Risk Factors And Mechanism Of Sexual Dysfunction In Male Patients With Pelvic Fracture

Objective:Sexual dysfunction and genitourinary injuries associated with pelvic fractures are the result of direct or indirect trauma,with erectile dysfunction being one of the major long-term complications,which usually contributes to a reduced quality of life.The aim of this study was to investigate the association between pelvic fractures and sexual dysfunction and provide a basis for orthopedic surgeons and interdisciplinary teams in the treatment of pelvic fractures,improving long-term outcomes and reducing complications.Method:1)The clinical data of 77 male patients with complex pelvic fractures who were admitted to 3 large tertiary hospitals in Xinjiang from October 2017 to December 2021 were retrospectively analyzed.According to different surgical treatment methods,the patients were divided into modified Stoppa approach group 20 Examples:31cases in the ilioinguinal approach group and 26 cases in the combined anterior-posterior approach group.The International Index of Erectile Function-5(IIEF-5)scores and ED of each group were compared 1 year after surgery.rate,pelvic function score(Majeed score),excellent and good pelvic function rate and postoperative complications.2)The second part of the study retrospectively analyzed 162 male pelvic fracture patients who met the inclusion and exclusion criteria and were admitted to 3 large tertiary hospitals in Xinjiang from December 2018 to December 2021.IIEF-5 was used to evaluate the patients'SF.Univariate analysis was conducted to determine whether factors such as age at injury,evaluation time after injury,cause of injury,type of pelvic fracture,different fracture patterns,and surgical approaches were related to SD secondary to pelvic fracture.Variables with statistical significance in the univariate analysis were included in the multifactorial analysis.Logistic regression analysis,using the maximum likelihood ratio forward method to screen out the final variables,obtain the independent predictors of secondary SD in male pelvic fracture patients,draw the ROC curve,analyze the predictive efficacy of the independent predictors,and construct a prediction for men based on the independent predictors A nomogram model for the risk of secondary SD in patients with pelvic fractures,a calibration curve was drawn,the calibration degree of the nomogram model was analyzed,a decision curve was drawn,and the net rate of return of the nomogram model was further analyzed.3)The third part is a retrospective cohort study by consulting authoritative anatomical data and understanding the anatomical positional relationship between the pelvis and EF-related tissues based on human anatomical models.Sixty-five cases of male pelvic fracture patients diagnosed and treated in three large tertiary hospitals in Xinjiang from December 2019 to December 2021 were included.According to the Tile classification of pelvic fractures,there were 44 cases in the Tile B group and 21 cases in the Tile C group.All patients were treated surgically.Observation items:(1)Compare the clinical baseline data of the 2 groups of patients.(2)One year after surgery,the IIEF-5 score was used to evaluate and compare the EF status and ED incidence of the two groups of patients.(3)Based on the anatomical location characteristics of EF-related tissues and the related blood vessels,nerves and muscles that are easily damaged by EF after pelvic fracture,pelvic fractures are divided into inferior pubic ramus fractures or ischial ramus fractures,pelvic pubic symphysis separation,and meridian fractures.There are four patterns of sacral fractures from the 2nd to 4th sacral foramina and Denis type Ⅲ sacral fractures.The differences in different fracture patterns between the two groups of patients were compared.Results:1)The results of the first part show that there is no statistically significant difference in age,cause of injury,and pelvic fracture classification(Tile classification)between the three groups of patients(all P values>0.05),and they are comparable.The EF scores of each group(IIEF-5)and ED rate had no statistical significance(P>0.05),the Majeed score variance analysis test results were statistically significant(F=3.467,P=0.036),post hoc multiple comparisons showed that the Majeed score of the modified Stoppa approach group was higher than Combined anterior and posterior approach group(P=0.031),while there was no statistically significant difference between the ilioinguinal approach group,the modified Stoppa approach group and the combined anterior and posterior approach group(all P values>0.05).The results of the rank sum test of grade data showed that there was a statistically significant difference in pelvic function between each group(H=6.934,P=0.031).The modified Stoppa approach group had the highest rate of excellent and excellent pelvic function(95.00%vs.87.10%,73.08%).There was no statistically significant difference in the occurrence of postoperative complications between each group(P>0.05).2)In the second part,univariate analysis revealed that factors such as age at injury,evaluation time after injury,cause of injury,and surgical approach had no significant effect on sexual dysfunction of pelvic fractures,while pelvic fracture classification(X~2=12.135,P=0.002),sacral fracture(X~2=25.087,P<0.001),superior and inferior pubic ramus fracture(X~2=14.228,P=0.001),and pubic symphysis separation(X~2=34.122,P<0.001)had a significant difference in the effect on sexual dysfunction.The results of multivariate logistic regression analysis showed that Denis typeⅡ(OR=3.939,P=0.030)and Denis typeⅢ(OR=4.864,P=0.028)sacral fractures,bilateral superior and inferior pubic rami fractures(OR=3.688,P=0.039),and pubic symphysis separation(OR=11.625,P<0.001)were independent risk factors for sexual dysfunction in male pelvic fractures.ROC curves showed that the area under the curve(AUC)of sacral fracture,superior and inferior pubic ramus fracture,and pubic symphysis separation for predicting sexual dysfunction in male pelvic fracture patients were 0.686(95%CI:0.602 to 0.770),0.658(95%CI:0.573 to 0.743),and 0.703(95%CI:0.619 to 0.788),respectively.A nomogram prediction model was constructed for analysis.Calibration curves showed that the risk prediction value of sexual dysfunction in male pelvic fracture patients was in good agreement with the actual observed value(P>0.05).In most reasonable threshold probability range,sacral fracture,superior and inferior pubic ramus fracture and pubic symphysis separation predicted sexual dysfunction in male pelvic fracture patients with good net yield,and the net yield of combined prediction was higher than that of a single index,which had good predictive value for sexual dysfunction of pelvic fracture.3)The results of the third part:(1)There were no significant differences in baseline data such as age,time from injury to surgery,cause of injury,and associated injuries between the two groups(all P values>0.05).(2)All patients recovered well after surgery,and no iatrogenic erectile function-associated nerve,blood vessel,or muscle injuries occurred,Fracture healing time 13.0(12.5,15.0)weeks.One year after operation,the IIEF-5 score of Tile B group was 22.0(16.3,23.0)points,which was higher than 13.0(9.5,21.5)points of Tile C group,and the incidence of erectile dysfunction was 45.5%(20/44),which was lower than 76.2%(16/21)of Tile C group,and the differences were statistically significant(Z=-2.87,X~2=5.44,P<0.05).(3)Patients with tile B fractures had a lower proportion of inferior pubic branch fractures or ischial branch fractures,sacral fractures through the second to fourth sacral foramen,and DenisⅢsacral fracture patterns than tile C,and the differences were statistically significant(X~2=8.92,10.77,and 13.44,all P values<0.05),while the proportion of pelvic pubic symphysis separation patterns was not significantly different between the 2 groups(X~2=1.90,P>0.05).Conclusion:1)There is no significant relationship between different surgical approaches in treating male complex pelvic fractures and secondary SD.The modified Stoppa approach has better pelvic function than the combined anterior-posterior approach and has the highest excellent and good rate.It is a better choice for clinical treatment of complex pelvic fractures.2)Denis typeⅡor Denis typeⅢ sacral fracture,bilateral superior and inferior pubic ramus fractures,and pubic symphysis separation are key risk factors for secondary SD in male patients with pelvic fractures;the nomogram prediction model constructed based on this will be more effective in the development of SD secondary to pelvic fractures.has good predictive value.3)The incidence of ED in patients with Tile C type pelvic fractures is higher than that in Tile B type patients.The anatomical reasons for the high incidence of ED may be related to the occurrence of inferior pubic ramus fractures or ischial ramus fractures,sacral fractures through the 2nd-4th sacral foramen,and Denis type Ⅲ sacral fractures are associated with a high probability.