| Objective:Compared the Stoppa approach with the Ilioinguinal approach in the application of anterior pelvic ring fractures, provided the theoretical basis for how to choose corresponding surgical approach according to fracture type in clinic.Methods:Do the retrospective study about 39 cases which were involved in anterior pelvic ring fractures that treated by the Stoppa approach and the Ilioinguinal approach in the Orthopedic Department of the First Affiliated Hospital of Dalian Medical University from January of 2002 to March of 2011. Divided the patients into two groups A and B. Group A has 19 cases which applied the Stoppa approach, in the cases, 13 were male, 6 were female, they aged between 22 years old to 60 years old, the average was about 40.2±9.5 years old; the traffic accident injury number was 16, the falling injury number was 3; fracture type: according to Tile type, in group A, 3 cases were Tile type B, 16 cases were Tile type C; There were 10 cases in (the Stoppa approach) that assisted by small incision in iliac crest to place the plate during the operation; Group B has 20 cases which applied the Ilioinguinal approach; in the cases, 15 were male, 5 were female; they aged between 18years old to 56 years old, the average was about 38.6±10.2 years old; in group B the traffic accident injury number was 15 and the falling injury number was 5; in group B, 3cases were Tile type B, 17 cases were Tile type C; 9 cases in group B (the Ilioinguinal approach ) that assisted by small incision to reset the fracture during the operation. All of the 39 cases were anterior pelvic ring fractures, some combined with multiple trauma or posterior pelvic ring fractures, all patients were treated by anterior approach to reset the pelvic fracture. All patients in admission received positive treatment, the preoperative condition were stable. 24 hours before surgery all the patients were used antibiotic conventionally, and were hypodermic injection by low molecular weight heparin to prevent DVT (Deep Venous Thrombosis) meantime.Results:According to Matta grade: the results of the surgery in group A: 12 cases were superior, 4 cases were fine and 3 cases were moderate; in group B: 10 cases were superior, 6 cases were fine and 4 cases were moderate. The results of the two groups in reduction of anterior pelvic ring fractures and fixation were well. Compared with the aspects of operation time, incision length, intraoperative bleeding, intraoperative and postoperative transfusion, postoperative drainage, postoperative complication, postoperative load time and bone union time in two groups, P<0.05, there were obvious differences and statistically significant. The operation time of group A was (236±44.2) min, group B was (268.5±42) min, group A was rather shorter than group B; the incision length of group A (16.8±2.3) cm was shorter than group B(19.7±2.8) cm; the intraoperative bleeding with intraoperative and postoperative transfusion of group A (457.8±221.9) ml (126.3±232.9)ml were less than group B (672.5±312.2) ml (392.5±289.4) ml; the postoperative drainage of group A (131.6±41.5)ml was less than group B (182.5±46.7) ml; the removal drainage time of group A (1.5±0.5) days was shorter than group B (1.8±0.4) days; the LOS(length of stay) of group A was (17.4±2.7) days, group B was (18.2±4.5)days, P>0.05, there was no obvious difference between two groups.3 patients in our follow-up were lost, group A was 1 cases. The time of follow-up was 12 to 30 months, the mean was 20 months. There were no death in 36 cases of follow-up, all patients were bone union. The postoperative load time and bone union time of group A (5.6±1.4) weeks (33.5±2.6) weeks were Significantly shorter than group B (7.1±1.6) weeks (36±2.7) weeks. In above aspects, compared group A with group B, P<0.05, there were obvious differences and statistically significant. As to complications, group A has one case, group B has twelve cases, compared group A with group B, there were obvious differences and statistically significant (P<0.05). In group A (the Stoppa approach), one patient's incision had slightly fat liquefaction, because this patient was fat. we treated by dressing change, and the incision healed. The others'incision healed stage I. Yet in group B (the Ilioinguinal approach), there were three patients suffered different degree of the incision fat liquefaction, by dressing change the wound healed and the two patients leaved hospital. One patient suffered sinus formation 9 months after operation, X-ray showed the screws loose, but the bone wasn't displacement. After second admission, we treated the patient by fistula resection and internal fixation removed, postoperation we check the X-ray showed bone union, the patient recover well, the incision healed stage I. eight patients felt different degree of numb in the outer thigh postoperation, though trophic nerve therapy the feeling of this patient recovered somewhat after half an year in our follow-up. The two groups were without serious complications such as intraoperative hemorrhage, severe nerve damage, DVT, inguinal hernia, long-term continuous pain, traumatic arthritis, lymphatic leak etc.Conclusion:Through the comparision between the two approaches, we found that the Stoppa approach has some advantages such as operate easier, smaller trauma, less complications, faster postoperative recovery etc. In this article the number of two groups was relatively less, the time of follow-up was short, and also need large sample to further study, but author compared the collect cases and based on the comparation we found that in dealing with anterior pelvic ring fracture, the Stoppa approach was better than the ilioinguinal approach, we can replace the ilioinguinal approach with the Stoppa approach in clinical applications. For pubic symphysis separation or combined with contralateral pubis fracture, maybe it has more superiority. |
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