A Network Meta-analysis Of The Clinical Efficacy And Safety Of Different Surgical Approaches For The Treatment Of Posterolateral Tibial Plateau Fractures

Objective:The posterolateral tibial plateau fracture is a special intra-articular fracture.Due to the deep posterolateral position and concealment of the fracture fragments,it is difficult to expose the operative field.In addition,because of the fibular head and lateral collateral ligament in the front,the operation space is small,the anterolateral side is close to the common peroneal nerve,and the rear is close to the popliteal artery and vein and the tibial nerve,which further increases the incidence of intraoperative complications.The surgical approach for posterolateral tibial plateau fractures remains inconclusive.This study starts from the surgical approach,collects previous research results,applies Bayesian theory,conducts network meta-statistical analysis,summarizes,and aims to provide help for clinical practice.Methods:Systematically searched domestic and foreign well-known databases to obtain literature,and screened literature according to predetermined inclusion and exclusion criteria.Relevant data were extracted and analyzed by software such as ADDIS for network meta-analysis.The anterolateral approach,the modified anterolateral approach,the supra-fibular head approach,the direct posterolateral approach,the extensile lateral approach,the postero-central approach,and the posteromedial approach were compared.Evaluation indicators included:operation time,intraoperative blood loss,postoperative fracture healing time,HSS score of knee joint function at the last follow-up after operation,and incidence of postoperative complications.Results:A total of 29 studies that met the inclusion and exclusion criteria were finally included.A total of 2125 clinical patients were obtained.Among the operative approaches for the treatment of posterolateral tibial plateau fractures,the operative time of the posteromedial approach is longer than that of other operative approaches,and the modified anterolateral approach is more advantageous in terms of operative time;The supra-fibular head approach has advantages in terms of intraoperative blood loss;in terms of postoperative fracture healing time,the modified anterolateral approach is superior to the posteromedial approach and the direct posterolateral approach,and the other approaches are no significant difference between the two approaches;the modified anterolateral approach was superior in the HSS score of knee joint function at the last follow-up after surgery;for the incidence of postoperative complications,the supra-fibular head approach was more advantageous.Conclusion:The modified anterolateral approach is superior in terms of operation time,postoperative fracture healing time and postoperative knee function score,and the supra-fibular head approach is superior in terms of intraoperative blood loss and incidence of postoperative complications.However,since the application of Bayesian theory to network meta-analysis will introduce indirect comparison results and only obtain results from the level of probability,the results should be treated with caution.Clinicians should be familiar with the physiological and anatomical structure,combined with the patient’s imaging examination and the specific characteristics of the fracture,and specifically select the corresponding surgical approach,in order to bring better therapeutic effects to the patient.