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首页> 外文期刊>BJU international >Proposed mechanisms of lower urinary tract injury in fractures of the pelvic ring.
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Proposed mechanisms of lower urinary tract injury in fractures of the pelvic ring.

机译：骨盆环骨折中下尿路损伤的建议机制。

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摘要

Authors from the UK review their experience of lower urinary tract injuries in association with fractures of the pelvic ring. They found that the pattern of pelvic fracture did not help with the prediction of the presence of lower urinary injury, but that the type of injury was related to the fracture mechanism. This study represents a large review of such injuries in both men and women, and the authors present their own theories on mechanisms of injury. OBJECTIVE To investigate whether the observation of particular pelvic fracture patterns enables the clinician to predict the presence and type of injuries to the lower urinary tract, as the mechanisms of injury to the lower urinary tract in association with fractures of the pelvic ring are unclear. PATIENTS AND METHODS The case-notes and radiographs of 168 patients with either pelvic ring or acetabular fractures were reviewed; 108 pelvic ring fractures (81 men, 27 women) and 60 acetabular fractures (46 men, 14 women). The pelvic fractures were classified according to the system described by Tile and were correlated with the incidence and type of lower urinary tract injury (LUTI). RESULTS Overall, of the 108 men and women with pelvic ring fractures, 27 (25%) had a LUTI documented either radiologically or as an intraoperative finding. Of the 81 men with pelvic ring fractures, 24 (30%) had a LUTI, of whom six (7%) had an isolated bladder laceration, 14 (17%) a partial urethral injury (PUI) and four (5%) a complete urethral disruption (CUD). Five of the 18 men with urethral injuries also had bladder injuries and in three of these, the bladder neck was also injured. Three of 27 women (11%) had a LUTI, all of whom had isolated bladder lacerations. Of the 46 men with an acetabular fracture, one (2%) had a CUD, and three (7%) had a PUI. One of 14 of women with an acetabular fracture sustained a bladder laceration. None of the three men with a Tile Type-A pelvic ring fracture sustained a LUTI. Of the 28 men with 'open-book' (Tile Type-B1) fractures, 21 (75%) had no associated LUTI and seven (25%) had a LUTI (five partial urethral injuries and two bladder lacerations). Of the 10 men with 'lateral compression' (Tile Type-B2) fractures, six had no LUTI and four had a LUTI (two partial urethral injuries and two bladder lacerations). Of the 40 men with 'vertical shear' (Tile Type-C) fractures, 27 (68%) had no LUTI and 13 (32%) a LUTI (four complete urethral disruptions, seven partial urethral injuries, and two bladder lacerations) including all of the combined bladder and urethral injuries and all of the bladder neck injuries. CONCLUSION The pelvic fracture pattern alone does not predict the presence of a LUTI. When it occurs, the type of LUTI appears to be related to the fracture mechanism. The pattern of injury to the soft tissue envelope and specifically to the ligaments supporting the lower urinary tract offers the best correlation with the observed LUTI. We propose a mechanism for this.
机译：来自英国的作者回顾了他们与骨盆环骨折相关的下尿路损伤的经历。他们发现骨盆骨折的类型无助于预测下尿路损伤的存在，但损伤的类型与骨折机制有关。这项研究代表了对男性和女性此类伤害的广泛回顾，并且作者提出了有关伤害机理的理论。目的探讨特定骨盆骨折类型的观察是否能够使临床医生预测下尿路损伤的存在和类型，因为尚不清楚下尿路损伤与骨盆环骨折相关的机制。病人和方法回顾了168例骨盆环或髋臼骨折患者的病例记录和X线片。 108例骨盆环骨折（男81例，女27例）和60例髋臼骨折（46例男14例）。根据Tile描述的系统对骨盆骨折进行分类，并将其与下尿路损伤（LUTI）的发生率和类型相关。结果总体上，在108例骨盆环骨折的男性和女性中，有27例（25％）的LUTI被影像学检查或术中发现。在81名骨盆环骨折的男性中，有24名（30％）患有LUTI，其中6名（7％）患有单纯性膀胱撕裂伤，14名（17％）的部分尿道损伤（PUI）和4名（5％）完全尿道破裂（CUD）。 18名尿道受伤的男性中有5名也有膀胱受伤，其中3名膀胱颈部也受伤。 27名女性中有3名（11％）患有LUTI，所有女性均患有膀胱撕裂伤。在46例髋臼骨折男性中，一名（2％）患有CUD，三名（7％）患有PUI。髋臼骨折的14名女性中有1名遭受了膀胱撕裂伤。三名患有Tile A型骨盆环骨折的男性均未发生LUTI。在28名“书本开裂”（B1型瓷砖）骨折的男性中，有21名（75％）没有相关的LUTI，有7名（25％）患有LUTI（5名部分尿道损伤和2次膀胱撕裂伤）。在10位“外侧受压”（B2型瓷砖）骨折的男性中，有6位没有LUTI，有4位患有LUTI（两次部分尿道损伤和两次膀胱撕裂伤）。在40名患有“垂直剪切”（C型瓷砖）骨折的男性中，有27名（68％）没有LUTI，有13名（32％）没有LUTI（四次完全尿道破裂，七次部分尿道损伤和两次膀胱撕裂伤），包括所有合并的膀胱和尿道损伤以及所有的膀胱颈损伤。结论单独的骨盆骨折模式不能预测LUTI的存在。当发生这种情况时，LUTI的类型似乎与骨折机制有关。软组织包膜的损伤模式，特别是支撑下尿路的韧带的损伤模式，与观察到的LUTI有最佳的相关性。我们为此提出了一种机制。

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