Modified Stoppa approach versus Ilioinguinal approach for pelvic and/or acetabular fractures: a meta-analysis

doi:10.3969/j.issn.2095-4344.2017.19.024

Abstract

Abstract:

BACKGROUND: Ilioinguinal approach and modified Stoppa approach are commonly used to treat pelvic and acetabular fractures, but which one is safer and more effective remains controversial, so a meta-analysis is necessary.

OBJECTIVE: To compare the efficacy of modified Stoppa approach and ilioinguinal approach for pelvic and/or acetabular fractures.
METHODS: A computer-based retrieval of Cochrane library, PubMed, Embase, OVID, CNKI, WanFang, CBM and VIP databases was performed for the randomized controlled trials concerning modified Stoppa approach and ilioinguinal approach for pelvic and/or acetabular fractures published before October 2016. Meta-analysis was performed on RevMan5.3 software.

RESULTS AND CONCLUSION: (1) Finally 11 randomized controlled trials were enrolled, including 722 patients. (2) Meta-analysis showed that the operation time, intraoperative blood loss, length of incision, volume of drainage and hospitalization time in the modified Stoppa approach group were significantly less than those in the ilioinguinal approach group (P < 0.05), and the clinical efficacy in the modified Stoppa approach group was significantly superior to that in the ilioinguinal approach group (P < 0.05). But there were no significant differences in Matta scores and postoperative complications between two groups (P > 0.05). (3) To conclude, modified Stoppa approach is safer and more effective for pelvic and/or acetabular fractures.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Fractures, Bone, Pelvis, Evidence-Based Medicine, Tissue Engineering

CLC Number:

R318

Chen Xiao, Ma Kun-long, Xu Hai-tao, Shao Gao-hai. Modified Stoppa approach versus Ilioinguinal approach for pelvic and/or acetabular fractures: a meta-analysis [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(19): 3108-3116.

Figures/Tables 4

2.3.2 术中出血量纳入研究中10篇进行了术中出血量比较[29-38]，其异质性检验显示有统计学差异(P < 0.000 01，I2=99%)，采用随机效应模型进行统计量合并。改良stoppa入路与髂腹股沟入路2组术中出血量比较差异有显著性意义[MD=-113.66，95%CI(-166.03，-61.29)，P < 0.000 1，见图6]。 2.3.3 术后并发症纳入研究中有6篇报道了术后并发症[29，33-34，37-39]，其异质性检验有统计学差异(P=0.02，I2=62%)，采用随机效应模型进行统计量合并。改良stoppa入路与髂腹股沟入路2组术后总并发症相比较差异无显著性意义[RR=0.62，95%CI(0.27，1.44)，P=0.27，见图7]；对其进行亚组分析，各并发症指标异质性检验均差异无显著性意义(P > 0.05，I2 < 50%)，均采用固定效应模型进行合并。其中5篇报道了切口感染，差异无显著性意义[RR=0.53，95%CI(0.18，1.51)，P=0.23]；4篇报道了神经损伤，差异无显著性意义[RR=0.1.71，95%CI(0.66，4.45)，P=0.27]；2篇报道了血管损伤，差异无显著性意义[RR=0.85，95%CI(0.21，3.54)，P=0.83]；2篇报道了髋关节炎发生率，差异无显著性意义[RR=0.88，95%CI(0.34，2.26)，P=0.78]；2篇报道了深静脉血栓发生率，差异无显著性意义[RR=0.60，95%CI(0.08，4.38)，P=0.61]；2篇报道了疝发生率，差异无显著性意义[RR=0.33，95%CI (0.04，3.08)，P=0.33]，详见图8。 2.3.4 住院时间纳入研究中有2篇报道了住院时间[36，38]，其异质性检验无显著统计学意义(P=0.46，I2=0%)，采用固定效应模型进行统计量合并。改良stoppa入路与髂腹股沟入路2组住院时间相比较有统计学意义[MD=-1.71，95%CI(-3.01，-0.41)，P=0.01，见图9]。 2.3.5 临床疗效纳入研究中有7篇报道了临床疗效[30-32，35-36，38-39]，其异质性检验有显著统计学差异(P=0.02，I2=60%)，采用随机效应模型进行统计量合并。改良stoppa入路与髂腹股沟入路2组临床疗效相比较差异有显著性意义[RR=1.21，95%CI(1.03，1.42)，P=0.02，见图10]。 2.3.6 切口长度纳入研究中有2篇报道了手术切口长度[36-37]，其异质性检验有显著统计学差异(P < 0.000 01，I2=98%)，采用随机效应模型进行统计量合并。改良stoppa入路与髂腹股沟入路2组手术切口长度相比较有统计学意义[MD=-6.53，95%CI(-11.82，-1.24)，P=0.02，见图11]。2.3.7 引流量纳入研究中有2篇报道了伤口引流量[36，38]，其异质性检验无统计学意义(P=0.94，I2=0%)，采用固定效应模型进行统计量合并。改良stoppa入路与髂腹股沟入路2组伤口引流量相比较差异有显著性意义[MD=-50.17，95%CI(-65.62，-34.72)，P < 0.000 01，见图12]。 2.3.8 Matta评分纳入研究中有4篇报道了Matta评分[29，37-39]，其异质性检验无统计学意义(P=0.46，I2=0%)，采用固定效应模型进行统计量合并。改良stoppa入路与髂腹股沟入路2组Matta评分相比较差异无显著性意义[RR=1.07，95%CI(0.96，1.20)，P=0.24，见图13]。"

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