Arthroscopy-Assisted And Traditional Open Reduction And Internal Fixation For Tibial Plateau Fractures:A Meta-Analysis

ObjectiveTo compare the clinical effects of arthroscopic assisted reduction and internal fixation(ORIF)for Schatzker type I~IV tibial plateau fractures by using Meta-analysis method,and to further guide the clinical treatment of tibial plateau fractures.MethodsBy searching the domestic and foreign databases,we found out the literature about the clinical effect of arthroscopic assisted open reduction and internal fixation in the treatment of tibial plateau fractures.After specific inclusion and exclusion criteria,the required literature was screened out.The required clinical evaluation indexes were drawn up: incision length,intraoperative bleeding volume,excellent and good rate of knee joint after operation,anatomical reduction rate,operation time,hospitalization time and postoperative complications.RevMan 5.3 software was used to carry out meta-analysis of the included data.ResultsAfter the inclusion and exclusion criteria,a total of 13 articles were included.A total of 1279 patients with tibial plateau fractures were enrolled,including 566 in the arthroscopic reduction and internal fixation(ARIF)group and 713 in the conventional open reduction and internal fixation(ORIF)group.Meta-analysis showed that the postoperative complications of tibial plateau fractures in ARIF group were significantly lower than those in ORIF group [OR = 0.30,95% CI(0.11,0.76,P <0.05],and the difference was statistically significant;compared with ORIF group,the excellent rate of tibial plateau fractures in ARIF group [OR = 1.59,95% CI(0.90,0.28),P > 0.05],it was not considered that there was a difference between the two methods in overall excellent rate and that of ORIF group [OR = 1.59,95% CI(0.90,0.28),P > Compared with ORIF group,ARIF group had a significant difference in the amount of bleeding [WMD=-3.29,95% CI(-5.80,-0.77),P < 0.05].Compared with ORIF group,the reduction rate of tibial plateau fracture in ARIF group was significantly higher [OR=3.54,95% CI(1.68,7.43),P < 0.05],and the difference was statistically significant;compared with ORIF group,the length of tibial plateau fracture incision in ARIF group decreased.Small [WMD=-5.36,95% CI(-5.76,-4.97),P < 0.05],the difference was statistically significant;there was no significant difference in the operation time between the two groups [WMD = 0.42,95% CI(-0.12,0.957),P > 0.05];compared with ORIF group,the hospital stay of ARIF group after tibial plateau fracture surgery decreased [WMD=-5.03,95% CI(-7.00,-3.05),P <0.05],the difference was statistically significant.ConclusionCompared with ORIF group,the treatment of tibial plateau fracture had significant difference.Compared with atzker type I~IV tibial plateau fractures,ARIF group had the advantages of less bleeding,higher anatomical reduction rate,smaller incision,shorter hospitalization time and fewer complications.However,ARIF group had no obvious advantages in the excellent and good rate and operation time.