Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH 44109, USA.
J Orthop Trauma. 2012 May;26(5):308-13. doi: 10.1097/BOT.0b013e31821d700e.
Previous studies have reported a negative effect of pelvic trauma on genitourinary and reproductive function of women. However, fracture pattern, injury severity, and final fracture alignment have not been well studied. The purpose of this project was to describe sexual function in women after pelvic ring injury.
Cohort study: a prospective collection of sexual function data for women with prior pelvic ring injury versus control groups of uninjured women and other women from the orthopaedic trauma clinic.
Level I trauma center.
PATIENTS/PARTICIPANTS: One hundred eighty-seven women younger than age 55 years with pelvic ring injury, including 101 B-type (61-B1: n = 25, B2: n = 69, B3: n = 7) and 86 C-type (61-C1: n = 56, C2: n = 18, C3: n = 12) fractures. Four had open fractures, and 23 had associated genitourinary injury.
Seventy-four were treated operatively. Surgical treatment was percutaneous in 62: iliosacral screws (n = 58), external fixation (n = 4), or both (n = 19). Open reduction and internal fixation was performed for the pubis symphysis (n = 27), sacroiliac joint (n = 2), and posterior ileum (n = 3).
Sexual function questionnaires were completed for 92 patients (49%) with minimum 12 months and mean 46 months follow-up.
Forty-eight patients (56%) reported pain with intercourse. Their mean Musculoskeletal Function Assessment was 44.3 versus 20.9 without dyspareunia (P < 0.0001). Seventy-eight percent of patients with B-type fractures and 43% of patients with C-type fractures had dyspareunia (P = 0.002). Dyspareunia occurred after 91% of anteroposterior compression injuries (P = 0.02) and in 79% with a symphyseal disruption treated with plate fixation (P = 0.005). All patients with bladder ruptures (n = 5) reported dyspareunia. Sacral fracture or sacroiliac injury, type of posterior treatment, and residual malalignment of the posterior ring were not associated with dyspareunia. Fourteen patients each had associated femur fractures and/or tibia fractures. Seventeen of them had pain during intercourse (P = 0.19 for association of femoral or tibial fractures with dyspareunia).
Dyspareunia is common in women after pelvic ring fracture. Women with pelvic ring injury are more likely to report dyspareunia than other female patients with musculoskeletal trauma. Dyspareunia was related to anteroposterior compression and B-type injuries. Symphyseal plate fixation is also associated with dyspareunia. Pain with intercourse was also noted in all patients with a history of bladder rupture. Poor functional outcomes as measured by Musculoskeletal Function Assessment scores were reported in women with dyspareunia.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
先前的研究报告称，骨盆创伤对女性的泌尿生殖和生殖功能有负面影响。然而，骨折模式、损伤严重程度和最终骨折对线尚未得到很好的研究。本项目的目的是描述骨盆环损伤后女性的性功能。
队列研究：前瞻性收集骨盆环损伤女性的性功能数据，与未受伤的对照组女性和来自矫形创伤诊所的其他女性进行比较。
一级创伤中心。
患者/参与者：187 名年龄在 55 岁以下的骨盆环损伤女性，包括 101 例 B 型（61-B1：n = 25，B2：n = 69，B3：n = 7）和 86 例 C 型（61-C1：n = 56，C2：n = 18，C3：n = 12）骨折。4 例为开放性骨折，23 例合并泌尿生殖系统损伤。
74 例接受手术治疗。手术治疗为经皮治疗 62 例：髂骨螺钉（n = 58）、外固定（n = 4）或两者兼有（n = 19）。耻骨联合（n = 27）、骶髂关节（n = 2）和后肠（n = 3）采用切开复位内固定。
完成了 92 例（49%）患者的性功能问卷，随访时间至少为 12 个月，平均为 46 个月。
48 例（56%）患者报告性交时疼痛。他们的肌肉骨骼功能评估平均为 44.3，而无性交痛者为 20.9（P < 0.0001）。B 型骨折患者中 78%和 C 型骨折患者中 43%有性交痛（P = 0.002）。性交痛发生在 91%的前后压缩损伤后（P = 0.02）和 79%的耻骨联合中断采用钢板固定治疗后（P = 0.005）。所有膀胱破裂（n = 5）的患者均有性交痛。骶骨骨折或骶髂关节损伤、后路治疗类型和后环残余对线不良与性交痛无关。各有 14 例患者伴有股骨或胫骨骨折。其中 17 例患者性交时疼痛（股骨或胫骨骨折与性交痛相关的 P = 0.19）。
骨盆环骨折后女性性交痛很常见。骨盆环损伤的女性比其他患有肌肉骨骼创伤的女性更有可能报告性交痛。性交痛与前后压缩和 B 型损伤有关。耻骨联合钢板固定也与性交痛有关。所有有膀胱破裂史的患者均有性交痛。肌肉骨骼功能评估评分报告的功能结局较差的女性有性交痛。
预后 III 级。有关证据水平的完整描述，请参见作者说明。
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