髋臼骨折前方手术入路选择的系统文献综述

The choice of anterior approach for acetabular fractures： a systematic review

目的评价髋臼骨折前方手术入路，即髂腹股沟入路、Stoppa入路、腹直肌旁入路的疗效及安全性。方法计算机检索Pubmed、Embase、Cochrane Library数据库，时间截止至2017年5月，纳入髂腹股沟、Stoppa、腹直肌旁入路治疗髋臼骨折的双臂及单臂研究。由3位研究者独立评价纳入研究的质量，并提取数据，采用RevMan5．3及Meta．Analyst beta3．13软件进行统计学分析。结果22个中低质量的研究被纳入，包含7个双臂研究，15个单臂研究；共980例髋臼骨折患者，其中髂腹股沟入路组581例，Stoppa入路组264例，腹直肌旁入路组135例。Meta分析结果表明：Stoppa）入路的解剖复位率高于髂腹股沟入路（OR=0．58，95％C1：0．36-0．94，P=0．03）；腹直肌旁入路的解剖复位率高于髂腹股沟入路（OR=2．95，95％CI：1．22-7．10，P=0．02）。相比髂腹股沟入路，Stoppa入路的手术时间较短（MD=48．01，95％CI：17．08-78．95，P=0．002），而髂腹股沟入路与腹直肌旁入路手术时间无明显差异。此外，三者在术中出血量、术后功能评价方面以及并发症等方面未见明显差异。结论现有证据表明Stoppa入路和腹直肌旁入路的解剖复位率可能高于髂腹股沟入路；相比髂腹股沟入路，Stoppa入路的手术时间可能较短。针对此问题，还需要进一步设计基线良好、直接比较的对照试验来进一步研究。

Objective To evaluate the efficacy and safety in the treatment of acetabular fractures via anterior approaches, including ilioinguinal, stoppa, pararectus approach. Methods Systematic literature retrieval was carried out to obtain twoarm and one-arm researches on the treatment of acetabular fractures via any one of the three approaches before May 2017, from pubmed, embase, cochrane library Databases. Data extraction and quality evaluation of studies were performed by 3 investigators independently. A meta-analysis was performed by RevMan 5.3 and Meta-Analyst beta 3.13. Results Totally 22 low to moderate quality studies, including 7 two-arm and 15 one-ann were included. There were 980 patients, including 581 in ilioinguinal ap- proach group, 264 in stoppa approach group and 135 in pararectus approach group. Meta-analysis showed the rate of anatomic reduction in stoppa approach was higher than that in ilioinguinal approach （OR=0.58, 95%CI：0.36-0.94, P=0.03）, which in pararectus approach was higher than that in ilioinguinal approach （OR=2.95,95%CI： 1.22-7.10, P=0.02）. Compared to the ilioinguinal ap- proach, the operation time in the Stoppa approach was shorter （MD=48.01, 95%CI： 17.08-78.95, P=0.O02）, there was no statistical- ly significant difference between pararectus approach and ilioinguinal approach. In addition, there were no statistically significant differences among three approaches in intra-operative blood loss, postoperative functional outcomes and complications. Conclusion The available limited evidence suggests that the rate of anatomical reduction in stoppa and pararectus approach may be higher than ilioinguinal approach. Compared to the ilioinguinal approach, the operation time in the stoppa approach may be shorter. In this field, further rigorous design, baseline parallel, direct comparison controlled studies on this topic are still needed.