创伤性骨盆骨折后男性性功能障碍对健康相关生活质量的影响。

The effect of sexual dysfunction on health-related quality of life in men following traumatic pelvic fractures.

机构信息

From the Department of Urology (A.Y.W., N.V.J.), Vanderbilt University Medical Center, Nashville, Tennessee; Harborview Injury Prevention and Research Center (M.S.V., F.P.R., N.V.J.), Department of Anesthesiology and Pain Medicine (M.S.V.), and Department of Pediatrics (F.P.R.), University of Washington, Seattle, Washington.

出版信息

J Trauma Acute Care Surg. 2021 Aug 1;91(2):325-330. doi: 10.1097/TA.0000000000003187.

DOI:10.1097/TA.0000000000003187

PMID:33797492

Abstract

BACKGROUND

Pelvic trauma disproportionately affects a younger population and has the potential to cause long-term sexual dysfunction. We hypothesized that the presence of sexual dysfunction after traumatic pelvic fracture negatively impacts health-related quality of life (HrQOL) in men.

METHODS

A total of 228 patients with traumatic pelvic fractures treated at a level 1 trauma center between 2012 and 2017 completed a survey that evaluated postinjury HrQOL and sexual function. Inverse probability weighting was used to adjust for survey nonresponse. Pelvic fracture characteristics were classified based on the Orthopedic Trauma Association classification system. Sexual function was evaluated using the International Index of Erectile Function, and HrQOL was evaluated using the EuroQol 5 Dimensions Questionnaire (EQ-5D). Quality-adjusted life years were determined based on calculated EQ-5D utility indices. Multiple regression models were created to evaluate the association between sexual health and HrQOL.

RESULTS

After inverse probability weighting and adjustment for potential confounders, a decrease in International Index of Erectile Function was associated with a decline in overall HrQOL as measured by the EQ-5D visual analog scale (β = 0.28, p = 0.02). No association was identified between Orthopedic Trauma Association pelvic fracture configuration and risk of postinjury erectile dysfunction (ED) (p = 0.99). Furthermore, 53.3% of men reported persistent ED at a median of 42.6 months (interquartile range, 28.0-63.3 months) following injury. The presence of ED was independently associated with a decrease in HrQOL (β = 10.92, p < 0.001). This difference equates to a loss of 1.6 quality-adjusted life years per 10 years for men with ED following pelvic fracture relative to those without.

CONCLUSION

Sexual dysfunction is an independent risk factor for decreased HrQOL in pelvic trauma survivors. Further work is needed to create appropriate patient-centered survivorship care pathways that incorporate sexual health evaluation.

LEVEL OF EVIDENCE

Prognostic, level IV.

摘要

背景

骨盆创伤对年轻人群的影响更大，并有可能导致长期性功能障碍。我们假设，创伤性骨盆骨折后性功能障碍的存在会对男性的健康相关生活质量（HrQOL）产生负面影响。

方法

2012 年至 2017 年期间，在一家一级创伤中心治疗的 228 例创伤性骨盆骨折患者完成了一项调查，该调查评估了损伤后的 HrQOL 和性功能。采用逆概率加权法对调查无应答进行调整。根据骨科创伤协会分类系统对骨盆骨折特征进行分类。采用国际勃起功能指数评估性功能，采用欧洲五维健康量表（EQ-5D）评估 HrQOL。根据计算出的 EQ-5D 效用指数确定质量调整生命年。创建多变量回归模型以评估性功能与 HrQOL 之间的关联。

结果

经过逆概率加权和潜在混杂因素的调整，国际勃起功能指数的下降与 EQ-5D 视觉模拟量表（VAS）测量的整体 HrQOL 下降相关（β=0.28，p=0.02）。骨科创伤协会骨盆骨折形态与损伤后发生勃起功能障碍（ED）的风险之间没有关联（p=0.99）。此外，53.3%的男性在损伤后中位数为 42.6 个月（28.0-63.3 个月）时报告持续存在 ED。ED 的存在与 HrQOL 下降独立相关（β=10.92，p<0.001）。这一差异相当于骨盆骨折后 ED 男性每 10 年损失 1.6 个质量调整生命年，而无 ED 男性则没有损失。