Pelvic fracture & the complication of urethra rupture 骨盆骨折和尿道破裂并发症 ASIST. PROF. DR. AREERATH AKATVIPAT FACULTY OF VETERINARY MEDICINE, CHIANG MAI UNIV

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$Pelvic fracture & the complication of urethra$ AREERATH AKATVIPAT FACULTY OF VETERINARY MEDICINE,

1 Pelvic fracture & the complication of urethra rupture 骨盆骨折和尿道破裂并发症 ASIST. PROF. DR. AREERATH AKATVIPAT FACULTY OF VETERINARY MEDICINE, CHIANG MAI UNIVERSITY CHIANG MAI, THAILAND 爱莉莱阿卡提瓦帕特博士, 助理教授泰国清迈, 清迈大学兽医学院

2 Anatomy of pelvic 骨盆解剖学 The pelvic compose of 骨盆构成 Sacrum 骶骨 Ilium wing 髂骨翼 Acetabulum 关节窝 Ischium 坐骨 Pubis 耻骨 I A P S IS Pelvic is boxlike structure 骨盆是盒式结构 2

3 Pelvic fracture in small animals 小动物的骨盆结构 25 to 50 % of all fracture in veterinary practices 兽医实践所有骨折中占 25%-50% mostly due to car accident 多数由车祸造成 Commonly more than 2 site of pelvic bone are fracture 常见骨盆多于两处骨折 Weight bearing bone are 承重骨骼是 Acetabulum 关节窝 Ilium 髂骨 Sacroiliac joint 骶髂关节 Ischium fracture usually treat with conservative 坐骨骨折通常保守治疗 conference, Nanjing, China 27 th -29 th June

Complication & concurrent injuries 并发症及并发损伤 q commonly shock and/or hypovolaemia 常见休克或血容量过低 q> 30 % thoracic injuries; lung contusion, pneumothorax, diaphragmatic hernia, pleural effusion, hemothorax

4 Complication & concurrent injuries 并发症及并发损伤 q commonly shock and/or hypovolaemia 常见休克或血容量过低 q> 30 % thoracic injuries; lung contusion, pneumothorax, diaphragmatic hernia, pleural effusion, hemothorax >30% 胸部损伤 ; 肺部挫伤, 气胸, 膈疝, 胸腔积液, 血胸 qcns trauma 中枢神经系统创伤 qspinal injuries 脊髓损伤 qsciatic nerve injuries 坐骨神经损伤 qpudendal and pelvic nerve damage 阴部和骨盆神经损伤 q urinary tract injuries (39 % with pelvic fracture; Richard Jerram 2010) 尿道损伤 (39% 伴有骨盆骨折 ) 4

5 Initial assessment with polytrauma 多发性损伤初步评估 Airway examination 气道检查 Breathing 呼吸 Circulation 循环 Always wear a glove during examination, be gentle and quiet as much as possible 检查时须戴手套, 尽可能轻柔 5

$Urinary tract trauma with pelvic fracture 尿道损伤并骨盆骨折$ is possible to have a urinary tract rupture?

Pretty can pass stream of urine Pretty 能排出尿细流 B.

6 Urinary tract trauma with pelvic fracture 尿道损伤并骨盆骨折 commonly found but easily missed 常见但易忽略 Which patient is possible to have a urinary tract rupture? 哪位病患可能有尿道破裂 A. Pretty can pass stream of urine Pretty 能排出尿细流 B. Palpable UB in Bobby abdomen Bobby 的腹部有明显的膀胱 C. Hero has some yellow urine color from urinary catheter Hero 的导尿管有黄色尿液 6

7 Signs of urinary tract injuries 尿道损伤症状 Haematuria 血尿 Dysuria 排尿困难 Abdominal pain and/ or distension 腹痛或腹胀 Lack of palpable bladder 没有明显的膀胱 Free abdominal fluid 腹部游离积液 Abdominal and perineal bruising 腹部和会阴淤血 Blood urea nitrogen and creatinine increasing 血尿素氮和肌酐升高 7

8 Positive contrast cystography 阳性对照膀胱造影 Sterile technique 无菌技术 Urinary tract catheterization 尿路插管 Use non ionic water soluble iodinecontaining contrast medium such as iohexol 使用可溶于无离子水的含碘造影剂, 例如碘海醇 2 ml /kg; un-dilute 2ml/kg; 未经稀释 8

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11 Emergency & Surgical management 急救和手术治疗 Stabilized patient first!!!! 先固定病患 O2 supplementation 补充氧气 Severe pain need analgesia 剧烈疼痛镇痛 Fluid therapy & balancing electrolytes 液体治疗并平衡电解质 keep warm 保暖 Blood transfusion if indicated 如果需要进行输血 11

12 Emergency & Surgical management (cont.) 急救和手术治疗 Short term management in urinary tract rupture 尿道破裂短期处理 try to drain urine from abdominal cavity by 通过以下方法尝试排出腹腔内尿液 regular abdominocentesis 常规腹腔穿刺 Placing urinary catheter in abdomen 腹腔内置放导尿管 Peritoneal drainage 腹腔引流 approx. 24 hour can be wait 大约可暂缓 24 小时 12

13 Emergency & Surgical management (cont.) 急救和手术治疗 Urine infiltration in the caudal abdomen and hind limbs resulting in 尿液渗入下腹部和后肢可导致 : tissue necrosis 组织坏死 azotemia 氮质血症 uremia 尿毒症 edema of that area 患处水肿 bruising of the skin 皮肤淤青 13

14 Case study 1 病例 1 A 6 YEAR MALE CAT 六岁公猫 14

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20 3 wks post OP 术后 3 周 20

21 Urethra healing 尿道愈合 take 5 14 days to heal the urethra (Meige F et. Al. 2008) 尿道愈合花费 5-14 天 Some paper recommended to maintain transurethral catheter for 3 weeks (Bjorling DE. 2003) 一些文献建议持续放置经尿道导管 3 周 Not to use antibiotics if no sign of infection 如无发炎迹象不要使用抗生素 Urethral stricture can occur as a frequent complication 尿道狭窄为常见并发症 21

22 Case study 2 病例 2 A 2 YEAR OLD MALE SHIH-TZU 2 岁公西施犬 22

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25 Post OP Day 1 术后 1 天 6 wks Post OP 术后 6 周 25

Post operative care 术后护理 All patient should be monitoring at the hospital after operation (3 to 14 days) 所有病患术后需留院观察 (3 至 14 天 ) pain management is very important; opioids ( such as morphine,

26 Post operative care 术后护理 All patient should be monitoring at the hospital after operation (3 to 14 days) 所有病患术后需留院观察 (3 至 14 天 ) pain management is very important; opioids ( such as morphine, fentanyl etc.) are recommended 疼痛处理很重要 ; 建议使用阿片类药物 ( 例如吗啡, 芬太尼等 ) NSAIDS can be use if no sign of renal insufficiency or coagulopathies 如果没有肾功能不全或凝血可以使用 NSAIDS Up to 14 days analgesia fentanyl patch and/or NSAID can be used 镇痛不超过 14 天可使用芬太尼贴剂或 NSAID Fentanyl patch last for 72 hours, start effect after 12 hrs in cats and 24 hrs in dogs 芬太尼贴剂持续作用 72 小时, 猫 12 小时开始作用, 犬 24 小时开始作用 26

27 Post operative care (cont.) 术后护理 Strictly limit activity (at least 6 weeks) 严格限制活动 ( 至少 6 周 ) Provide soft bedding to prevent bed sores 使用柔软的寝具以防止褥疮 Physiotherapy can performed after days 天后可进行理疗 Monitoring urination and defecation 监控排尿排便情况 Re-radiographed at 3 weeks of when complication was concerned 如果怀疑并发症出现 3 周后重新造影 27

$Complication of pelvic fracture 骨盆骨折并发症 nerve damage 神经损伤 Implant$

28 Complication of pelvic fracture 骨盆骨折并发症 nerve damage 神经损伤 Implant failure 移植失败 Infection 感染 Constipation 便秘 Urethral stricture 尿道狭窄 28

会阴尿道造口术 Transpelvic urethrostomy 穿骨盆尿道造口术 Subpubic urethrostomy 耻骨下尿道造口术

29 Complication of urethral rupture 尿道破裂并发症 Failure to urethral anastomose 尿道吻合术失败 Urine diversion by urethrostomy 尿道造口术导尿 Perineal urethrostomy 会阴尿道造口术 Transpelvic urethrostomy 穿骨盆尿道造口术 Subpubic urethrostomy 耻骨下尿道造口术 Antepubic urethrostomy 耻骨前尿道造口术 Vaginourethroplasty (Halfacree ZJ, et al 2011) 阴道尿道成形术 29

30 Urethral reconstruction with buccal mucosa 使用颊粘膜尿道重造 Petrus Oliva et. al experimented in 16 male rabbit 佩特鲁斯奥利瓦等 2012 年在 16 只公兔上实验 30

31 Urethral reconstruction with buccal mucosa (cont.) 使用颊粘膜尿道重造 Young Ju Lee and Soo Woong Kim, Korean J Urol Sep;54(9):

32 Question & Discussion 问题和讨论 THANK YOU FOR YOUR ATTENTION 感谢您的关注 32

UTI (Urinary Tract Infection) - Traditional Chinese

UTI (Urinary Tract Infection) Urinary tract infection, also called UTI, is an infection of the bladder or kidneys. Urethra Kidney Ureters Bladder Vagina Kidney Ureters Bladder Urethra Penis Causes UTI