Department of Orthopaedic and Trauma surgery, S. Andrea Hospital, University of Rome "La Sapienza", Italy.
Department of Orthopaedic and Trauma surgery, S. Andrea Hospital, University of Rome "La Sapienza", Italy.
Injury. 2024 Feb;55(2):111166. doi: 10.1016/j.injury.2023.111166. Epub 2023 Nov 1.
Pelvis fractures are among the most difficult fractures to manage and treat for Orthopedic surgeons. Anatomic reduction is the main goal to reach in the acetabular fractures' treatment. The following study compares clinical outcomes and complications of Ilioinguinal versus modified Stoppa approach in Open Reduction and Internal Fixation (ORIF) of anterior column acetabulum fractures.
A comparative analysis on 90 patients undergoing ORIF on acetabular fracture has been performed. Patients have been divided into two groups. The first group was treated by Ilioinguinal approach (n = 48), the second group by modified Stoppa approach (n = 42). The following parameters have been compareted: quality of fragment reduction; operative time; peri‑ and post-operative blood loss; complications; clinical and radiographic outcomes.
The modified Stoppa approach has shown a shorter mean operative time (146 min vs 175 min), fewer complications (14/48 vs 6/42), less blood loss both in the perio-operative phase (0.8 Hb pt vs 1.3 Hb pt) than in postoperative one (1.1 Hb pt vs 1.5 Hb pt), a lower rate of nerve, infections and critical complications. On the other hand, the ilioinguinal approach has showed better results in terms of quality of fracture reduction (43/48 patiens with anatomical or near anatomical reduction vs. 37/42). No significant differences concerning vascular lesions, clinical and functional outcomes have been found between the two groups.
The modified Stoppa approach results in shorter operative time, less intra-operative blood loss and fewer complications than the ilioinguinal one. Greater anatomic reduction is achieved by Ilioinguinal approach; however, this does not necessarily translate into better clinical and functional outcomes which, overall, are comparable in the two analysed approaches. In conclusion, the modified Stoppa approach is deemed to be a better alternative in treating these fractures.
骨盆骨折是骨科医生最难治疗的骨折之一。髋臼骨折治疗的主要目标是实现解剖复位。以下研究比较了经髂腹股沟和改良Stoppa 入路切开复位内固定（ORIF）治疗前柱髋臼骨折的临床效果和并发症。
对 90 例行 ORIF 治疗髋臼骨折的患者进行了对比分析。患者分为两组。第一组采用髂腹股沟入路（n=48），第二组采用改良Stoppa 入路（n=42）。比较两组患者的以下参数：骨折块复位质量、手术时间、围手术期失血量、并发症、临床和影像学结果。
改良Stoppa 入路的手术时间更短（146 分钟比 175 分钟），并发症更少（48 例中有 14 例比 42 例中有 6 例），术中（0.8 Hb pt 比 1.3 Hb pt）和术后（1.1 Hb pt 比 1.5 Hb pt）失血量更少，神经损伤、感染和严重并发症的发生率更低。另一方面，髂腹股沟入路在骨折复位质量方面的效果更好（48 例中有 43 例解剖或近乎解剖复位比 42 例中有 37 例）。两组之间在血管损伤、临床和功能结果方面无显著差异。
改良Stoppa 入路的手术时间更短，术中失血量更少，并发症更少，优于髂腹股沟入路。髂腹股沟入路可实现更大的解剖复位，但这并不一定转化为更好的临床和功能结果，这在两种分析方法中总体上是相当的。总之，改良Stoppa 入路被认为是治疗这些骨折的更好选择。
