Fixation of Pelvic–Acetabular Fractures Using a Midline-Modified Stoppa Approach: Clinical and Operative Outcomes

Abstract

Background/Purpose: This served as the first report from our locality to evaluate the modified Stoppa approach, via a low-midline wound, for treating pelvic–acetabular fractures. Methods: A total of 17 polytrauma patients with pelvic and/or acetabular fractures were consecutively treated using the modified Stoppa approach. They were followed up for at least 1 year postoperatively for radiographic and clinical assessments, which included the Modified Merle d’Aubigne Score, Harris Hip Score, and pain visual analogue scale. Results: Among the 17 patients, 11 had pelvic ring fractures, two had isolated acetabular fractures, and four had a combination of both. Excellent and anatomical reduction was achieved in 73.3% of pelvic fractures and 71.4% of acetabular fractures. Functional outcomes simulated a bimodal distribution. Age of patient and Injury Severity Score were significant predictors for functional results, whereas fracture characteristics and quality of reduction were not correlated with clinical outcomes in this series. We experienced a low complication rate. Conclusion: Excellent exposure for fracture reduction and fixation with low complication rate was achieved with the modified Stoppa approach. We were encouraged by the results of this preliminary series for treating pelvic–acetabular fractures in polytrauma patients. 中 文 摘 要: 背景/目的: 這是以改進Stoppa入路以下中線切口進行盤骨髖臼骨折的本地首個報告。 方法: 從2010年5月至2014年5月期間，採用改進Stoppa入路連續為17位病人治療其盤骨或髖臼骨折。隨訪至少一年，並紀錄影像結果和臨床成效。臨床評估包括改良Merle d’ Aubigne評分、哈里斯髖關節評分和疼痛的視覺模擬評分。 結果: 在17位病人當中，11位有盤骨骨折，2位有髖臼骨折，另外4位同時有盤骨及髖臼骨折。於73.3%的盤骨環骨折及71.4%的髖臼骨折，解剖復位達到優秀水平。而功能結果則呈現了雙峰的分佈。病人的年齡和創傷嚴重程度得分 (ISS) 能顯著地預測功能結果，而骨折特性和復位的準確度則與臨床結果沒有相關。術後的併發症比率偏低。 結論: 改進Stoppa入路能做到優良的顯露，良好的骨折復位及低併發症比率。患有盤骨髖臼骨折的多發性創傷病人術後的初步成果，整體來說令人鼓舞。 Keywords: acetabulum, fracture fixation, internal, multiple trauma, orthopaedic procedures, pelvis