经髂腹股沟入路与 Stoppa 入路治疗移位型髋臼骨折临床疗效的 Meta 分析

Ilioinguinal approach versus stoppa approach for open reduction and internal fixation in the treatment of displaced acetabular fractures：a Meta-analysis

目的：采用 Meta 分析比较经髂腹股沟入路与 Stoppa 入路治疗移位型髋臼骨折临床疗效的差异。方法计算机检索 Cochrane 数据库、PubMed 数据库、中国期刊全文数据库及中国生物医学文献数据库、万方数据库,并辅以手工检索,收集2005年1月—2015年8月有关经髂腹股沟入路与Stoppa 入路治疗移位型髋臼骨折对照研究的中英文文献,严格评价纳入研究的文献质量及提取相关资料,运用 RevMan 5.0软件统计分析所有相关数据。结果纳入8项研究共637例患者。 Meta 分析显示对于移位型髋臼骨折,经 Stoppa 入路较髂腹股沟入路手术时间短[加权均数差（WMD）=68.29,95% CI 10.52~126.05,P 〈0.05]、术中平均失血量少（WMD =142.26,95% CI 9.30~275.23,P 〈0.05）,而在骨折端复位满意率[相对危险度（RR）=0.63,95% CI 0.17~2.37）, P 〉0.05]、术后早期并发症发生率（RR =0.89,95% CI 0.33~2.40,P 〉0.05）、术后晚期并发症发生率（RR =0.91,95% CI 0.27~3.01,P 〉0.05）、术后髋关节 HHS 评分优良率（RR =0.52,95% CI 0.25~1.10,P 〉0.05）等方面两种入路差异均无统计学意义。结论经髂腹股沟入路与 Stoppa 入路治疗移位型髋臼骨折均能获得基本满意的临床效果,经 Stoppa 入路手术时间更短、术中失血量更少。临床医师可以根据患者具体情况进行选择。

Objective To compare the efficacy and safety of ilioinguinal approach with Stoppa approach for open reduction and internal fixation in the treatment of displaced acetabular fracture. Methods Reports of studies using case-control studies to compare the ilioinguinal approach with Stoppa approach in the management of displaced acetabular fracture were retrieved from the Cochrane Library, PubMed Data, CNKI, Chinese Biomedical and Medical Database, Wanfang Data（ from January 2005 to August 2015）. Methodological quality of the trials was critically assessed. Statistical software Revman 5. 0 was used for data-analysis. Results A total of 8 studies involved 637 patients were included. The results showed that, when the efficacy, safety of ilioinguinal approach and Stoppa approach were compared in the treatment of displaced acetabular fracture, there were statistical significance in the average operation time[weighted mean difference （WMD = 68. 29, 95% CI 10. 52 - 126. 05, P 〈 0. 05] and the median intraoperatie blood loss （WMD） =142. 26, 95% CI 9. 30 - 275. 23, P 〈 0. 05）. However, there was no statistical significance in the rate of fracture end reset satisfaction[ relative risk（ RR） = 0. 63, 95% CI 0. 17 - 2. 37, P 〉 0. 05], the early complications rate（RR = 0. 89, 95% CI 0. 33 - 2. 40, P 〉 0. 05）, the late complications rate （RR = 0. 91, 95% CI 0. 27 - 3. 01, P 〉 0. 05）, rate of HHS good function （ RR = 0. 52, 95% CI 0. 25 - 1. 10, P 〉0. 05）. Conclusions The Stoppa approach is superior to the ilioinguinal approach in the treatment of displaced acetabular fracture in regards to the average operation time and the median intraoperative blood loss, but both approaches achieve similar and satisfactory clinical effect in the treatment of displaced acetabular fracture in the period of follow-up time.