| BackgroundWith the rapid development of society,the transportation industry is changing rapidly,and the construction industry is thriving.The incidence of high energy damage caused by various traffic accidents and falling in high altitude has skyrocketed,which has a great adverse effect on patients’life.Common high-energy injury of acetabulum fracture,acetabulum fracture is mainly caused by violence,by acetabulum fracture has the characteristics of anatomical structure complex,deep fracture,leading to surgical operation area will be exposed,reduction and fixation operations such as extremely difficult,the acetabulum fracture surgery has become one of the most important challenges facing clinical orthopaedics.ObjectiveThere are many factors affecting the surgical treatment of acetabular fracture,especially the choice of incision,and the key to the success of the operation is the appropriate surgical approach.To explore the clinical efficacy of modified Stoppa approach for the exploration of acetabular fracture,the operative method was analyzed,and its safety and scientificity were observed to provide reference and reference for the treatment of clinical acetabular fractures.Methods83 patients with acetabular analysis the hospital from January 2014 to June 2017 were carried out in front of the surgical approach for treatment of fractures,will take the ilioinguinal approach in the treatment of 36 patients as control group,47 cases of modified Stoppa approach for surgical treatment of patients as the study group.The basic data for two groups of patients with operation index,VAS score,Matta score,Harris score,complications and results related indicators of quality of life for the statistical analysis,the clinical efficacy of different surgical treatment contrast.Results(1)Patients in the control group of gender(male and female ratio),average age,average time from injury to operation and other general data were 25:11,(45.61±4.32),(8.41±2.12)d,the study group of patients with gender(male and female ratio),average age,after injury the average time of operation to the general data such as data were 31:16,(46.12±4.22),(8.23±1.91)d,the statistical analysis showed no difference(P>0.05).(2)Among the 36 patients in the control group,there were 17 cases of traffic accident,10 cases of high altitude fall,5 cases of heavy injuries,and 4 other cases.Among them,there were 18 patients with anterior column fracture,13 patients with anterior wall fracture,3 patients with transverse fracture,and 2 patients with T shaped fracture.Among the 47patients in the study group,22 were in traffic accidents,16 in high altitude,6 in heavy objects and 3 in other cases.There were 24 patients with anterior column fracture,15patients with anterior wall fracture,5 patients with transverse fracture,and 3 patients with T shaped fracture.There was no difference in statistical analysis(P>0.05).(3)The control group of patients with operation time,intraoperative blood loss,length of incision,respectively(176.51±12.61)min,(617.61±83.61)ml,(13.62±2.14)cm,study group of patients with operation time,intraoperative blood loss,length of incision,respectively(131.16±8.42)min,(563.42.42.8)ml,(9.32±1.27)cm index compared with statistical difference(P<0.05).(4)The VAS scores in the control group and the study group were(7.4±1.2)and(7.3±1.5)before treatment,and there was no statistical difference(t=0.45,P>0.05).The VAS score of the patients in the study group was(2.0±0.6),and the VAS score of the control group was(2.1±0.5),and there was no statistical difference(t=0.36,P>0.05).(5)The Matta score of the control group was 13 cases(36.11%),22 cases(61.12%),1cases(2.77%)and 97.22%.The Matta score of the study group was 17(36.17%),29 cases(61.7%)were satisfactory,the satisfaction was 97.87%,no statistical difference(χ~2=4.205,P>0.05).(6)13 patients with the control group after treatment in patients with Harris scoring optimal,accounts for 36.11%,19 patients with benign,accounts for 52.78%,3cases of patients with common,the proportion of 8.33%,2 patients with poor,accounts for 2.78%,fine rate was 97.22%,the team after treatment in patients with Harris score of 17 cases of patients,accounts for 36.96%,25 patients with benign,the proportion of 54.35%,3 cases of patients with common,the proportion of 6.52%,1 patients with poor,accounts for2.17%,to 97.83%,There was no statistically significant difference between the two groups(χ~2=4.914,P>4.914).(7)The incidence of complications in the control group was 18.92%,including incision infection in 4 cases,nerve injury in 2 cases,fat liquefaction in 1 cases,the incidence of complications in the study group was 4.35%,and wound infection and nerve injury were 1 cases in each group,there was a significant difference between the two groups(χ~2=4.503,P<0.05).(8)The quality of life scores of the patients in the control group and the study group were(28.8±5.1)and(28.7±5.3),respectively(t=0.087,P>0.05).The score of quality of life(45.8±0.9)after treatment in the study group was not significantly higher than that of the control group(45.6±1.7),and there was no statistical difference(t=0.298,P>0.05).Conclusion(1)The modified Stoppa approach has the advantages of small incision,simple operation,short operative time,less intraoperative bleeding,less surgical trauma and less complications,which is more satisfactory to the exposure of the quadrilateral body and more convenient for the management of the communicating branch of the"dead crown".The surgical treatment of bilateral acetabular fractures can be completed by one incision.(2)The improved Stoppa approach for the treatment of acetabular fractures is better than the ilioinguinal approach. |
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