Journal of Trauma and Injury

  • 제20권2호
  • /
  • Pages.90-95
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  • 2007
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  • 2799-4317(pISSN)
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  • 2287-1683(eISSN)
대한외상학회 (The Korean Society of Traumatology)
권호 표지

골반 골절 위치와 방광, 요도, 하부 위장관계 손상의 관련성

Relation between Location of Pelvic bone Fractures and the Injury to the Urinary bladder, Urethra or Lower gastrointestinal tract

  • 김창호 (경북대학교 의과대학 응급의학교실) ;
  • 박정배 (경북대학교 의과대학 응급의학교실) ;
  • 류현욱 (경북대학교 의과대학 응급의학교실) ;
  • 서강석 (경북대학교 의과대학 응급의학교실) ;
  • 서준석 (대구응급의료정보센터) ;
  • 정제명 (경북대학교 의과대학 응급의학교실) ;
  • 제동욱 (경북대학교 의과대학 응급의학교실) ;
  • 성애진 (경북대학교 의과대학 응급의학교실)
  • Kim, Chang Ho (Department of Emergency Medicine, College of Medicine, Kyungpook National University) ;
  • Park, Jung Bae (Department of Emergency Medicine, College of Medicine, Kyungpook National University) ;
  • Ryoo, Hyun Wook (Department of Emergency Medicine, College of Medicine, Kyungpook National University) ;
  • Seo, Kang Suk (Department of Emergency Medicine, College of Medicine, Kyungpook National University) ;
  • Seo, Jun Seok (Daegu Emergency Medical Information Center) ;
  • Chung, Jae Myung (Department of Emergency Medicine, College of Medicine, Kyungpook National University) ;
  • Je, Dong Wook (Department of Emergency Medicine, College of Medicine, Kyungpook National University) ;
  • Sung, Ae Jin (Department of Emergency Medicine, College of Medicine, Kyungpook National University)
  • 투고 : 2007.09.06
  • 심사 : 2007.11.01
  • 발행 : 2007.12.30
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초록

Purpose: This research was conducted to study whether the specific location of pelvic-bone fractures could increase the risk for injury to the urinary bladder, urethra, or lower gastrointestinal tract. Methods: We retrospectively reviewed the data of 234 patients with pelvic-bone fractures who visited the emergency department of Kyungpook National University Hospital from January 2004 to December 2006. The location of the pelvic-bone fracture was divided into 8 parts. The association of fracture location with injury to the urinary bladder, urethra, or lower gastrointestinal tract was analyzed with Fisher' s-exact test and multiple logistic regression. Results: Nineteen(19) patients had urinary bladder injury, 8 had urethral injury, and 9 had lower gastrointestinal tract injury. The following fracture locations were found to be significant; urinary bladder: sacroiliac (SI) joint (p<0.001), symphysis pubis (p=0.011), and sacrum (p=0.005); urethra: SI joint (p=0.020); lower gastrointestinal tract: symphysis pubis (p=0.028). After the multiple logistic regression analysis, the primary and the independent predictors for each of the injuries were as follows; urinary bladder: sacroiliac joint (p=0.000, odds ratio [OR]=10.469); lower gastrointestinal tract: symphysis pubis (p=0.037, OR=7.009). Conclusion: Consideration of further workup for injuries to the lower gastrointestinal and urinary tract is needed for some locations of pelvic-bone fractures because certain pelvic-bone fracture locations, especially the sacroiliac joint and the symphysis pubis, are associated with increased risk for injury to the lower gastrointestinal and urinary tracts.

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참고문헌

  1. Vrahas MS, Reid JS. Late recognition of a rectal tear associated with a pelvic fracture. A case report. J Bone Joint Surg Am 1994;76:1072-6 https://doi.org/10.2106/00004623-199407000-00018
  2. Iselin CE, Webster GD. The significance of the open bladder neck associated with pelvic fracture urethral distraction defects. J Urol 1999; 162:347-51 https://doi.org/10.1016/S0022-5347(05)68557-6
  3. Arun N, Kekre NS, Nath V, Gopalakrishnan G. Indwelling catheter causing perforation of the bladder. Br J Urol 1997;80:675-6 https://doi.org/10.1046/j.1464-410X.1997.00316.x
  4. Aihara R, Blansfield JS, Millham FH, LaMorte WW, Hirsch EF. Fracture locations influence the likelihood of rectal and lower urinary tract injuries in patients sustaining pelvic fractures. J Trauma 2002;52:205-8 https://doi.org/10.1097/00005373-200202000-00001
  5. Koraitim MM, Marzouk ME, Atta MA, Orabi SS. Risk factors and mechanism of urethral injury in pelvic fractures. Br J Urol 1996;77:876-80 https://doi.org/10.1046/j.1464-410X.1996.01119.x
  6. Hamill J, Holden A, Paice R, Civil I. Pelvic fracture pattern predicts pelvic arterial hemorrhage. Aust N Z J Surg 2000;70:338-43 https://doi.org/10.1046/j.1440-1622.2000.01822.x
  7. Pohlemann T, Bosch U, Gansslen A, Tscherne H. The Hannover experience in management of pelvic fractures. Clin Orthop 1994;305:69-80
  8. Bodner DR, Selzman AA, Spirnak JP. Evaluation and treatment of bladder rupture. Semin Urol 1995;13:62-5
  9. Flint LM, Brown A. Richardson JD, Polk HC. Definitive control of bleeding from severe pelvic fractures. Ann Surg 1979;189:709-16 https://doi.org/10.1097/00000658-197906000-00006
  10. Mucha P, Farnell MB. Analysis of pelvic fracture management. J Trauma 1984;24:379-86 https://doi.org/10.1097/00005373-198405000-00002
  11. Munshi IA, Hong JJ, Mueller CM, Barie PS. Spontaneous rupture of the urinary bladder in the alcoholic patient. J Trauma 1999;46:1133-4 https://doi.org/10.1097/00005373-199906000-00033
  12. Cass AS, Luxenberg M. Features of 164 bladder rupture. J Urol 1987;138:743-5 https://doi.org/10.1016/S0022-5347(17)43358-1
  13. Choi DY, Park YH. Risk factor for lower urinary tract injuries in patients with traumatic pelvic fractures. Korean J of Urol 1991;32:94-9
  14. Carroll PR, McAninch JW. Major bladder trauma: mechanisms of injury and a unified method of diagnosis and repair. J Urol 1984;132:254-7 https://doi.org/10.1016/S0022-5347(17)49581-4
  15. Avey G, Blackmore CC, Wessells H, Wright JL, Talner LB. Radiographic and clinical predictors of bladder rupture in blunt trauma patients with pelvic fracture. Acad Radiol 2006;13:573-9 https://doi.org/10.1016/j.acra.2005.10.012
  16. Chapple CR. Urethral injury. BJU Int 2000;86:318-26 https://doi.org/10.1046/j.1464-410x.2000.00101.x
  17. Andrich DE, Mundy AR. The nature of urethral injury in cases of pelvic fracture urethral injury trauma. J Urol 2001;165:1492-5 https://doi.org/10.1016/S0022-5347(05)66334-3
  18. Hwang TG, Chun CS. Clinical observation on urethral injury. Korean J of Urol 1981;22:602-10
  19. Kim W. A clinical observation of urethral injury. Korean J of Urol 1983;24:867-72
  20. Basta AM, Blackmore CC, Wessells H. Predicting urethral injury from pelvic fracture patterns in male patients with blunt trauma. J Urol 2007;177:571-5 https://doi.org/10.1016/j.juro.2006.09.040
  21. Lee SJ, Kim HJ. Analysis of lower urinary tract injury associated with pelvic fracture. Korean J of Urol 2001;42:603-608
  22. Demetriades D, Karaiskakis M, Toutouzas K, Alo K, Velmahos G, Chan L. Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes. J Am Coll Surg 2002;195:1-10 https://doi.org/10.1016/S1072-7515(02)01197-3