Boston University Orthopaedics, Boston Medical Center, Boston, MA.
Department of Orthopaedics and Sports Medicine, University of Washington, Harborview Medical Center, Seattle, WA; and.
J Orthop Trauma. 2024 Sep 1;38(9):459-465. doi: 10.1097/BOT.0000000000002846.
To identify the infection rate in patients with combined pelvic ring and bladder injuries. Secondary aims included identifying treatment and injury factors associated with infection.
Retrospective review.
Single Level I Tertiary Academic Center.
All patients over a 12-year period with combined pelvic ring and bladder injuries were evaluated. Exclusion criteria were nonoperative management of the pelvic ring, isolated posterior fixation, and follow-up <90 days.
Primary outcome measured was deep infection of the anterior pelvis requiring surgical irrigation and debridement.
In total, 106 patients with anterior stabilization of the pelvis in the setting of a bladder injury were included. Seven patients (6.6%) developed a deep infection and required surgical debridement within 90 days. Patients undergoing open reduction and internal fixation with plating of the anterior pelvis and acute concomitant bladder repair had an infection rate of 2.2% (1/43). Patients undergoing closed reduction and anterior fixation with either external fixation or percutaneous rami screw after bladder repair had an infection rate of 17.6% (3/17). There was a higher infection rate among patients with combined intraperitoneal (IP) and extraperitoneal (EP) bladder injuries (23%) when compared with those with isolated EP (3.8%) or IP (9.1%) bladder injuries (P = 0.029).
Acute open reduction and internal fixation of the anterior pelvis in patients with combined pelvic ring and bladder injuries has a low infection rate. Patients with combined IP and EP bladder injuries are at increased risk of infection compared with those with isolated IP and EP injuries.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
确定合并骨盆环和膀胱损伤患者的感染率。次要目的包括确定与感染相关的治疗和损伤因素。
回顾性研究。
单一一级三级学术中心。
对 12 年来所有合并骨盆环和膀胱损伤的患者进行评估。排除标准为骨盆环非手术治疗、单纯后路固定和随访时间<90 天。
主要结果是需要手术灌洗和清创的前骨盆深部感染。
共纳入 106 例膀胱损伤患者行骨盆前路固定。7 例（6.6%）发生深部感染，90 天内需行手术清创。行前路切开复位内固定加钢板固定和急性同期膀胱修补术的患者感染率为 2.2%（43 例中有 1 例）。行闭合复位和前路固定，膀胱修补后行外固定或经皮骶骨螺钉固定的患者感染率为 17.6%（17 例中有 3 例）。与单纯腹膜外（EP）或腹膜内（IP）膀胱损伤（3.8%和 9.1%）相比，合并 IP 和 EP 膀胱损伤的患者感染率更高（23%）（P=0.029）。
合并骨盆环和膀胱损伤患者行急性前路切开复位内固定术感染率较低。与单纯 IP 和 EP 损伤相比，合并 IP 和 EP 膀胱损伤的患者感染风险增加。
预后 III 级。有关证据水平的完整描述，请参见作者说明。
