骨科英文书籍精读（199）｜尿道和膀胱损伤的处理
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MANAGEMENT OF THE URETHRA AND BLADDER
Urological injury occurs in about 10 per cent of patients with pelvic ring fractures. As these patients are often seriously ill from other injuries, a urinary catheter may be required to monitor urinary output, and therefore the urologist is placed under pressure to make a rapid diagnosis of urethral damage.
There is no place for passing a diagnostic catheter as this will most probably convert any partial tear to a complete tear. For an incomplete tear, the insertion of a suprapubic catheter as a formal procedure is all that is required. Around half of all incomplete tears will heal and require little long-term management.
The treatment of a complete urethral tear is controversial. Primary realignment of the urethra may be achieved by performing suprapubic cystostomy, evacuating the pelvic haematoma and then threading a catheter across the injury to drain the bladder. If the bladder is floating high it is repositioned and held down by a sling suture passed through the lower anterior part of the prostatic capsule, through the perineum on either side of the bulbar urethra and anchored to the thighs by elastic bands. An alternative – and much simpler – approach is to perform the cystostomy as soon as possible, making no attempt to drain the pelvis or dissect the urethra, and to deal with the resulting stricture 4–6 months later. The latter method is contraindicated if there is severe prostatic dislocation or severe tears of the rectum or bladder neck.With both methods there is a significant incidence of late stricture formation, incontinence and impotence.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
Urological /juərə'lɔdʒikəl/adj. 泌尿道的；泌尿科学的
catheter /ˈkæθətər/n. [医] 导管；导尿管；尿液管
suprapubic catheter耻骨上导尿管
controversial /ˌkɑːntrəˈvɜːrʃl/adj. 有争议的；有争论的
realignment/ˌriːəˈlaɪnmənt/n. 重新排列；（公司或体系）重组；重新结盟；复位
cystostomy/sis'tɔstəmi/n. 膀胱造口术
prostatic capsule前列腺囊 /'prɔsteitik/adj. 前列腺的
perineum /ˌperɪˈniːəm/n. [解剖] 会阴
elastic bands. /ɪˌlæstɪk ˈbændz/橡皮筋
elastic /ɪˈlæstɪk/n. 松紧带；橡皮圈adj. 有弹性的；灵活的；易伸缩的
incidence /ˈɪnsɪdəns/n. 发生率；影响；[光] 入射；影响范围
incontinence /ɪnˈkɑːntɪnəns/n. [医] 失禁；无节制；不能自制
continence /ˈkɑːntɪnəns/n. 自制，克制；节欲（尤指禁欲）
impotence /ˈɪmpətəns/n. [泌尿][中医] 阳萎；虚弱；无效（等于impotency）
potence /'pəutəns/n. 潜能；权力；效能
百度翻译：
尿道和膀胱的处理
大约10%的骨盆环骨折患者发生泌尿系统损伤。由于这些患者经常因其他损伤而重病，可能需要导尿管来监测尿量，因此泌尿科医生要承受压力，以便快速诊断尿道损伤。
没有地方可以通过诊断导管，因为这很可能会将部分撕裂转化为完全撕裂。对于不完全撕裂，作为一个正式的程序插入耻骨上导管是所有需要的。大约一半的不完全的眼泪会愈合，不需要长期的治疗。
完全性尿道撕裂的治疗是控制性的。尿道的初次调整可以通过耻骨上膀胱造口术，盆腔血肿清除，然后将导管穿过损伤处，排出膀胱。如果膀胱漂浮在高处，它会被重新定位，并通过前列腺囊的前下部，通过球尿道两侧的尿道，再通过弹力带固定在大腿上。另一种更简单的方法是尽快进行子宫颈动脉切开术，不尝试引流骨盆或切开尿道，并在4-6个月后处理由此产生的狭窄。如果有严重前列腺病变或直肠或膀胱严重撕裂，后一种方法是禁忌的脖子。用两种方法均有明显的晚期狭窄形成、尿失禁和阳痿的发生率。