骨盆骨折后男性勃起功能障碍的预后分析

Prognosis of erectile dysfunction after pelvic fracture

目的 探讨骨盆骨折后影响男性勃起功能障碍预后的相关因素。方法 回顾性分析2015年1月—2021年1月新疆医科大学第一附属医院创伤骨科收治的64例男性骨盆骨折患者的临床资料,患者伤后均继发勃起功能障碍,年龄19~62岁,平均39.1岁;致伤原因道路交通伤41例,高处坠落伤15例,摔伤6例,挤压伤2例。其中48例行手术治疗,16例行非手术治疗。对骨盆骨折后勃起功能障碍的缓解情况进行定期随访调查,随访时间为伤后6~36个月,平均21.3个月。以年龄、骨盆骨折Tile分型、是否合并骶骨骨折、是否合并耻骨联合分离、是否合并耻骨支骨折、是否合并泌尿系损伤、损伤严重度评分(ISS)及是否手术治疗这8项相关因素,应用乘积极限法(Kaplan-Meier法)得出生存分析函数图像,应用内插法计算患者勃起功能障碍的中位未缓解率时间,及伤后1、2年的未缓解率,应用Log-rank检验进行单因素分析,应用COX比例风险模型进行多因素分析,并探讨这些因素与患者勃起功能障碍缓解的关系。结果 64例男性骨盆骨折后勃起功能障碍患者的中位未缓解时间为19.28个月,伤后1年和2年的未缓解率为70.3%和38.9%。单因素分析结果显示骨盆骨折后男性勃起功能障碍的未缓解率与骨盆骨折Tile分型(P<0.001)、ISS(P<0.001)及泌尿系损伤(P=0.007)相关。多因素分析结果显示骨盆骨折Tile分型(HR=0.588,95%CI0.373~0.929,P=0.023)和ISS(HR=0.419,95%CI0.209~0.836,P=0.014)是其预后相关的独立危险因素。结论 骨盆骨折Tile分型和ISS是影响骨盆骨折后男性勃起功能障碍缓解的独立危险因素。

Objective To investigate the prognostic factors of erectile dysfunction after pelvic fracture.Methods The clinical data of 64 male patients with pelvic fracture admitted to the Department of Trauma Orthopaedic of the First Affiliated Hospital of Xinjiang Medical University from Jan.2015 to Jan.2021 were retrospectively analyzed,and all the above patients developed erectile dysfunction after injury.Their age ranged from 19 to 62 years,with an average age of 39.1 years.There were 41 cases of road traffic injury,15 cases of high fall injury,6 cases of fall injury and 2 cases of crush injury,among whom 48 cases were treated by operation and 16 cases were treated by non-operation.The remission of erectile dysfunction after pelvic fracture was regularly followed up for 6-36 months(mean 21.3 months).Survival analysis function images were obtained by Kaplan-Meier method based on eight related factors including age,Tile classification of pelvic fracture,sacral fracture,pubic symphysis separation,pubic ramus fracture,urinary system injury,injury severity score(ISS),and surgical treatment.The median time of failure to remission of erectile dysfunction was calculated by interpolation method,and the failure rate of 1 and 2 years after injury was calculated.Univariate analysis was performed by log-rank test,and multivariate analysis was performed by COX proportional risk model,and the relationship between these factors and remission of erectile dysfunction was discussed.Results In 64 male patients with erectile dysfunction after pelvic fracture,the median unremission time was 19.28 months,and the 1-year and 2-year unremission rates were 70.3%and 38.9%.Univariate analysis showed that the rate of unalleviated erectile dysfunction after pelvic fracture was associated with Tile classification(P<0.001),ISS(P<0.001)and urinary tract injury(P=0.007).Multivariate analysis showed that Tile classification of pelvic fractures(HR=0.588,95%CI:0.373~0.929,P=0.023)and ISS(HR=0.419,95%CI:0.209~0.836,P=0.014)were independent prognostic risk factors.Conclusion Tile classification of pelvic fractures and ISS are independent risk factors for remission of erectile dysfunction after pelvic fractures.