Treatment of pelvic fractures complicated with urethral rupture via lateral-rectus approach and Pfannenstiel approach
10.3760/cma.j.cn115530-20220304-00125
- VernacularTitle:腹直肌外侧入路结合Pfannenstiel入路治疗骨盆骨折合并尿道断裂的疗效分析
- Author:
Qiguang MAI
1
;
Yuhui CHEN
;
Zhenhua ZHU
;
Tao LI
;
Hua WANG
;
Kangshuai XU
;
Hai HUANG
;
Cheng YANG
;
Jianwen LIAO
;
Shicai FAN
Author Information
1. 南方医科大学第三附属医院骨科医学中心创伤骨科，广州 510630
- Keywords:
Pelvis;
Fractures, bone;
Surgical approach;
Urethral rupture
- From:
Chinese Journal of Orthopaedic Trauma
2022;24(12):1016-1023
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the safety and clinical efficacy of the lateral-rectus approach combined with the Pfannenstiel approach in the treatment of pelvic fractures complicated with urethral rupture.Methods:From January 2013 to June 2021, 20 patients with pelvic fracture complicated with urethral rupture were surgically managed through the lateral-rectus approach and the Pfannenstiel approach at Department of Traumatic Surgery, Center for Orthopaedic Surgery, the Third Hospital Affiliated to Southern Medical University. They were 15 males and 5 females, with an average age of 42 years (from 18 to 55 years). By the Tile classification, there were 11 cases of type B and 9 cases of type C. The first-stage urethral realignment was performed via the Pfannenstiel approach in the supine position after general anesthesia in conjunction with an urologist; at the second-stage, the lateral-rectus approach was used to reduce and fixate the acetabular or pelvic fractures. The operation time, intraoperative blood loss, fracture reduction quality, pelvic functional recovery and complications were documented.Results:In this cohort, the operation time ranged from 80 to 240 min, averaging 140.5 min; the time for simple urethral convergence ranged from 20 to 30 min; the intraoperative blood loss ranged from 400 mL to 2,000 mL, averaging 730 mL. According to the Mears andVelyvis evaluation for fracture reduction quality, anatomical reduction was achieved in 13 cases, satisfactory reduction in 6 cases, and unsatisfactory reduction in one. The 20 patients were followed up for 12 to 68 months (mean, 37 months) after surgery. One fracture got nonunited but the other fractures got united after 3.0 to 4.5 months (mean, 3.5 months). According to the Majeed scoring system, the pelvic function at 12 months after surgery was excellent in 12 cases, good in 6 and fair in 2, giving an excellent and good rate of 90% (18/20). Screw loosening was found in one patient, traction injury to the lumbosacral trunk nerve in another patient, varying degrees of dysuria which responded to periodic urethral dilation in 8 patients, urethral stricture in 3 patients and erectile dysfunction in 5 patients. No abdominal hernia or pelvic infection was observed.Conclusions:The lateral-rectus approach combined with the Pfannenstiel approach can be used effectively to reduce and fixate the pelvic and acetabular fractures, and to repair the urethral rupture in one stage as well. They are also safe due to a low incidence of such complications as abdominal wall hernia and pelvic infection.
