Hsu Sheng-Der, Lee Shih-Yu, Lin Kuen-Tze, Lin Chun-Shu, Chien Wu-Chien, Chen Cheng-Jueng, Chung Chi-Hsiang, Chang Wei-Kuo
Division of Traumatic and General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan.
PLoS One. 2017 Dec 1;12(12):e0174733. doi: 10.1371/journal.pone.0174733. eCollection 2017.
Pelvic angiographic embolization is an effective procedure to provide haemostasis in patients with pelvic fractures. However, management with repeated follow-up radiographs may result in infertility. The study aimed to evaluate the risk of infertility following pelvic fracture treated with pelvic angiographic embolization in female patients. We used data from the National Health Insurance Research Database (NHIRD) provided by the Bureau of National Health Insurance of the Department of Health in Taiwan from the period of 1997-2010. A total of 36 and 18,029 patients were included in the case and control cohorts, respectively. The risk estimations for the case and control cohorts were compared using a Cox's proportional hazards regression model. The significance level was set at <0.05. After adjusting for possible confounding factors, the incidence of infertility in the case cohort was nearly 30.7-fold higher than that in the control cohort (adjust hazard ratio [HR] = 30.7, 95% confidence interval [CI] = 10.643-70.109). Patients between 15-35 years of age had a much higher incidence of infertility in the case cohort than in the control cohort (adjusted HR = 49.9, 95% CI = 15.177-64.099). Taken together, pelvic fractures in female patients treated with arterioembolization for haemostasis might be associated with a higher risk of infertility in Taiwan. Physicians should be aware of the link and inform patients of this risk prior to arterioembolization.
盆腔血管造影栓塞术是为骨盆骨折患者止血的有效方法。然而，反复进行随访X光检查可能会导致不孕。本研究旨在评估女性患者骨盆骨折经盆腔血管造影栓塞术后不孕的风险。我们使用了台湾地区卫生署国民健康保险局提供的1997年至2010年期间的国民健康保险研究数据库（NHIRD）的数据。病例组和对照组分别纳入了36例和18029例患者。使用Cox比例风险回归模型比较病例组和对照组的风险估计值。显著性水平设定为<0.05。在调整可能的混杂因素后，病例组的不孕发生率比对照组高出近30.7倍（调整后风险比[HR]=30.7，95%置信区间[CI]=10.643 - 70.109）。15至35岁的患者中，病例组的不孕发生率比对照组高得多（调整后HR = 49.9，95% CI = 15.177 - 64.099）。综上所述，在台湾，接受动脉栓塞止血治疗的女性骨盆骨折患者可能面临更高的不孕风险。医生应了解这种关联，并在动脉栓塞术前告知患者这一风险。
