Efficacy comparison of the anterior-posterior approach and lateral rectus abdominis approach in the treatment of sacroiliac joint dislocation with ipsilateral sacral wing fracture
Objective:To compare the efficacy of the anterior-posterior and lateral rectus abdominis approaches in the treatment of sacroiliac joint dislocation with ipsilateral sacral wing fracture(SJDISWF).Methods:A retrospective analysis was conducted on the clinical data from 81 SJDISWF patients treated at Tengzhou Central People's Hospital from January 2020 to June 2023.Patients were divided into two groups based on the surgical approach:the lateral rectus abdominis group(42 cases)and the anterior-posterior group(39 cases).Surgical and recovery outcomes,quality of fracture reduction,pain level,pelvic function,biochemical markers of bone metabolism,and complication rates were compared between the two groups.Results:Both groups were followed up for 7-12 months,with an average of(10.5±1.3)months.The lateral rectus abdominis group had shorter operation time,less intraoperative blood loss,smaller incision length,and shorter fracture healing time compared to the anterior-posterior group(P<0.05).There was no statistically significant difference in the excellent rate of fracture reduction postoperatively between the two groups(P>0.05).The VAS scores of the lateral rectus abdominis group were lower than those of the anterior-posterior group on day 3 and day 7 post-surgery(both P<0.05).There was no statistically significant difference in the excellent rate of pelvic function at 6 months post-surgery between the two groups(P>0.05).The levels of osteocalcin mid-terminal fragment(N-MID),osteocalcin(OC),and bone alkaline phosphatase(BAP)were higher at 6 months postoperatively compared to preoperative levels in both groups(all P<0.05),with higher levels in the lateral rectus abdominis group compared to the anterior-posterior group(all P<0.05).There was no statistically significant difference in the complication rates between the two groups(P>0.05).Conclusions:The lateral rectus abdominis approach and the anterior-posterior approach for treating SJDISWF have similar outcomes in terms of reduction quality,pelvic functional recovery,and safety.However,the lateral rectus abdominis approach has advantages of shorter operation time,less intraoperative blood loss,smaller incision size,reduced postoperative pain,and increased postoperative bone metabolic markers N-MID,OC,and BAP levels.
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