Tile B、C型骨盆骨折对男性勃起功能的影响及相关解剖学原因  

Influence of Tile B and C pelvic fractures on the erectile function of male patients and its related anatomical reasons

作　　者：段赟 马超[3] 赵清斌 王小挺[2] 何云 伊力亚尔·阿不都斯木 马子越 阿布都萨拉木·阿布都克力木 谢增如[1] Duan Yun;Ma Chao;Zhao Qingbin;Wang Xiaoting;He Yun;Yiliyaer Abudusimu;Ma Ziyue;Abudushalamu Abudukelimu;Xie Zengru(Department of Orthopaedics,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Department of Orthopaedics,the Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi 830002,China;Department of Orthopaedics,Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University,Urumqi 830000,China;Department of Orthopaedics,the People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China)

机构地区：[1]新疆医科大学第一附属医院骨科,乌鲁木齐830054 [2]新疆医科大学第六附属医院骨科,乌鲁木齐830002 [3]新疆医科大学附属中医医院骨科,乌鲁木齐830000 [4]新疆维吾尔自治区人民医院骨科,乌鲁木齐830001

出　　处：《中华解剖与临床杂志》2023年第12期787-792,共6页Chinese Journal of Anatomy and Clinics

基　　金：国家自然科学基金(82260409)。

摘　　要：目的探讨Tile B型、Tile C型骨盆骨折对男性患者勃起功能的影响及相关解剖学原因。方法回顾性队列研究。纳入2019年12月—2021年12月新疆医科大学第一附属医院、新疆医科大学第六附属医院及新疆维吾尔自治区人民医院诊治的男性骨盆骨折患者65例,年龄19~56(37.5±5.9)岁。65例中,骨盆骨折Tile B型44例(Tile B型组),C型21例(Tile C型组)。患者均手术治疗,其中8例行改良Stoppa入路,6例行耻骨联合入路,6例行骶髂关节后方入路,16例行髂腹股沟入路,16例行前后联合入路,13例行微创手术。观察项目:(1)比较2组患者的临床基线资料。(2)术后1年采用国际勃起功能问卷5(IIEF5)评分评估并比较2组患者勃起功能情况及勃起功能障碍(ED)发生率。(3)基于勃起功能相关组织的解剖学位置特征,根据骨盆骨折后易损伤勃起功能的相关血管、神经及肌肉的不同,将骨盆骨折分为耻骨下支骨折或坐骨支骨折、骨盆耻骨联合分离、经第2~4骶孔的骶骨骨折、DenisⅢ型骶骨骨折4种模式,比较2组患者不同骨折模式占比的差异。结果(1)2组患者年龄、受伤至手术时间、致伤原因、合并伤等基线资料比较,差异均无统计学意义(P值均>0.05)。(2)所有患者术后恢复良好,随访22.0(13.0,28.0)个月均未发生医源性勃起功能相关神经、血管和肌肉损伤,骨折愈合时间13.0(12.5,15.0)周。术后1年,Tile B型组IIEF5评分22.0(16.3,23.0)分高于Tile C型组的13.0(9.5,21.5)分,ED发生率45.5%(20/44)低于Tile C型组的76.2%(16/21),差异均有统计学意义(Z=-2.87、χ^(2)=5.44,P值均<0.05)。(3)Tile B型骨折患者出现耻骨下支骨折或坐骨支骨折、经第2~4骶孔的骶骨骨折、DenisⅢ型骶骨骨折模式的比例低于Tile C型,差异均有统计学意义(χ^(2)=8.92、10.77、13.44,P值均<0.05);而出现骨盆耻骨联合分离模式的比例2组间差异无统计学意义(χ^(2)=1.90,P=0.169)。结论Tile C型骨盆骨折患者EObjective To investigate the influence of Tile B and C pelvic fractures on the erectile function of male patients and its related anatomical reasons.Methods The retrospective cohort study was conducted.A total of 65 male patients with pelvic fractures who were diagnosed and treated at the First Affiliated Hospital of Xinjiang Medical University,the Sixth Affiliated Hospital of Xinjiang Medical University,and the People's Hospital of Xinjiang Uygur Autonomous Region from December 2019 to December 2021 were included.The patients were aged 19−56(37.5±5.9)years old.In accordance with the Tile classification system,the 65 patients were divided into two groups:44 patients with type B fracture were allocated to the Tile B group and 21 patients with type C fractures were allocated to the Tile C group.All patients were treated surgically.Eight cases were treated through the modified Stoppa approach,six cases were treated through the pubic symphysis approach,six cases were treated through the posterior sacroiliac joint approach,16 cases were treated through the ilioinguinal approach,16 cases were treated through the combined anterior and posterior approach,and 13 cases received minimally invasive surgery.The following observations were performed:(1)The clinical baseline data of patients in the two groups were compared.(2)The erectile function and incidence of erectile dysfunction(ED)at 1 year after the operation were evaluated and compared between the two groups by using the International Index of Erectile Function-5(IIEF-5)score.(3)On the basis of the anatomical location characteristics of erectile function-related tissues and in accordance with differences in blood vessels,nerves,and muscles that were prone to causing damage to erectile function after pelvic fractures,the pelvic fracture patterns were divided into four patterns:inferior pubic or ischial branch fractures,pubic symphysis separation,sacral fractures through the second to fourth sacral foramens,and DenisⅢtype sacral fractures.The differences in differen

关 键 词：勃起功能障碍 骨盆骨折 Tile分型 解剖学 

分 类 号：R683[医药卫生—骨科学] R698[医药卫生—外科学]