Meta-analysis: Comparison Of Clinical Curative Effects Of Modified Stoppa Approach And Ilioinguinal Approach In The Operative Treatment For Acetabular Fractures

Objectives:To compare the clinical curative effects of modified Stoppa approach with ilioinguinal approach in the operative treatment of acetabular fractures using meta-analysis and to provide more evidences for Evidence-based medicine on the options of clinical treatment.Methods:Clinical studies of modified Stoppa approach and ilioinguinal approach in the operative treatment of acetabular fractures were searched in the database of Cochrane library、Pubmed、Elsevier Science direct、Web of Science、China Biology Medicine disc、China National Knowledge Infrastructure、Wan Fang database、VIP database from January 1,2005 to January 1,2015. Meta-analysis across the studies was performed for the clinical curative effects of the two approaches using Rev Man5.3 software and R3.1.2 software.Results:1.The results of literature search, selection, quality evaluation、heterogeneity test and analysis model:15 articles with a total of 828 patients were analyzed in this meta-analysis from 2763 articles. The score of MINORS is 2 points to 20 points. Literatures were heterogeneity tested by the statistics of p and I2. Using random effect model to analyze operation time, intraoperative bleeding volume, anatomical reduction rate, the clinical outcome satisfactory rate, the incidence of traumatic arthritis and the total incidence of complications with p<0.05 and I2>50%; Using fixed effect model to analyze the incidence of heterotopic ossification, the incidence of iatrogenic vascular injury, the incidence of iatrogenic nerve injury, the incidence of infection and the incidence of deep venous thrombosis with p>0.05 and I2<50%.2.Comparing the differences of clinical curative effects of modified Stoppa approach with ilioinguinal approach in the operative treatment of acetabular fractures:(1)The weighted mean difference(WMD) of operation time in the two surgical approaches is-61.64(95%CI:-77.24 ~-46.04), which is significant difference between modified Stoppa approach and ilioinguinal approach(p<0.00001).(2)The WMD of intraoperative bleeding volume in the two surgical approaches is-156.14(95%CI:-337.31~25.03),which is no significant difference between modified Stoppa approach and ilioinguinal approach(p=0.09>0.05).(3)The anatomical reduction rate of the two surgical approaches was no significant difference(p=0.2511 > 0.05). The total anatomical reduction rate was 60.26%(95%CI:52.48%-67.56%), the anatomical reduction rate of modified Stoppa approach was 66.18%(95%CI:52.24%-77.78%) and the anatomical reduction rate of ilioinguinal approach was 56.64%(95%CI:47.40%-65.44%).(4)The clinical outcome satisfactory rate of the two surgical approaches was no significant difference(p=0.6453>0.05).The total clinical outcome satisfactory rate was 76.82%(95%CI:67.69%-83.89%), the clinical outcome satisfactory rate of modified Stoppa approach was 79.95%(95%CI:59.68%-91.48%)and the clinical outcome satisfactory rate of ilioinguinal approach was 75.38%( 95%CI :64.29%-83.89%).(5)The incidence of heterotopic ossification of the two surgical approaches was significant difference(p=0.0492 < 0.05). The total incidence of heterotopic ossification was 3.44%( 95%CI : 2.15%-5.45%),the incidence of heterotopic ossification of modified Stoppa approach was 1.66%(95%CI:0.69%-3.93%)and the incidence of heterotopic ossification of ilioinguinal approach was 4.64%(95%CI:2.67%-7.95%).(6)The incidence of iatrogenic vascular injury of the two surgical approaches was no significant difference(p=0.4539>0.05).The total incidence of iatrogenic vascular injury was 3.91%(95%CI:2.25%-6.71%), the incidence of iatrogenic vascular injury of modified Stoppa approach was 3.09%(95%CI:1.34%-6.97%)and the incidence of iatrogenic vascular injury of ilioinguinal approach was 4.71%(95%CI:2.25%-9.60%).(7)The incidence of iatrogenic nerve injury of the two surgical approaches was no significant difference(p=0.1275>0.05).The total incidence of iatrogenic nerve injury was 6.21%(95%CI:4.44%-8.61%), the incidence of iatrogenic nerve injury of modified Stoppa approach was 4.08%(95%CI:2.13%-7.67%)and the incidence of iatrogenic nerve injury of ilioinguinal approach was 7.28%(95%CI:4.93%-10.63%).(8)The incidence of infection of the two surgical approaches was no significant difference(p=0.8563>0.05).The total incidence of infection was 6.39%(95%CI:4.72%-8.59%), the incidence of infection of modified Stoppa approach was 6.18%(95%CI:3.87%-9.74%)and the incidence of infection of ilioinguinal approach was 6.54%(95%CI:4.39%-9.63%).(9)The incidence of deep venous thrombosis of the two surgical approaches was no significant difference(p=0.4019 > 0.05).The total incidence of deep venous thrombosis was 3.28%(95%CI:1.91%-5.58%), the incidence of deep venous thrombosis of modified Stoppa approach was 3.94%(95%CI:1.98%-7.71%)and the incidence of deep venous thrombosis of ilioinguinal approach was 2.46%(95%CI:1.03%-5.78%).(10)The incidence of traumatic arthritis of the two surgical approaches was no significant difference(p=0.7411>0.05).The total incidence of traumatic arthritis was 14.72%(95%CI:6.50%-30.01%), the incidence of traumatic arthritis of modified Stoppa approach was 17.18%(95%CI:2.80%-59.87%)and the incidence of traumatic arthritis of ilioinguinal approach was 12.75%(95%CI:7.03%-22.00%).(11)The total incidence of complications of the two surgical approaches was no significant difference(p=0.9494>0.05). The total incidence of the total complication was 20.04%(95%CI:13.13%-29.36%), the total incidence of complications of modified Stoppa approach was 19.96%(95%CI:7.75%-42.55%)and the total incidence of complications of ilioinguinal approach was 19.34%( 95%CI :12.28%-29.11%).Conclusion:1.The modified Stoppa approach has less operation time, lower incidence of heterotopic ossification, slightly less intraoperative bleeding volume, slightly higher anatomical reduction rate, slightly higher clinical outcome satisfactory rate, slightly less incidence of iatrogenic vascular injury, slightly less incidence of iatrogenic nerve injury, slightly less incidence of infection, slightly higher incidence of deep venous thrombosis, slightly higher incidence of traumatic arthritis and total complication.2.Modified Stoppa approach, as an effective choice and a preferred solution for treatment of anterior acetabular fracture, has good clinical curative effects and it is worth promoting in clinical practice.