腹直肌外侧入路结合Pfannenstiel入路治疗骨盆骨折合并尿道断裂的疗效分析  

Treatment of pelvic fractures complicated with urethral rupture via lateral-rectus approach and Pfannenstiel approach

作　　者：麦奇光 陈煜辉 朱振华 李涛 王华 徐康帅 黄海 杨诚 廖坚文 樊仕才 Mai Qiguang;Chen Yuhui;Zhu Zhenhua;Li Tao;Wang Hua;Xu Kangshuai;Huang Hai;Yang Cheng;Liao Jianwen;Fan Shicai(Department of Traumatic Surgery,Center for Orthopaedic Surgery,the Third Hospital Affiliated to Southern Medical University,Guangzhou 510630,China)

机构地区：[1]南方医科大学第三附属医院骨科医学中心创伤骨科,广州510630

出　　处：《中华创伤骨科杂志》2022年第12期1016-1023,共8页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金(81772428,82072411);广东省教育厅高水平大学建设经费南方医科大学临床研究启动项目(LC2016ZD032)。

摘　　要：目的探讨腹直肌外侧入路联合Pfannenstiel入路治疗骨盆骨折合并尿道断裂的安全性及临床疗效。方法回顾性分析2013年1月至2021年6月期间南方医科大学第三附属医院骨科医学中心创伤骨科采用腹直肌外侧入路联合Pfannenstiel入路治疗的20例骨盆骨折合并尿道断裂患者资料。男15例, 女5例;年龄为18~55岁, 平均42岁;骨盆骨折根据Tile分型:B型11例, C型9例。12例患者合并髋臼骨折。手术在全身麻醉下平卧位进行, 先联合泌尿外科医师采用Pfannenstiel入路一期行尿道会师术, 再采用腹直肌外侧入路复位固定髋臼或骨盆骨折。记录患者的手术时间、术中出血量、骨折复位质量、骨盆功能恢复情况及并发症发生情况等。结果 20例患者的手术时间为80~240 min, 平均140.5 min;单纯尿道会师手术时间为20~30 min;术中出血量为400~2 000 mL, 平均730 mL。术后按照Mears和Velyvis复位标准评定骨折复位质量:解剖复位13例, 满意复位6例, 复位不满意1例。20例患者术后获12~68个月(平均37个月)随访。1例患者出现骨折不愈合, 其余患者的骨折愈合时间为3.0~4.5个月, 平均3.5个月。术后12个月根据Majeed功能评分标准评定骨盆功能:优12例, 良6例, 可2例, 优良率为90%(18/20)。1例患者出现螺钉松动;1例患者出现腰骶干神经牵拉伤;8例患者出现不同程度的排尿困难, 定期尿道扩张后排尿满意;3例患者尿道狭窄;5例患者勃起功能障碍;未见腹壁疝及盆腔感染等并发症发生。结论腹直肌外侧入路结合Pfannenstiel入路能有效复位固定骨盆及髋臼骨折, 并可一期修复尿道, 腹壁疝及盆腔感染等并发症发生率低, 相对安全、有效。Objective:To investigate the safety and clinical efficacy of the lateral-rectus approach combined with the Pfannenstiel approach in the treatment of pelvic fractures complicated with urethral rupture.Methods:From January 2013 to June 2021, 20 patients with pelvic fracture complicated with urethral rupture were surgically managed through the lateral-rectus approach and the Pfannenstiel approach at Department of Traumatic Surgery, Center for Orthopaedic Surgery, the Third Hospital Affiliated to Southern Medical University. They were 15 males and 5 females, with an average age of 42 years (from 18 to 55 years). By the Tile classification, there were 11 cases of type B and 9 cases of type C. The first-stage urethral realignment was performed via the Pfannenstiel approach in the supine position after general anesthesia in conjunction with an urologist;at the second-stage, the lateral-rectus approach was used to reduce and fixate the acetabular or pelvic fractures. The operation time, intraoperative blood loss, fracture reduction quality, pelvic functional recovery and complications were documented.Results:In this cohort, the operation time ranged from 80 to 240 min, averaging 140.5 min;the time for simple urethral convergence ranged from 20 to 30 min;the intraoperative blood loss ranged from 400 mL to 2,000 mL, averaging 730 mL. According to the Mears andVelyvis evaluation for fracture reduction quality, anatomical reduction was achieved in 13 cases, satisfactory reduction in 6 cases, and unsatisfactory reduction in one. The 20 patients were followed up for 12 to 68 months (mean, 37 months) after surgery. One fracture got nonunited but the other fractures got united after 3.0 to 4.5 months (mean, 3.5 months). According to the Majeed scoring system, the pelvic function at 12 months after surgery was excellent in 12 cases, good in 6 and fair in 2, giving an excellent and good rate of 90% (18/20). Screw loosening was found in one patient, traction injury to the lumbosacral trunk nerve in another patient, varying degrees

关 键 词：骨盆 骨折 手术入路 尿道断裂 

分 类 号：R687.3[医药卫生—骨科学]