*Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, United Kingdom; †Department of Trauma and Orthopaedics, Leeds Teaching Hospitals, University of Leeds, Leeds, United Kingdom; and ‡Department of Health Statistics, University of Leeds, Leeds, United Kingdom.
J Orthop Trauma. 2014 Jan;28(1):28-35. doi: 10.1097/BOT.0b013e31828fc063.
To provide evidence on the midterm sexual-function- and health-related quality-of-life outcome of patients with a traumatic pelvic fracture, as recorded at least 12 months after their surgery.
Prospective noncomparative study.
Tertiary referral centre for pelvic-and-acetabular reconstruction.
Cohort of patients attending a dedicated pelvic-and-acetabular reconstruction clinic because of blunt pelvic trauma, at a minimum of a year after their injury.
Operatively treated pelvic fractures and concomitant surgical interventions for associated injuries, if any, sustained by the patients after blunt trauma.
Sexual function questionnaires: IIEF (international index of erectile function) and FSFI (female sexual function index). Quality of life was assessed with the EuroQol-5D questionnaire.
Of a cohort of 110 patients, 80 patients (48 males and 32 females) consented to participate with a median age of 46 years (range, 19-65 years). Of the above cohort, 62.5% were a result of road traffic accidents and 52.5% were classified as lateral compression type fractures. Assessment occurred at a median period of 36 months after injury (range, 12-96). Overall, significant decrease of their quality of life (P < 0.0001) and sexual function were recorded (males, P < 0.00014; females, P < 0.001). Sexual dysfunction was identified in 43.8% of the female and 52.1% of the male patients, as per the validated gender-specific sexual function scores (female sexual function index and international index of erectile function, respectively). Regression analysis identified the presence of urinary tract injury (P < 0.049) and open surgical treatment (P < 0.047) as independent risk factors for sexual dysfunction. A near significant association with injury severity score (P = 0.05) was seen. Male gender (P < 0.006), abdominal injury (P < 0.0001), pelvic fracture severity (P < 0.049), pain (P < 0.0001), and sexual dysfunction (P < 0.034) were identified as significant independent risk factors for decreased quality of life.
All domains of female and male sexual function were significantly decreased at a minimum of a year after pelvic fracture. Quality of life was also significantly decreased in this group with sexual dysfunction shown to be an independent risk factor for decreased quality of life after injury. Further pivotal clinical studies should follow based on the provided evidence. High clinical suspicion and prompt engagement of appropriate multidisciplinary pathways, including urological, gynecological, and psychiatric consultations, is recommended.
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
提供至少在创伤性骨盆骨折患者手术后 12 个月记录的中期性功能和健康相关生活质量结局的证据。
前瞻性非对照研究。
骨盆和髋臼重建的三级转诊中心。
因钝性骨盆创伤而在专门的骨盆和髋臼重建诊所就诊的患者队列，至少在受伤 1 年后。
手术治疗骨盆骨折和相关损伤的同时手术干预，如果有的话，患者在钝性创伤后发生的损伤。
性功能问卷：国际勃起功能指数（IIEF）和女性性功能指数（FSFI）。生活质量使用 EuroQol-5D 问卷进行评估。
在 110 名患者的队列中，有 80 名患者（48 名男性和 32 名女性）同意参加，中位年龄为 46 岁（范围，19-65 岁）。在上述队列中，62.5%是道路交通事故的结果，52.5%是侧压型骨折。评估发生在损伤后中位数 36 个月（范围，12-96）。总体而言，记录到他们的生活质量（P <0.0001）和性功能显著下降（男性，P <0.00014；女性，P <0.001）。根据经过验证的性别特异性性功能评分（女性性功能指数和国际勃起功能指数），43.8%的女性和 52.1%的男性患者存在性功能障碍。回归分析确定存在尿路损伤（P <0.049）和开放性手术治疗（P <0.047）是性功能障碍的独立危险因素。损伤严重程度评分（P = 0.05）与损伤严重程度评分之间存在显著相关性。男性（P <0.006）、腹部损伤（P <0.0001）、骨盆骨折严重程度（P <0.049）、疼痛（P <0.0001）和性功能障碍（P <0.034）是生活质量下降的显著独立危险因素。
至少在骨盆骨折后 1 年，女性和男性的所有性功能领域均显著下降。该组的生活质量也显著下降，性功能障碍是受伤后生活质量下降的独立危险因素。应根据提供的证据进行进一步的关键临床研究。建议高度怀疑临床，并及时进行适当的多学科途径（包括泌尿科、妇科和精神科咨询）。
预后 II 级。请参阅作者说明，以获取完整的证据水平描述。
