Comparative Of Adult Acetabular Fractures In The Treatment Of Paramedian Approach And Modified Stoppa Approach

BackgroundThe reduction quality of acetabular fracture is tightly bound to the prognosis of the patients.The key to reduction is the exposure of the operative field,that is,the use of limited incision to maximize exposure the operative field.Therefore,choosing the right operative approach determines the quality of fracture reduction and the function outcomes of postoperative.Acetabular fractures involving anterior column generally choose anterior approach,such as modified Stoppa approach,ilioinguinal approach,and pararectus approach.The paramedian approach is based on modified Stoppa approach that instead of incision white line,cut the anterior rectus sheath at the ipsilateral side 2~3 cm and led to the lateral,longitudinal incision posterior rectus sheath.However,there still have controversial about which of the two approaches had a better exposure,used less time,get fewer surgical trauma,and had better postoperative functional outcomes.ObjectiveTo compare the treatment of adult acetabular fractures through the Paramedian approach and the modified Stoppa approach,and provide more ideas and evidence for the treatment of acetabular fractures.MethodRetrospective analysis of 51 cases of adult acetabular fractures in the First Affiliated Hospital of Zhengzhou University from February 2010 to February 2016.Including 32 males and 19 females,of which 23 cases were treated with Paramedian approach(group A),and 28 cases were treated with modified Stoppa approach(group B).The summary of the patients,operative time,intraoperative blood loss and reduction of the fracture were compared between the two groups.According to the reduction score of Matta imaging criteria,postoperative complications were evaluated,and the recovery of hip joint function was evaluated according to the modified Merled'Aubigne-Postel scoring system.ResultsThe two group patients completed the operation successfully,and were followed up for 12~24 months.The average follow-up time was group A(18.1 + 3.4)months,and group B(16.2 + 3.8)months,no cases were lost follow-up.The intraoperative blood loss: group A(481.30 + 137.92)ml were significantly less than group B(595.71 + 137.50)ml(P < 0.05);operative time: A group(138.13 + 21.99)min were significantly less than group B(170 + 28.07)min(P < 0.05);There was no significantly statistical differences between the two groups in quality of fracture reduction in term of Matta's imaging criteria(P>0.05)and postoperative complications(P>0.05)between the two groups.At the latest follow up,Merled' Aubigne-Postel score recorded in the paramedian group was(16.70±1.87),while the modified Stoppa group got a score of(16.29±2.29),also have no statistical difference between these two groups(P>0.05).ConclusionsBoth of paramedian approach and modified Stoppa approach can achieve satisfactory reduction.The operative time and intraoperative blood loss of the paramedian approach are significantly less than the modified Stoppa approach.However,the modified Stoppa approach has the advantage in the treatment of bilateral acetabular fractures.