Sharma Ajay, Choudhary Laxman, Chandel Akshant, Kumar Satyendra, Bains Amandeep
Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India.
Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, India.
J Orthop Sci. 2025 Sep 5. doi: 10.1016/j.jos.2025.08.006.
The Stoppa approach was modified to manage fractures of the anterior column as an alternative to the ilioinguinal approach to reduce complications. A debate persists regarding the superiority of one approach over the other. Therefore, in the present study we performed a randomized controlled trial (RCT) to investigate the following hypotheses: (1) Whether the modified Stoppa approach leads to reduced blood loss, (2) Whether the functional and radiological outcomes with the modified Stoppa approach are superior to those with the ilioinguinal approach, and (3) Whether the complication rates differ between the two approaches.
A total of 92 patients were initially enrolled in the study. After applying exclusion criteria and obtaining informed consent, 60 patients with acetabular fractures were randomly allocated into two groups and underwent internal fixation at our tertiary care hospital using either the ilioinguinal approach or the modified Stoppa approach. Bleeding and surgical time was evaluated intraoperatively. Post-operative evaluation of wound drainage and neurovascular status was done. Post-operative radiographs reduction assessment of reduction was done as per Matta scoring and clinically Merle D'Aubigne score was compared at 12 months. All data were statistically analyzed with non-parametric tests by using SPSS 20.0 software.
Among the studied population, 48.3 % cases (21.6 % and 26.7 % with ilioinguinal and modified Stoppa approach, respectively) of all patients exhibited excellent radiological outcomes. Additionally, 33.3 % (15 % with the ilioinguinal approach and 18.3 % with the modified Stoppa approach) achieved an excellent clinical score based on the Merle D'Aubigne criteria at 12 months. However, no significant difference was found between two approaches. Both the approaches offer adequate exposure however; quadrilateral surface is directly visualised with the modified Stoppa approach. Considering two significant findings, i.e., reduced intra-operative blood loss and shorter surgical duration was associated with the modified Stoppa approach.
Notably, in the context of the ongoing debate between proponents of these two approaches, our study presents a valuable contribution. Overall, the modified Stoppa approach is a better choice in treating anterior acetabular fractures.
改良Stoppa入路被用于处理髋臼前柱骨折，作为髂腹股沟入路的替代方法以减少并发症。关于两种入路孰优孰劣的争论一直存在。因此，在本研究中我们进行了一项随机对照试验（RCT），以研究以下假设：（1）改良Stoppa入路是否能减少失血；（2）改良Stoppa入路的功能和影像学结果是否优于髂腹股沟入路；（3）两种入路的并发症发生率是否存在差异。
共有92例患者最初纳入本研究。在应用排除标准并获得知情同意后，60例髋臼骨折患者被随机分为两组，并在我们的三级医疗中心医院采用髂腹股沟入路或改良Stoppa入路进行内固定。术中评估出血量和手术时间。术后评估伤口引流和神经血管状况。术后根据Matta评分进行X线片复位评估，并在12个月时比较临床Merle D'Aubigne评分。所有数据使用SPSS 20.0软件进行非参数检验的统计学分析。
在研究人群中，所有患者中有48.3%的病例（分别为髂腹股沟入路21.6%和改良Stoppa入路26.7%）显示出优异的影像学结果。此外，根据Merle D'Aubigne标准，在12个月时，33.3%（髂腹股沟入路15%，改良Stoppa入路18.3%）获得了优异的临床评分。然而，两种入路之间未发现显著差异。两种入路均能提供足够的暴露；改良Stoppa入路可直接观察四边形表面。考虑到两个重要发现，即改良Stoppa入路与术中失血量减少和手术时间缩短相关。
值得注意的是，在这两种入路支持者之间持续的争论背景下，我们的研究做出了有价值的贡献。总体而言，改良Stoppa入路是治疗髋臼前柱骨折的更好选择。
