骨科英文书籍精读（185）｜骨盆损伤（5）
Enquire when the patient passed urine last and look for bleeding at the external meatus. An inability to void and blood at the external meatus are the classic features of a ruptured urethra. However, the absence of blood at the meatus does not exclude a urethral injury, because the external sphincter may be in spasm, halting the passage of blood from the site of injury. Thus every patient who has a pelvic fracture must be considered to be at risk.
The patient can be encouraged to void; if he is able to do so, either the urethra is intact or there is only minimal damage which will not be made worse by the passage of urine. No attempt should be made to pass a catheter, as this could convert a partial to a complete tear of the urethra. If the urethral injury is suspected, this can be diagnosed more accurately and more safely by retrograde urethrography.
A ruptured bladder should be suspected in patients who do not void or in whom a bladder is not palpable after adequate fluid replacement. This palpation is often difficult because of abdominal wall haematoma.
The physical findings initially can be minimal, with normal bowel sounds, as extravasation of sterile urine produces little peritoneal irritation. Only a very small proportion of patients with a ruptured bladder are hypotensive, so if a patient is hypotensive another cause must be sought.
Neurological examination is important; there may be damage to the lumbar or sacral plexus.
If the patient is unconscious, the same routine is followed. However, early x-ray examination is essential in these cases.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
meatus/mɪˈeɪtəs/n. [解剖] 道；[解剖] 口；[昆] 导管
urethra /jʊˈriːθrə/n. [解剖] 尿道
sphincter /ˈsfɪŋktər/n. [解剖] 括约肌
spasm /ˈspæzəm/n. [临床] 痉挛；抽搐；一阵发作
void /vɔɪd/n. 空间；空白；空虚感;v.排放（大小便）
catheter, /ˈkæθətər/n. [医] 导管；导尿管；尿液管
retrograde urethrography逆行尿道造影
fluid replacement补液
bowel sounds肠鸣音
as extravasation of sterile urine produces little peritoneal irritation. 无菌尿液外渗几乎不会产生腹膜刺激征。
extravasation /ik,strævə'seiʃən/n. 溢出；溢出物
sterile /ˈsterəl/adj. 不育的；无菌的；贫瘠的；不毛的；枯燥乏味的
peritoneal /,pɛrətə'niəl/adj. 腹膜的
hypotensive /,haipəu'tensiv/n. 低血压患者adj. 降低血压的；患低血压的
lumbar or sacral plexus腰丛或骶丛
百度翻译：
询问病人最后一次排尿的时间，并寻找外耳道有无出血。尿道破裂的典型特征是排尿困难和外耳道出血。然而，尿道口无血并不排除尿道损伤，因为外括约肌可能痉挛，阻止了血液从损伤部位的通过。因此，每个骨盆骨折患者都必须被视为有危险。
可以鼓励病人排尿；如果他能够这样做，要么尿道完整，要么只有很小的损伤，不会因尿液的通过而恶化。不应试图通过导尿管，因为这可能会将尿道的部分撕裂转化为完全撕裂。如果怀疑尿道损伤，逆行尿道造影可以更准确、更安全地诊断。
膀胱破裂应怀疑病人没有排尿或膀胱在适当的补液后摸不到。由于腹壁血肿，这种触诊通常很困难。
最初的体格检查结果可能很小，肠音正常，因为无菌尿的外渗几乎不会引起腹膜刺激。只有极少数膀胱破裂的病人是低血压的，所以如果病人低血压，就必须寻找另一个原因。
神经系统检查很重要，可能会损伤腰椎或骶神经丛。
如果病人失去知觉，则按同样的程序进行。然而，在这些病例中，早期的x光检查是必要的。