The Clinical Efficacy Of The Modified Stoppa Approach Plus Iliac Fossa Approach For The Treatment Of Complex Quadrilateral Plate Fracture

Objective:Evaluate the clinical efficacy of modified Stoppa approach combined with iliac fossa approach in the treatment of complex fractures of the quadrilateral plates and provide references for the choices of the clinical treatment plan.Methods:A retrospective study of 43 cases of quadrilateral plate fractures treated in our hospital from September 2012 to September 2016.The patients were divided into 2 groups,A and B.Patients in group A were treated with modified Stoppa approach combined with iliac fossa approach.Patients in group B were treated with ilioinguinal approach.In group A,male patients,15 cases,female 9 cases.Age 51±4.7 years of age.By the Letournel-Judet classification,there were 18 double column fractures,4 anterior column and half transverse fractures,1 transverse fractures and 1 T-shaped fractures.In group B,male patients,12 cases,female 7 cases.Age 49±5.2 years and by the Letournel-Judet classification,there were 13 double column fractures,3 anterior column and half transverse fractures,2 transverse fractures and 1 T-shaped fractures.Clinical evaluation involved postoperative fracture reduction rates(Matta),operative time,blood loss,postoperative complications,and hip function at the last follow-ups.Results:All 43 patients had finished the operation.The operation time of group A and B were 95±25 minutes and 110±15 minutes,which the differences were significant(P < 0.05).The intra-operative blood loss volume of group A and B were 425±121.5ml and 725±175ml,which the differences were significant(P < 0.05).According to the Matta criteria,in group A,fracture reduction was excellent in 15 cases,good in 6 and poor in 3,giving an excellent to good rate of 87.5%,and in group B,fracture reduction was excellent in 12 cases,good in 4,fair in 2 and poor in 1,giving an excellent to good rate of 84.2%,which have no statistical significance(P > 0.05).According to the Merle d’ Aubigne-Postel criteria at the last follow-ups,in group A,hip function was excellent in 17 cases,good in 3,fair in 1 and poor in 3,giving an excellent to good rate of 83.3%,and in group B,hip function was excellent in 11 cases,good in 4,fair in 2 and poor in 2,giving an excellent to good rate of 78.9%,which have no statistical significance(P > 0.05).Conclusion:The modified Stoppa approach combined with iliac fossa approach is a good alternative in the treatment of complex quadrilateral plate fractures,because it provides such an advantage as exposure of quadrilateral surface and the true pelvis edge which allows for reduction and plating under direct visualization.This operation had features of less bleeding amount during the operation,minimal trauma,less complications,safe and reliable.Patients can do functional exercise in the early stage after operation and recover well.It can reduce the pain that patients suffer from,so it is more available for the old patients to receive operation.For other types of complex acetabular fractures,the operation can be combined with other approaches,such as the Kocher-Langenbeck approach,for satisfied clinical results.