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| Efficacy of Ilioinguinal Approach Modified Stoppa Approach and Parabdominis Rectus Approach in Treating Pelvic and Acetabular Fractures |
| NI Bowen, HAO Peng, CHEN Kang |
| Weihai Municipal Hospital, Shandong Weihai 264200, China |
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Abstract Objective: To explore the efficacy of ilioinguinal approach, modified Stoppa approach and parabdominis rectus approach in the treatment of pelvic and acetabular fractures. Methods: The data of patients with pelvic and acetabular fractures in the hospital from August 2020 to August 2022 were retrospectively analyzed, and the patients were classified into three groups according to the different regimens. Patients with ilioinguinal approach were selected as group A, patients with modified Stoppa approach were included in group B, and patients with parabdominis rectus approach were enrolled as group C. According to the propensity matching scoring method, 50 cases in group A, 50 cases in group B, and 52 cases in group C were finally obtained. There were no statistical differences among the three groups in terms of baseline data (P>0.05). The general surgery, postoperative hospital stay, quality of fracture reduction at 7 days after surgery, hip function (modified Merle D’ Aubignéand Postel scoring system) at different time points (before surgery, at discharge and at the last follow-up at 6 months after surgery) and occurrence of postoperative complications were compared among the three groups. Results: There were statistically significant differences in fracture end exposure time, intraoperative blood loss and postoperative Hb among the three groups (P<0.05). The exposure time in groups B and C was obviously shorter compared with that in group A (P<0.05), and the intraoperative blood loss was significantly less (P<0.05), and the postoperative Hb was significantly higher (P<0.05), but there were no statistical differences in the above surgical indicators between group B and group C (P>0.05). There was no statistically significant difference in the excellent and good rate of fracture reduction quality among the three groups at 7 days after surgery (P>0.05). Although the excellent and good rate in group C was higher than that in group A and group B, there was no statistical difference between the two groups (P>0.05). At discharge and at the last follow-up at 6 months after surgery, the Postel score of the three groups was gradually improved, and there was a statistical significance from the aspect of time-point effect among the three groups (P<0.05), but there was no statistical difference in the score from the aspects of between-group effect and interaction effect of between-group and time-point (P>0.05). The Postel score in the three groups at discharge and at the last follow-up at 6 months after surgery was higher than that before surgery (P<0.05). The total postoperative complication rate was significantly different in the three groups (P<0.05), and the rate in group C was significantly lower than that in group A (9.62% vs 36.00%, P<0.05). Conclusion: All three kinds of plate internal fixation in the treatment of pelvic and acetabular fractures can achieve good fracture reduction quality and restore hip function, but modified Stoppa approach and parabdominis rectus approach have better effects on exposure time, blood loss and postoperative Hb than ilioinguinal approach, and parabdominis rectus approach has a higher excellent and good rate of fracture reduction than the other two approaches and fewer complications.
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2023, Vol. 29 
