Wright Jonathan L, Nathens Avery B, Rivara Frederick P, MacKenzie Ellen J, Wessells Hunter
Department of Urology, Surgery, Pediatrics and Epidemiology, University of Washington School of Medicine, Harborview Medical Center and Harborview Injury Prevention Research Center, Seattle, Washington 98104, USA.
J Urol. 2006 Oct;176(4 Pt 1):1540-5; discussion 1545. doi: 10.1016/j.juro.2006.06.044.
We determined the prevalence and predictors of sexual and excretory dysfunction in patients 1 year after pelvic fracture.
The multicenter Pennsylvania Trauma Outcomes Study enrolled 1,238 patients and contacted them 1 year after injury. Sexual limitations and excretory dysfunction (bladder/bowel incontinence) were defined based on responses from the Functional Capacity Index. Health related quality of life was determined using SF-36. The relationship between specific fracture patterns and dysfunction along with the effect of dysfunction on quality of life in patients with pelvic fracture were evaluated by multivariate analysis.
Of 1,160 eligible patients 292 (26%) had pelvic fractures. Sexual dysfunction was reported in 21% vs 14% of those with vs without pelvic fractures and bowel or bladder incontinence was reported in 8% vs 4%. On multivariate analysis men with sacroiliac fractures were at higher risk for sexual (RR 4.0, 95% CI 2.3 to 6.8) and excretory (RR 4.3, 95% CI 1.4 to 13.5) dysfunction. In women symphyseal diastasis was associated with sexual (RR 4.8, 95% CI 2.0 to 11.2) and excretory (RR 12.5, 95% CI 1.9 to 80.2) dysfunction. Of patients with pelvic fractures men with sexual dysfunction and women with excretory dysfunction had significantly worse quality of life than those without dysfunction.
One year after trauma men with sacroiliac fractures and women with symphyseal diastasis were at increased risk for sexual and excretory dysfunction independent of overt pelvic organ injury. In patients with pelvic fracture male sexual dysfunction and female excretory dysfunction were associated with decreased quality of life. Our data highlight the need for further study of dysfunction following pelvic trauma and interventions to decrease the risk of long-term disability.
我们确定了骨盆骨折患者伤后1年性功能和排泄功能障碍的患病率及预测因素。
多中心宾夕法尼亚创伤结局研究纳入了1238例患者，并在受伤1年后对他们进行随访。性功能受限和排泄功能障碍（膀胱/肠道失禁）根据功能能力指数的回答来定义。使用SF-36确定健康相关生活质量。通过多变量分析评估特定骨折类型与功能障碍之间的关系以及功能障碍对骨盆骨折患者生活质量的影响。
在1160例符合条件的患者中，292例（26%）发生了骨盆骨折。报告有骨盆骨折的患者中性功能障碍的发生率为21%，而无骨盆骨折的患者为14%；肠道或膀胱失禁的发生率分别为8%和4%。多变量分析显示，骶髂关节骨折的男性发生性功能（相对危险度4.0，95%可信区间2.3至6.8）和排泄功能（相对危险度4.3，95%可信区间1.4至13.5）障碍的风险更高。在女性中，耻骨联合分离与性功能（相对危险度4.8，95%可信区间2.0至11.2）和排泄功能（相对危险度12.5，95%可信区间1.9至80.2）障碍相关。在骨盆骨折患者中，发生性功能障碍的男性和发生排泄功能障碍的女性的生活质量明显低于无功能障碍者。
创伤后1年，骶髂关节骨折的男性和耻骨联合分离的女性发生性功能和排泄功能障碍的风险增加，与明显的盆腔器官损伤无关。在骨盆骨折患者中，男性性功能障碍和女性排泄功能障碍与生活质量下降有关。我们的数据强调了对骨盆创伤后功能障碍进行进一步研究以及采取干预措施以降低长期残疾风险的必要性。
