Clinical Study Of Anterior Pelvic Ring Fracture With Posterior Urethral Injury

Objective: To study the clinical data of 40 patients with anterior pelvic ring fracture complicated with posterior urethral injury who were treated by trauma surgery in our hospital,and to compare and analyze the effect of two treatments.Objective to investigate the clinical effect and complications of anterior pelvic ring fracture and posterior urethral injury,and to find a better treatment for such patients.Methods: From September 2017 to June 2020,40 male patients with anterior pelvic ring fracture combined with posterior urethral injury who were treated by trauma surgery in Affiliated Hospital of Qingdao University were selected for retrospective analysis.All patients had a clear history of trauma.After admission,save the patient’s life first,actively correct the shock and stabilize the patient’s vital signs.The unstable anterior pelvic ring fracture was confirmed by pelvic DR and pelvic CT three-dimensional imaging,and was classified according to tile classification;at the same time,the patient had dysuria,urethral bleeding and other symptoms,and the catheter could not be inserted into the bladder.According to the comprehensive situation of the patients,they were divided into group A and group B,16 cases in group A were treated with emergency urethral realignment + I-stage Stoppa approach fracture open reduction and plate internal fixation group;24 cases in group B were treated with emergency suprapubic bladder puncture and fistula + II stage MIPPO technology periosteal plate internal fixation group.The intraoperative blood loss,average hospital stay,fracture reduction(evaluated by Matta standard),limb function recovery(evaluated by Majeed score)3 months,6 months and 9months after operation,incidence of urethral stricture 6 months after operation and incidence of postoperative complications of the two groups were collected.The clinical effects of the two treatment schemes were evaluated by statistical analysis.Results: The intraoperative blood loss in group A was more than that in group B,the incidence of postoperative incision infection in group A was higher than that in group B,the fracture reduction in group A was better than that in group B,and the recovery of body function in group B was better than that in group a three months after operation,with significant difference(P < 0.05).However,there was no significant difference in the average length of hospital stay,the recovery of physical function 6 and 9 months after operation,the incidence of urethral stricture 6 months after operation and the overall incidence of postoperative complications between the two groups(P > 0.05).Conclusion: For patients with unstable anterior pelvic ring fracture complicated with male posterior urethral injury,there was no significant difference in the prognosis of fracture and complications of urethral injury between emergency urethral realignment +I-stage Stoppa approach fracture open reduction and plate internal fixation and emergency suprapubic bladder puncture and fistula + II stage MIPPO technology periosteal plate internal fixation.The former has the advantages of more accurate fracture reduction,simple and effective operation,reducing the difficulty of delayed operation,but there are more intraoperative bleeding,higher risk of infection in the operation area;the latter has the advantages of less intraoperative bleeding,higher safety,faster postoperative recovery,easy tolerance of severe patients,but it is easier to damage the lateral femoral cutaneous nerve,and has high requirements for the operator’s technology and experience.The two methods have their own advantages and disadvantages,and both have good feasibility and safety.They are both safe and effective treatment methods for patients with pelvic anterior ring fracture with posterior urethral injury.We need to choose the appropriate treatment according to the actual situation of the patients.