6. Urological injury
6. 泌尿系损伤
This is a well recognised complication particularly where there is separation of the pubic symphysis or a fractured pubic ramus.
这是一种众所周知的并发症，特别是存在耻骨联合分离或耻骨支骨折时。
Injuries to the bladder range from contusions to bladder rupture.Most bladder ruptures are extraperitoneal with intraperitoneal ruptures resulting from blunt trauma to a distended bladder or iatrogenic causes. Occasionally, bladder injury may be suspected on plain radiography when there is a ‘pear-shaped’ bladder, with a paralytic ileus and loss of obturator fat planes. However, the diagnosis is con?rmed by a retrograde cystogram or preferably CT cystography.
膀胱损伤的程度包括挫伤和膀胱破裂。多数膀胱破裂由钝性创伤累及膨胀的膀胱或医源性因素引起的腹膜内和腹膜外破裂。X线平片可偶然发现可疑膀胱损伤的表现，包括 “梨形”膀胱征合并麻痹性肠梗阻或闭孔脂肪层面消失。然而，确诊尚需逆行膀胱造影X线片或更精确的CT膀胱造影检查。
Typically, a retrograde cystogram will depict a ‘?ame-shaped’ contrast extravasation into the perivesical fat and occasionally into the thigh or anterior abdominal wall. In intraperitoneal ruptures,contrast will extravasate into the paracolic gutters and will be seen outlining small bowel loops. On CT, it is important to distinguish urinary contrast extravasation from vascular extravasation.For this reason, cystography should be performed after intravenous contrast CT or angiography to avoid obscuring any vascular extravasation (Fig. 3a and b).
膀胱破裂行逆行膀胱造影的典型X线片表现为“火焰形”造影剂外溢至膀胱周围脂肪，偶尔外溢至大腿或前腹壁。对于腹膜内破裂，造影剂外溢至结肠旁沟并可见小肠环形轮廓。在CT片上，重点是区分泌尿系和血管造影剂外溢。因此，膀胱造影应在静脉注射造影剂或血管造影术之后进行以避免任何血管性外溢而引起误诊。
图3：(a，b) 窗户清洁工自梯子上坠落。不稳定性骨盆骨折，膀胱逆行造影X线片表现腹膜外造影剂外溢，提示膀胱破裂。
Urethral injuries are more common in men and typically occur in the membranous urethra in the region of the urogenital diaphragm.A retrograde urethrogram can be performed if there is clinical suspicion. Clearly, this should be performed before attempts at urinary catheterisation if there is any concern for urethral trauma.
尿道损伤在男性患者中更为常见，典型者发生在泌尿生殖膈附近的尿道膜部。如果临床怀疑尿道损伤应进行逆行尿道造影检查。显然，如果有任何可疑的尿道损伤，应该在试图导尿之前进行造影。
7. Neurological injury
7. 神经损伤
Neurological injuries may be an early or late complication of pelvic fractures but are often overlooked in the busy trauma setting. Bladder, bowel and erectile dysfunction are some of the potentially devastating consequences, which are often permanent. The reported prevalence of neurological de?cit following pelvic fracture is approximately 10% [19]. The fracture pattern obviously determines both the risk and nature of neurological injury. For example transverse sacral fractures can cause intraspinal and intraforaminal nerve root injury, as discussed later. Sciatic nerve injuries may occur if the fracture involves the greater sciatic notch or the posterior acetabulum.
神经损伤作为骨盆骨折的早期或晚期并发症常在忙碌的创伤科被忽视。膀胱、肠和勃起功能障碍是一些潜在的灾难性后果，通常为永久性。骨盆骨折后神经功能障碍报道的发病率约为10%[19]。显然，骨折类型决定神经损伤的风险和性质。例如骶骨横行折能够引起骶管内和骶孔内神经根损伤，这些在后面讨论。如果骨折累及坐骨大孔或髋臼后柱则可引起坐骨神经损伤。
