Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
Injury. 2012 Feb;43(2):200-4. doi: 10.1016/j.injury.2011.07.006. Epub 2011 Aug 10.
Pronator quadratus (PQ) is an important contributor to forearm pronation, and there is concern that volar plating of a distal radius fracture (DRF) may damage the PQ function. The purpose of this study was to determine whether isokinetic pronation strength would decrease considerably after volar locking plating of a DRF, and whether clinical outcomes would be affected by any pronation strength decrease.
Thirty-four patients of mean age of 55 years (range, 21-74 years) underwent bilateral isokinetic testing at 6 months and 1 year after open reduction and internal fixation using volar plating. Isokinetic pronation and supination strengths were compared between the operated and normal sides. Clinical outcomes such as grip strengths, range of motions and disabilities of the arm, shoulder and hand (DASH) scores were evaluated and analysed for any associations with isokinetic results.
At 6 months, peak torque and total work values for both pronation and supination were lower in the operated sides than in the normal sides (all p < 0.001). However, at 1 year postoperatively, the differences in pronation strength were not statistically significant (p = 0.188 for peak torque and p = 0.190 for total work), whilst supination torque and total work were still significantly lower in the operated sides (p = 0.015 and p = 0.029, respectively). Decreases in pronation strength were found to correlate significantly with decreases in supination strength and grip power. Wrist motion and DASH scores were not found to be correlated with decrease in pronation or supination strengths.
In patients with a DRF treated by volar plating, pronation strength was not significantly different between the operated and normal sides at 1 year postoperatively, and decreases in pronation or supination strengths were not found to affect clinical outcomes as assessed by DASH scores. This study suggests that dissection of the PQ may have minimal clinical impact on forearm pronation function.
旋前方肌（PQ）是前臂旋前的重要贡献者，人们担心桡骨远端骨折（DRF）的掌侧钢板固定可能会损害 PQ 功能。本研究旨在确定 DRF 掌侧锁定钢板固定后等速旋前力量是否会显著下降，以及旋前力量的任何下降是否会影响临床结果。
34 名平均年龄为 55 岁（范围，21-74 岁）的患者在切开复位内固定术后 6 个月和 1 年进行双侧等速测试，使用掌侧钢板。比较了手术侧和正常侧的等速旋前和旋后力量。评估并分析了握力、关节活动度和手臂、肩部和手的残疾（DASH）评分等临床结果，以确定与等速结果的任何关联。
术后 6 个月，手术侧的峰值扭矩和总功值在旋前和旋后均低于正常侧（均 p <0.001）。然而，术后 1 年，旋前力量的差异无统计学意义（p = 0.188 为峰值扭矩，p = 0.190 为总功），而旋后扭矩和总功仍明显较低（p = 0.015 和 p = 0.029）。发现旋前力量的下降与旋后力量和握力的下降显著相关。腕关节运动和 DASH 评分与旋前或旋后力量的下降无关。
在接受掌侧钢板固定治疗的 DRF 患者中，术后 1 年手术侧和正常侧的旋前力量无显著差异，旋前或旋后力量的下降并未发现影响 DASH 评分评估的临床结果。本研究表明，旋前方肌的解剖对前臂旋前功能的临床影响较小。
