男性不稳定性骨盆骨折患者术后继发勃起功能障碍的关联因素分析  

Factors associated with erectile dysfunction after surgically treated unstable pelvic fractures in men

作　　者：王力[1,2] 贾通宇 刘凡 贾卓 常骁 李毅 王春杨[1] 宋涛[1] 张立海[3] 马鑫[1] WANG Li;JIA Tongyu;LIU Fan;JIA Zhuo;CHANG Xiao;LI Yi;WANG Chunyang;SONG Tao;ZHANG Lihai;MA Xin(Department of Urology,the Third Medical Center,Chinese PLA General Hospital,Beijing 100039,China;Chinese PLA Medical School,Beijing 100853,China;Department of Orthopedics,the Fourth Medical Center,Chinese PLA General Hospital,Beijing 100142,China)

机构地区：[1]解放军总医院第三医学中心泌尿外科,北京100039 [2]解放军医学院,北京100853 [3]解放军总医院第四医学中心骨科,北京100142

出　　处：《解放军医学院学报》2024年第6期596-601,共6页Academic Journal of Chinese PLA Medical School

摘　　要：背景勃起功能障碍(erectile dysfunction,ED)是男性不稳定性骨盆骨折术后患者的主要长期并发症之一,其机制不明,探究致伤因素、骨折类型、手术因素与ED的关系对于早期识别和干预具有重要意义。目的分析接受手术治疗的男性不稳定性骨盆骨折患者ED发生的关联因素。方法回顾性分析2010年1月—2022年12月于解放军总医院第一医学中心接受手术治疗的男性不稳定性骨盆骨折患者病历资料。采用单因素和Logistic多因素回归分析受伤年龄、受伤原因、Young-Burgess致伤因素分类、Tile分型、是否合并耻骨联合分离、是否合并外生殖器损伤、是否合并尿道损伤、创伤严重程度评分(injury severity score,ISS)、手术入路、固定材料共10个因素与男性不稳定性骨盆骨折术后继发ED的关联性。结果共纳入112例男性不稳定性骨盆骨折患者,平均年龄(36.55±10.79)岁。112例中49例(43.75%)术后发生ED。ED组与未发生ED组ISS评分(Z=-3.236,P=0.001)、是否合并耻骨联合分离(χ2=24.200,P<0.001)、是否合并尿道损伤(χ2=22.826,P<0.001)差异有统计学意义。多因素Logistic回归分析表明,合并尿道损伤(OR=3.765,P=0.003)、合并耻骨联合分离(OR=8.059,P=0.014)是男性不稳定性骨盆骨折术后患者继发ED的独立关联因素。结论对于男性不稳定性骨盆骨折患者,合并尿道损伤、合并耻骨联合分离是术后康复期继发ED的重要关联因素。因此,在制定诊疗方案时应联合泌尿外科对ED进行早期识别和干预。Background Erectile Dysfunction(ED)is one of the main long-term complications in male patients with unstable pelvic fractures.However,its mechanism is unclear.Exploring the relationship between injury factors,fracture types,surgical factors and ED is important for early identification and intervention.Objective To analyze the correlated factors for erectile dysfunction in men with surgically treated unstable pelvic fractures.Methods A retrospective analysis was conducted on male patients with surgically treated unstable pelvic fractures at the First Medical Center of Chinese PLA General Hospital from January 2010 to December 2022.Univariate and multivariate logistic regression analysis were conducted to examine the impact of 10 factors on erectile dysfunction(ED)in men with surgically treated unstable pelvic fractures,including age of injury,trauma mechanism,Young-Burgess classification,fracture types,external genital injury,pubic symphysis diastasis,urethral injury,Injury Severity Score(ISS),surgical approach,and fixation hardware.Results Among 112 male patients with unstable pelvic fractures,49(43.75%)developed ED after surgery.Multivariate logistic regression analysis indicated that urethral injury(OR=3.765,P=0.003)and pubic symphysis diastasis(OR=8.059,P=0.014)were independent correlated factors for ED after surgically treated unstable pelvic fractures in men.Conclusion Urethral injury and pubic symphysis diastasis are important factors for the development of ED after surgically treated unstable pelvic fractures in men.It is essential to collaborate with urologist in formulating a treatment plan for the early detection and intervention of ED.

关 键 词：勃起功能障碍 不稳定性骨盆骨折 关联因素分析 预后 创伤 

分 类 号：R641[医药卫生—外科学] R697.14[医药卫生—临床医学]