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骨科手术中的泌尿生殖系统并发症。

Genitourinary complications in orthopaedic surgery.

机构信息

Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, United States of America.

Department of Urology, University of Kansas Health System, Kansas City, KS, United States of America.

出版信息

Eur J Orthop Surg Traumatol. 2022 Feb;32(2):201-210. doi: 10.1007/s00590-021-02944-y. Epub 2021 Mar 29.

Abstract

Genitourinary complications following orthopaedic intervention are uncommon but well-described occurrences and exist on a spectrum of severity. These complications vary depending on the anatomic location and surgical approach, with surgery of the spine, hip, and pelvis of particular concern. Injuries to the urinary tract may present acutely with urinary retention or hematuria. However, they often have a delayed presentation with severe complications such as urinary fistula and recurrent infection. Delayed presentations may place the onus of timely and proper diagnosis on the orthopaedic provider, who may serve as the patient's primary source of long-term follow-up. Detailed knowledge of anatomy and at-risk structures is key to both preventing and identifying injury. Although iatrogenic injury is not always avoidable, early identification can help to facilitate timely evaluation and management to prevent long-term complications such as bladder dysfunction, obstructive renal injury, sexual dysfunction, and chronic pain.  Keywords: urologic injury, bladder injury, genitourinary injury, hip arthroplasty, pelvic ring injuries, spine surgery.

摘要

骨科干预后的泌尿生殖系统并发症并不常见,但已有充分描述,其严重程度存在一定差异。这些并发症取决于解剖部位和手术入路,脊柱、髋关节和骨盆手术尤其值得关注。尿路损伤可表现为急性尿潴留或血尿。然而,它们通常表现为严重并发症,如尿瘘和反复感染,具有延迟表现。延迟表现可能使骨科医生承担及时和适当诊断的责任,因为他们可能是患者长期随访的主要来源。详细了解解剖结构和易受伤结构对于预防和识别损伤至关重要。虽然医源性损伤并非总是可以避免,但早期识别有助于及时进行评估和管理,以预防膀胱功能障碍、梗阻性肾损伤、性功能障碍和慢性疼痛等长期并发症。关键词: 泌尿科损伤,膀胱损伤,泌尿生殖系统损伤,髋关节置换术,骨盆环损伤,脊柱手术。

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