Nayak Tushar, Mittal Samarth, Trikha Vivek, Farooque Kamran, Gamanagatti Shivanand, Sharma Vijay
Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
Department of Orthopaedics, JPN Apex Trauma Centre, New Delhi, India.
J Clin Orthop Trauma. 2020 Nov-Dec;11(6):1121-1127. doi: 10.1016/j.jcot.2020.10.007. Epub 2020 Oct 10.
As the more commonly used ilioinguinal approach is extensive and associated with complications arising from the dissection along the inguinal canal, we attempt to evaluate the efficacy of the modified Stoppa approach as an alternative in the operative management of acetabular fractures.
Twenty-three patients with acetabular fractures, were operated by the modified Stoppa approach. Fractures were classified; operative time and blood loss were recorded; the radiological and clinical outcomes were prospectively analysed. We analysed the radiological results according to the criteria of Matta and the clinical results by the Merle d'Aubigne and Postel score with a mean follow up of 15.13 months.
The clinical outcomes were excellent or good in nineteen cases, fair and poor in two patients each. In eighteen of our cases the reduction was anatomic, imperfect in two cases, and poor in three cases. The mean pre-operative displacements on axial, sagittal and coronal NCCT sections were 3.8, 3.1 and 3.6 mm, respectively; and mean post-operative displacements were 0.2, 0.3 and 0.2 mm, respectively. The mean pre-operative and post-operative fracture gap were 12.8 mm and 1.1 mm respectively.
Minimizing perioperative morbidity and simultaneously allowing access for anatomical reduction are the major benefits of the approach. The modified Stoppa approach can substitute the ilioinguinal approach for the surgical fixation of acetabular fractures.
由于更常用的髂腹股沟入路范围广泛，且与沿腹股沟管解剖引发的并发症相关，我们试图评估改良Stoppa入路作为髋臼骨折手术治疗替代方法的疗效。
23例髋臼骨折患者采用改良Stoppa入路进行手术。对骨折进行分类；记录手术时间和失血量；对影像学和临床结果进行前瞻性分析。我们根据Matta标准分析影像学结果，并采用Merle d'Aubigne和Postel评分评估临床结果，平均随访时间为15.13个月。
19例患者临床结果为优或良，2例患者为中，2例患者为差。18例患者骨折复位解剖，2例患者复位欠佳，3例患者复位差。术前轴向、矢状面和冠状面非增强CT（NCCT）断层上的平均移位分别为3.8、3.1和3.6毫米；术后平均移位分别为0.2、0.3和0.2毫米。术前和术后骨折间隙的平均值分别为12.8毫米和1.1毫米。
该入路的主要优点是将围手术期发病率降至最低，同时便于进行解剖复位。改良Stoppa入路可替代髂腹股沟入路用于髋臼骨折的手术固定。
