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Modified Stoppa Approach versus Ilioinguinal Approach for Anterior Acetabular Fractures; A Systematic Review and Meta-Analysis
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نویسنده
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meena sanjay ,sharma pankaj kumar ,mittal samarth ,sharma jyoti ,chowdhury buddhadev
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منبع
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bulletin of emergency and trauma - 2017 - دوره : 5 - شماره : 1 - صفحه:6 -12
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چکیده
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Introduction: modified stoppa approach was introduced as an alternative to ilioinguinal approach for management of anterior fractures of acetabulum in order to reduce complications of the latter. however, the efficacy of either approach over other is not well established. the aim of this meta-analysis is to compare the efficacy of modified stoppa and ilioinguinal approach in the management of acetabular fractures in terms of a) quality of reduction achieved b) complication rates c) functional outcomes d) operative time e) intra-operative blood loss. methods: databases of pubmed, embase and cochrane registry of controlled trials were taken into consideration for studies on modified stoppa approach versus ilioinguinal approach group for the treatment of anterior acetabular fractures. dichotomous variables were presented as risk ratios (rrs) /odds ratio (or) with 95% confidence intervals (cis), and continuous data was measured as mean differences, with 95% cis. result: four studies involving 375 patients were included in this meta-analysis. out of those 375 patients, 192 were managed with ilioinguinal approach and 183 were managed with modified stoppa approach. anatomical reduction was significantly higher in stoppa group (p=0.052, rr=1. 19 (1.02, 1.37), p=0.90, i2=0%). the complication rate was significantly higher in the ilioinguinal approach as compared with the stoppa approach (p=0.01, rr 0.63 (0.44 to 0.91), p=0.73 (i2=0%). the operative time was significantly shorter with modified stoppa approach (md 48.79 (-80.29 to -17.30), p=0.002). no significant differences were found between the two groups in terms of their functional outcomes (p=0.63, rr 0.96 (-0.80 to 1.15), p=0.56, i2=0%) and blood loss (md=-212.89 (-476.27 to 50.49) p=0.06, i2=71%). conclusion: anterior acetabular fractures, if operated with the modified stoppa approach were found to have better reduction and lower complication rates with less operative time, when compared to ilioinguinal approach. no significant difference in terms of blood loss was found in both the groups. further higher quality randomized controlled trials are needed to verify our results.
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کلیدواژه
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Acetabular fractures; Modified stoppa approach; Ilioinguinal approach; Quality of reduction; Functional outcomes; Intraoperative blood loss.
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آدرس
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lady hardinge medical college and associated hospitals, lady hardinge medical college, department of orthopaedics, India, pushpawati singhania research institute, department of orthopaedics, India, woodend hospital, department of orthopaedics, UK, r. m. l. hospital, department of anaesthesiology, India, all india institute of medical sciences, department of orthopaedics, India
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Authors
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