Mallet Richard, Tricoire Jean-Louis, Rischmann Pascal, Sarramon Jean Pierre, Puget Jean, Malavaud Bernard
Department of Urology, Hôpital Rangueil, Toulouse, France.
Urology. 2005 Mar;65(3):559-63. doi: 10.1016/j.urology.2004.10.002.
To evaluate, given the central role of the pudendal nerves in erection, the impact of potential infraclinical lesions on male sexual function. After intramedullary femoral fixation, countertraction on the fracture table has sporadically been involved in pudendal neurapraxia. Patients with tibial fractures served as controls.
A total of 168 patients treated for femoral or tibial shaft fractures by intramedullary nailing were mailed the International Index of Erectile Function questionnaire, which addresses all aspects of male sexual function and permits grading of the severity of erectile dysfunction (ED). Univariate and multivariate analyses were conducted to test for factors associated with ED.
Of the 168 patients, 101 (60.1%) returned the questionnaire. A greater proportion of ED was observed in sexually active patients after femoral fracture than after tibial fracture (40.5% versus 12.5%, P <0.01). The differential prevalence of ED in both groups subjected to comparable high-energy trauma suggested that post-traumatic stress disorder was of marginal importance in ED occurring after femoral nailing. Greater intraoperative doses of curare were associated with better sexual functioning in sexually active patients after femoral fracture (10.6 versus 7.5 mg in patients without and with ED, respectively, P = 0.02), suggesting that postoperative ED could be partially prevented by optimal muscle relaxation during fracture reduction.
Erectile dysfunction was shown to be highly prevalent after intramedullary nailing of femoral shaft fractures. Greater intraoperative curare doses, resulting in optimal relaxation and reduced pressure on the pudendal nerves by the perineal post, were associated with better sexual functioning.
鉴于阴部神经在勃起中起核心作用，评估潜在的亚临床损伤对男性性功能的影响。在股骨髓内固定后，骨折台上的对抗牵引偶尔会导致阴部神经失用。胫骨骨折患者作为对照。
通过髓内钉治疗股骨干或胫骨干骨折的168例患者收到了国际勃起功能指数问卷，该问卷涉及男性性功能的各个方面，并允许对勃起功能障碍（ED）的严重程度进行分级。进行单因素和多因素分析以测试与ED相关的因素。
168例患者中，101例（60.1%）返回了问卷。与胫骨骨折后相比，股骨干骨折后性活跃患者中观察到的ED比例更高（40.5%对12.5%，P<0.01）。两组遭受类似高能创伤后ED的差异患病率表明，创伤后应激障碍在股骨髓内钉固定后发生的ED中作用不大。术中更大剂量的箭毒与股骨干骨折后性活跃患者更好的性功能相关（分别有和没有ED的患者中箭毒剂量分别为10.6和7.5mg，P=0.02），这表明在骨折复位期间通过最佳的肌肉松弛可以部分预防术后ED。
股骨干骨折髓内钉固定后勃起功能障碍的发生率很高。术中更大剂量的箭毒可导致最佳的松弛状态，并减轻会阴部支柱对阴部神经的压力，与更好的性功能相关。
