Mulders Marjolein A M, Walenkamp Monique M J, Bos Fernande J M E, Schep Niels W L, Goslings J Carel
Trauma Unit, Department of Surgery, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
Department of Surgery, Maasstad Hospital, P.O. Box 9100, 3007 AC, Rotterdam, The Netherlands.
Strategies Trauma Limb Reconstr. 2017 Nov;12(3):181-188. doi: 10.1007/s11751-017-0288-4. Epub 2017 May 17.
To position the volar plate on the distal radius fracture site, the pronator quadratus muscle needs to be detached from its distal and radial side and lifted for optimal exposure to the fracture site. Although the conventional approach involves repair of the pronator quadratus, controversy surrounds the merits of this repair. The purpose of this study was to compare the functional outcomes of patients with distal radius fractures treated with pronator quadratus repair after volar plate fixation versus no pronator quadratus repair. A systematic search was conducted in Medline, EMBASE and the Cochrane Central Register of Controlled Trials, on 23 July 2015. All studies comparing pronator quadratus repair with no pronator quadratus repair in adult patients undergoing volar plate fixation for distal radius fractures were included. The primary outcome was the Disability of the Arm, Shoulder and Hand (DASH) score at 12 months. Secondary outcomes included range of motion, grip strength, post-operative pain and complications. A total of 169 patients were included, of which 95 underwent pronator quadratus repair, while 74 patients underwent no pronator quadratus repair. At 12 months follow-up no statistically significant differences in DASH-scores and range of motion were observed between pronator quadratus repair and no repair. Moreover, post-operative pain and complication rates were similar between both groups. At 12 months of follow-up, we do not see any advantages of pronator quadratus repair after volar plate fixation in the distal radius. However, a definitive conclusion cannot be drawn from this systematic review due to a lack of available evidence.
为了将掌侧板放置于桡骨远端骨折部位，需要将旋前方肌从其远端和桡侧分离并掀起，以便最佳地暴露骨折部位。虽然传统方法包括修复旋前方肌，但对于这种修复的优点存在争议。本研究的目的是比较掌侧板固定后行旋前方肌修复与不行旋前方肌修复的桡骨远端骨折患者的功能结局。2015年7月23日在医学文献数据库（Medline）、荷兰医学文摘数据库（EMBASE）和考克兰系统评价数据库（Cochrane Central Register of Controlled Trials）进行了系统检索。纳入所有比较成年桡骨远端骨折患者行掌侧板固定时旋前方肌修复与不修复的研究。主要结局是12个月时的手臂、肩部和手部功能障碍（DASH）评分。次要结局包括活动范围、握力、术后疼痛和并发症。共纳入169例患者，其中95例行旋前方肌修复，74例未行旋前方肌修复。在12个月随访时，旋前方肌修复组与未修复组在DASH评分和活动范围方面未观察到统计学上的显著差异。此外，两组术后疼痛和并发症发生率相似。在12个月随访时，我们未发现桡骨远端掌侧板固定后旋前方肌修复有任何优势。然而，由于缺乏可用证据，无法从本系统评价得出明确结论。
