Ahsan Zahab S, Yao Jeffrey
Indiana University School of Medicine, 635 Barnhill Drive, Indianapolis, IN 46202 USA.
Hand (N Y). 2012 Sep;7(3):276-80. doi: 10.1007/s11552-012-9420-6.
Open reduction internal fixation (ORIF) of distal radius fractures via a volar approach involves surgical release of the overlying pronator quadratus (PQ) muscle. Complete repair of the PQ, defined as full and stable replacement of the periphery of the PQ back to its original anatomic location, is not always possible upon conclusion of the operation. Postoperative consequences of incomplete PQ repair with regards to range of motion (ROM), grip strength, and complications are not well documented. It was hypothesized that the completeness of PQ repair would yield no significant difference in the postoperative ROM, grip strength, and incidence of complications.
A retrospective review was performed of 110 repairs of distal radius fractures with ORIF via placement of a volar locking plate. The following clinical data were extracted: complete or incomplete PQ repair, patient age, gender, follow-up ROM/grip strength, and incidence of postoperative complications.
No significant difference in ROM, grip strength, and postoperative complications was detected between the complete and incomplete PQ repair groups. Complications consisted of two incidences of malunion requiring revision surgery and one occurrence of complex regional pain syndrome. There were no tendon ruptures. No statistical difference in ROM/grip strength or incidence of postoperative complications was detected between the complete and incomplete PQ repair groups. Regardless of the level of injury sustained by the PQ, surgeons should make an effort to cover the distal aspect of the volar plate during closure following distal radius fracture ORIF. Coverage of the distal aspect of the plate with the PQ (at a minimum) provides adequate results in ROM and grip strength, as well as protection against flexor tendon injury.
Therapeutic Level III: Retrospective Comparative Study.
经掌侧入路对桡骨远端骨折进行切开复位内固定（ORIF）手术需要切开并松解覆盖其上的旋前方肌（PQ）。手术结束时，不一定总能完全修复PQ，即无法将PQ的周边完整且稳定地恢复到其原始解剖位置。关于不完全修复PQ对术后活动范围（ROM）、握力和并发症的影响，目前尚无充分的文献记载。研究假设PQ修复的完整性在术后ROM、握力和并发症发生率方面不会产生显著差异。
对110例采用掌侧锁定钢板置入术进行ORIF治疗桡骨远端骨折的修复病例进行回顾性研究。提取以下临床数据：PQ修复是否完全、患者年龄、性别、随访时的ROM/握力以及术后并发症发生率。
完全修复PQ组与不完全修复PQ组在ROM、握力和术后并发症方面未检测到显著差异。并发症包括两例需要翻修手术的畸形愈合和一例复杂性区域疼痛综合征。未发生肌腱断裂。完全修复PQ组与不完全修复PQ组在ROM/握力或术后并发症发生率方面未检测到统计学差异。无论PQ损伤程度如何，在桡骨远端骨折ORIF术后关闭创口时，外科医生都应努力覆盖掌侧钢板的远端。（至少）用PQ覆盖钢板远端在ROM和握力方面能提供足够的效果，同时还能防止屈肌腱损伤。
治疗性三级证据：回顾性对比研究。
