[Ortho] Операция на переднем полукольце таза при наличии надлобкового свища?

[Chip Routt]

Sorry to be late...here’s an old reference.

Chip

Internal fixation in pelvic fractures and primary repairs of associated
genitourinary disruptions: a team approach.
Routt ML, Simonian PT, Defalco AJ, Miller J, Clarke T.
Harborview Medical Center, Department of Orthopaedic Surgery, Seattle,
Washington 98104, USA.
Associated urological and orthopedic injuries of the pelvic ring are complex
with numerous potential complications. These patients are treated optimally
using a team approach. The combined expertise is not only helpful initially
when managing these difficult patients, but also later as problems develop.
This study describes a treatment protocol and reports the early results of
23 patients with unstable pelvic fractures and associated bladder or
urethral disruptions, or both, treated surgically with open reduction and
internal fixation of the anterior pelvic ring injuries at the same
anesthetic and using the same surgical exposure as the urethral realignments
or bladder repairs or both. Early complications occurred in four patients
(17%): one patient sustained a fifth lumbar nerve injury caused by the
pelvic reduction procedure, and three patients had anterior pelvic internal
fixation failures. Late complications occurred in eight patients (35%).
There was one deep wound infection (4.3%) that presented 6 weeks after
injury. Late urological complications occurred in seven patients (30%). Four
of the nine male patients with urethral disruptions had urethral stricture
after their primary urethral realignments (44%). Three of the 18 male
patients admitted to impotence (16.7%). One of the three had a residual
thoracic paraplegia caused by a burst fracture. One of the five female
patients had urinary incontinence and required a bladder suspension
operation to restore normal function (20%). A low infection rate can be
expected despite the use of internal fixation. Early urethral "indirect"
realignments avoid more difficult delayed open repairs; however, late
urological complication rates are still high. Early "direct" bladder repairs
are easily performed at the time of anterior pelvic open reduction and
internal fixation. Suprapubic tubes are not necessary to adequately divert
the urine when large diameter urethral catheters are used in these patients.




> I'm currently working on a manuscript with Dr. Matta on this topic. his
> protocol which i use now is to prep the SP catheter into the field, do your
> normal approach, repair bladder as indicated and place a new SP catheter or
> foley.
> 
> no other special measures
> 
> no infections in 19 patients
> 
> dave
> 
> 
> 
> David P. Zamorano, MD
> Assistant Chief, Orthopaedic Trauma Service
> Dept. of Orthopaedic Surgery
> Harbor/UCLA Medical Center
> Office (310) 222-2716
> Fax (310) 533-8791
> 
> dpzamorano на hotmail.com
>> 
>> From: Alexander Chelnokov <alex на orto.unets.ru>
>> Reply-To: ORT-L на www2.aaos.org
>> To: ORT-L на www2.aaos.org
>> Subject: [ORT-L] ORIF and suprapubic tube?
>> Date: Thu, 31 May 2007 16:17:29 +0600
>>> >Dear colleagues,
>>> >
>>> >If a patient has a suprapubic tube, is it possible to perform open
>>> >reduction and plating of the anterior part of the ring? Any special
>>> >measures to prevent infection? THX!
>>> >
>>> >--
>>> >Best regards,
>>> > Alexander N. Chelnokov
>>> >Ural Scientific Research Institute
>>> >of Traumatology and Orthopaedics
>>> >7, Bankovsky str. Ekaterinburg 620014 Russia
>>> >
>>> >---
>>> >[This E-mail scanned for viruses by Declude Virus]
>>> >
>> 
>> 
>>  Make every IM count. Download Messenger and join the i‚m Initiative now.
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M.L. Chip Routt, Jr.,M.D.
Professor-Orthopedic Surgery
Harborview Medical Center
325 Ninth Avenue
Box 359798
Seattle, WA 98104-2499
phone 206-731-3658
FAX 206-731-3227
--