Abstract
ObjectivePelvic and acetabular fractures are common orthopedic diseases, and this research was to investigate the therapeutic effects of pararectus and Stoppa approaches in treating complex pelvic acetabular fractures.MethodsThe clinical information of patients with pelvic and acetabular fractures treated surgically in Lu'an Hospital of Chinese medicine, China from January 2016 to April 2020 was analyzed. There were 30 cases each in the transabdominal pararectus approach and modified Stoppa approach groups. The operation time, incision length, blood loss, and postoperative complications of both groups were recorded according to the Merle d'Aubigné-Postel hip score. The recovery of hip function was evaluated 6 months after surgery, and the clinical and therapeutic efficacies of the two groups were compared.ResultsThe patients were followed up for 6–7 months (average, 6.5 months). The average operation time, incision length, and blood loss in the pararectus and Stoppa approach groups were 180 ± 41.105 min, 8.667 ± 1.373 cm, 259.667 ± 382 mL and 202.667 ± 32.793 min, 11.600 ± 1.958 cm, and 353.667 ± 590 mL, respectively. The satisfactory rate of fracture reduction, excellent and good rate of hip function score, and incidence of complications were 28/30, 27/30, 1/30 and 25/30, 25/30, 3/30, respectively. There were significant differences in operation time, incision length, and blood loss between the two groups (p < 0.05). However, there was no significant difference in the excellent and good rate of hip function score, fracture reduction satisfaction, and complication rate between both groups (p > 0.05).ConclusionsThe pararectus approach can reveal the better anatomical structure of the pelvis and acetabulum, such as the corona mortis and quadrilateral plate, for conducive fracture reduction and fixation. It can also effectively shorten the length of the incision, reduce operative blood loss, and shorten the operation time. It is a better choice for the clinical treatment of complex pelvic and acetabular fractures.
Highlights
Pelvic and acetabular fractures are becoming more common, generally because of severe high-energy trauma
Case inclusion criteria were as follows and all of the three standards must be met: (1) the diagnosis of pelvic acetabular fracture was confirmed by radiography and computed tomography (CT) three-dimensional reconstruction, (2) patients were aged 18–60 years old, (3) according with surgical indications: displacement of acetabular roof fracture was more than 2 mm and fracture with medial, anterior, and posterior roof-arc angles was less than 45, 25, or 70° involve the weight-bearing dome, respectively; or the displacement of fracture in other parts of pelvis and acetabulum was more than 5 mm; or hip dislocation reduction failure
The operation time, incision length, blood loss, and average hospital stay were greater in the modified Stoppa approach group than in the pararectus approach group (Table 2)
Summary
Pelvic and acetabular fractures are becoming more common, generally because of severe high-energy trauma. The inguinal approach is a classic anterior surgical approach in the treatment of pelvic and acetabular fractures, which is generally suitable for superior pubic rami fractures, anterior column or anterior wall fractures [2, 3]. It requires passing through the inguinal canal, thereby causing some degree of damage to the inguinal area and may significantly increase the risk. The surgical field of vision via the ilioinguinal approach is compromised by the inguinal ligament and abdominal muscle, leading to non-exposure of the high iliac bone area and quadrilateral plate, thereby increasing the difficulty of fracture reduction [6]
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