| BACKGROUND:Posterior cruciate ligament?PCL?tibial avulsion fracture is a special type of posterior cruciate ligament injury of the knee joint.Once it occurs,it can easily cause posterior cruciate ligament laxity and secondary knee instability and arthritis[1].The avulsed fracture is easily displaced.Generally,non-surgical treatment is ineffective,and the fracture is displaced again and nonunion[2].Displaced PCL tibial avulsion fractures should operate as soon as possible to restore knee stability.At present,the surgical procedure of displaced PCL tibial avulsion fractures mainly includes open reduction internal fixation?ORIF?and arthroscopy reduction internal fixation?ARIF?.Both have achieved significant results[3,4].This article intends to compare the clinical effects of arthroscopy and open reduction and fixation in the treatment of PCL tibial avulsion fractures.To provide basis and reference for the clinical operation of PCL tibial avulsion fractures.METHODS:The computer searched Chinese databases such as Cnki,SinoMed and Wanfang Literature Database,as well as English databases such as PubMed,EMbase,Cochrane.The time from the establishment of the database to December 2019,collected Clinical controlled study from domestic and foreign reported cruciate ligament tibia surgical treatment of avulsion fractures.Eligible literatures were selected for literature quality assessment,data were extracted and statistical analysis was performed on Revman 5.3.RESULTS:Through preliminary screening,reading abstracts,and full-screen re-screening,a total of 11 articles were included,all of which were Chinese documents.There were589 cases,290 cases in the arthroscopy group and 299 cases in the open group.Meta analysis results show that:the length of hospital stay after arthroscopic surgery[WMD=-4.17,95%CI:?-4.99,-3.35?,P<0.00001]and the Lysholm score[5]after surgery[WMD=8.06,95%CI?2.60,13.53?,p=0.004]was better than the open group,and the difference was statistically significant.The surgical time of the two groups[WMD=8.34,95%?-12.86,29.54?,P=0.44],knee joint mobility[WMD=7.97,95%CI?-0.82,16.77?,p=0.08],fracture healing Rate[RR=1.08,95%CI?1.00,1.17?,P=0.06]fracture displacement rate[RR=0.60,95%CI?0.27,1.30?,P=0.19]and positive rate of posterior drawer test[RR=0.79,95%CI?0.31,2.04?,P and other results were not statistically significant?P>0.05?.CONCLUSION:Compared with the open surgery,arthroscopic minimally invasive surgery can shorten the length of hospital stay,improve the Lysholm score of the knee joint,and promote joint function recovery.There was no significant difference between the two in terms of operation time,range of motion,postoperative postoperative drawer test positive rate,fracture healing and displacement rate.The accuracy of the results may be affected due to the low quality of the literature included,the small number of cases,and the short follow-up time,more high-quality randomized controlled trials are needed to further verify the clinical efficacy of arthroscopy and open surgery. |
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