Meta-analysis Of The Efficacy Of Modified Stoppa Approach And Ilioinguinal Approach In The Treatment Of Pelvic Acetabular Fractures

Objective:efficacy of Modified Stoppa approach(MSA)and Ilioinguinal approach(IA)in the treatment of pelvic acetabular fractures was evaluated.Methods:Literature was searched using PubMed,Embase,viper,Cochrane and cnki databases to evaluate the efficacy of MSA and IA in the treatment of pelvic acetabular fractures.All included articles were evaluated by 2 trained reviewers according to the Cochrane Collaboration Handbook for potential risk.Search deadline March2020.RevMan5.3 software was used for statistical analysis of the results of surgical approaches in the two groups.Result : A total of 20 studies were included,including 679 patients in the observation group and 726 patients in the control group.Results analysis of 1405 patients showed that the operation time [MD=-42.60,95%ci(-52.66,-32.55),Z=8.30,df=17,P<0.00001].Intraoperative blood loss [MD=-173.81,95%ci(-219.17,-128.46),Z=7.51,df=15,P < 0.0000 1],the difference of MSA less than IA was significant.Incision length [MD = 5.95,95% CI(9.12,2.77),df = 9,Z = 3.67,P< 0.00001),significant differences,MSA incision length shorter than the IA group;Preoperative preparation time [MD = 0.15,95% CI(0.63,0.33),Z = 0.60,P =0.55),there was no significant difference,MSA and IA group no significant difference;Postoperative drainage volume [MD=-54.62,95%ci(-67.52,-41.72),P <0.000 01] showed significant difference between the MSA group and the IA group.Fracture healing time [MD=-0.73,95%ci(-1.05,-0.42),Z=4.61,P<0.00001],there was a significant difference between the two groups.Length of hospital stay [MD = 3.32,df = 5 remarks % CI(5.25,1.40),Z = 3.38,P < 0.001],the meaningful difference,MSAhospitalization time less than the IA group;Postoperative complications [RR=0.43,95%ci(0.33,0.56),Z=6.11,P < 0.000 01],the incidence of complications in the MSA group was lower than that in the IA group,which was statistically significant.Good and good rate of fracture reduction [RR=1.12,df=10,95%CI(1.05,1.19),Z=3.44,P <0.001].The rate of excellent and good hip function [RR=2.59,95%ci(1.69,3.96),Z=4.39,P<0.0001] was higher in the MSA group than in the IA group.Conclusions:1.In the treatment of pelvic acetabular fractures,the MSA group has more advantages than the IA group in terms of the incidence of complications,the length of incision,the length of incision,the amount of intraoperative blood loss,the length of stay,the fracture reduction and the rate of excellent and good hip function,etc.,which is worth promoting.2.There was no significant difference between the MSA group and the IA group in the incidence of nerve injury and traumatic arthritis in the preoperative preparation time,and there were significant differences in the incidence of DVT and hernia.3.According to the specific conditions such as the surgical conditions of fracture types,the orthopedic surgeon makes specific analysis,so as to select the appropriate approach;4 this meta-analysis into literature quality and quantity has certain limitation,it remains to be a certain number of high quality randomized controlled study to compare MSA and clinical outcome of pelvis and acetabulum fractures treated by IA imaging results and complications at the same time,should also be a long-term follow-up study,summarizes the results more reliable and to guide clinical choose the most appropriate approach.