Clinical Study On Relation Of Posterior Urethral Injury Caused By Different Types Of Pelvic Fracture

Objective: To observe the relation between Various types of pelvic fractures and urethral injury after pelvic fracture , to explore the clinical characteristics of urethral injury, guiding the diagnosis and treatment of urethral injury.Methods: To choose 60 patients suffering from urethral injury after pelvic fracture of our hospital from January of 2009 to December of 2010 .Pelvic fracture will be divided into compression pelvic fractures , separated and intermediate types which were based on pelvic morphology classification, and studied separately.60 patients were divided into 3 groups according to type of fracture, 24 cases of compression, 20 cases of separation, 16 cases of intermediate type. It was bladder fistula ndwelling and pelvic plain films and underwent three-dimensional spiral computed tomography/cysto-urethrography (CTCUG) for all patients .To measure the urethral stricture (atresia) in length and observe urethral stricture (atresia) position. Analysis the correlation of different types of pelvic fracture and urethral injury , observe state of urethral injury, injured characteristics and explore the characteristics and mechanism of urethral injury . The experimental data are analyzed by SPSS16.0 statistic software and obtain result.Results: Different types of pelvic fractures (including compression type, separate type and intermediate type) caused different posterior urethral injury in the mechanism and characteristics. 24 patients with compression of the pelvic fracture , 17 patients with membranous urethral stenosis (atresia), 3 cases with bulbar urethral stricture, 2 cases of membranous urethral stricture ball ,2 case of urethral stricture of the prostatic apex. Three-dimensional reconstruction of CT angiography measurement showed the distance of urethral stenosis (atresia) was 2.69±0.47 cm. The length of 16 cases of unilateral fracture of the pubic branch stenosis is 2.84±0.42cm, 8 cases of bilateral fracture of the pubic branch stenosis is 2.54±0.57cm, p > 0.01. No significant differences exit between two. 20 cases of isolated pelvic fracture urethral stricture are the prostatic apex to the membranous stenosis, 3 cases are membranous urethral stricture,6 cases of bulbar ball membranous,10 patients with membranous stenosis ball stricture, 1 case of urethral stricture of the prostatic apex . CT measurement of stricture length is 2.73±0.49cm. If diastasis of the symphysis publis different,degrees of urethral injuries were varied.Pubic symphysis separation is <1.0cm, the main site of injury to the prostatic apex urethra, urethral stricture length is 2.11±0.50cm.If the pubic symphysis separation is> 1.5cm, injury site to the membranous urethra, the narrow segment was 3.35±0.48cm. Comparing , p <0.01, with a statistically significant. Among 16 cases of pelvic fracture ,urethral stricture involving the site of the Ministry of the ball, membranous, the length is 4.59±0.87cm. comparison of Urethral stricture caused by pelvic fracture of compression-type pelvic fracture and separation in length, P >0.01, No significant differences exit between two.Compression between pelvic fractures and intermediate-type pelvic fracture,P <0.01,statistically significant.There is statistically significance of separation pelvic fracture comparised to intermediate-type in length ,P <0.01.Conclusion: Male posterior urethra traveling in two angle formed by the pubic arch, the urethral wall fixed to the triangle on the ligament, fracture occurs when the pelvic ring, urethra injury with the pelvic shift in patients .The severity of Urethra injury are related with type of pelvic fractures, displacement and its stability.Violence of Axial compression type has largest probability of urethra injury,to the most serious extent. The more Fracture displacement is,the more probability and the severity of urethra injury is greater.Compression-type pelvic fracture shift mainly to the contralateral pelvic , the result is caused of the membranous urethral injury of poor stability. It was positively correlated of urethral injury and the extent of pelvic displacement . Separation pelvic fracture is mainly affected by the extrusion of violence, and mainly caused by traction injury, the result is caused the prostatic urethra damage-based.Intermediate pelvic fractures caused before and after ring fracture of the pelvis, this feature makes the mechanism and characteristics of urethral injury complicated by the degree of urethral injury is relatively heavy. This pelvic fracture main cause the ball and the membranous urethra and Prostatic Urethral stricture (atresia), most of urethral stricture length greater than 4cm .The bladder endoscopic urethral realignment procedure is a better way for the treatment of urethral injury under the premise of stability of the pelvis,but it is only to appropriate surgical injury and some minor urethral rupture.For the complete rupture of the urethral injury, bleeding more, should be giving emergency surgery.Severe pelvic injury should be waiting pelvic to be stable after 6 months and giving surgical treatment.