因素分析显示,受伤年龄、致伤原因、手术入路、骨折后评估时间对闭合性骨盆骨折继发勃起功能障碍的影响无统计学意义,而骨盆骨折分型、合并耻骨联合分离、合并尿道损伤有统计学意义;对于单因素分析有统计学意义的因素进行多因素Logistic回归分析显示,合并耻骨联合分离(P<0.001)、合并尿道损伤(P=0.002)是骨盆骨折后勃起功能障碍的独立危险因素。结论:对于男性闭合性骨盆骨折患者,合并耻骨联合分离、合并尿道损伤是影响勃起功能障碍发生的重要因素,临床医师应慎重评估病情,必要时联合泌尿外科医师制定综合诊疗方案。

Background:Erectile dysfunction is a common complication of pelvic fracture.At present,the influencing factors and mechanism of erectile dysfunction after pelvic fracture are still unclear.Objective:To analyze the risk factors of erectile dysfunction in patients with closed pelvic fracture.Methods:A total of 96 male patients with pelvic fractures were selected with the mean age of(37.5±9.5)years(range,20-60).The relationship of age,the cause of trauma,the separation of pubic sym⁃physis,the classification of pelvic fracture,the injury of urethra,the evaluation time after fracture and the approach of operation with erectile dysfunction after closed pelvic fracture was analyzed statistically.Results:According to the chi-square test there was no significant difference in age,cause of trauma,operative approach and evaluation time after fracture,and statistically sig⁃nificant difference in the classification of pelvic fracture,the separation of pubic symphysis and urethra injury.According to bi⁃nary logistic analysis,the separation of pubic symphysis(P<0.001)and urethra injury(P=0.002)were independent risk factors for erectile dysfunction after closed pelvic fracture.Conclusions:For male patients with pelvic fractures,the separation of pubic symphysis and the urethra injury are independent risk factors for erectile dysfunction after pelvic fracture.The clinicians should make evaluation carefully,if necessary,invite urological surgeon for comprehensive diagnosis and treatment scheme.