Institut Chirurgical de la Main et du Membre Supérieur, Villeurbanne, France.
J Ultrasound Med. 2019 Oct;38(10):2785-2791. doi: 10.1002/jum.14968. Epub 2019 Feb 18.
The main complication of volar locking plates for distal radius fractures is flexor tendon rupture. The flexor pollicis longus (FPL) is the most commonly ruptured. Repair of the pronator quadratus (PQ) is one of the ways to prevent tendon rupture. The main purpose of this series was to evaluate the role of PQ repair after volar plating to prevent flexor tendon rupture using ultrasound (US). This work was a mono-operator prospective series of 20 consecutive patients with volar locking plates for distal radius fracture between September 2014 and May 2015. The PQ was repaired in all patients. A clinical, ultrasound, and perioperative evaluation of the flexor tendon was performed by this same surgeon. There was no flexor tendon rupture or tenosynovitis. There were no type A cases, which are characterized by contact between the plate and the FPL, and mostly type C cases, which are characterized by no contact between the plate and the FPL on US imaging. The suture of the PQ was sustainable over time when we removed the plate. Pronator quadratus repair is one of the ways to prevent flexor tendon rupture after volar plating. The outward-running suture is an effective technique for repairing the PQ. Ultrasound may be helpful during follow-up to detect asymptomatic flexor tendon irritation.
掌侧锁定钢板治疗桡骨远端骨折的主要并发症是屈肌腱断裂。拇长屈肌腱（FPL）是最常发生断裂的肌腱。修复旋前方肌（PQ）是预防肌腱断裂的方法之一。本系列研究的主要目的是使用超声（US）评估掌侧钢板固定后修复旋前方肌在预防屈肌腱断裂中的作用。这是一项单中心前瞻性研究，纳入 2014 年 9 月至 2015 年 5 月期间连续 20 例接受掌侧锁定钢板治疗桡骨远端骨折的患者。所有患者均行旋前方肌修复。由同一位外科医生进行了临床、超声和屈肌腱围手术期评估。无屈肌腱断裂或腱鞘炎。无 A 型病例（其特征为钢板与 FPL 接触），大多为 C 型病例（其特征为 US 成像示钢板与 FPL 无接触）。当我们取出钢板时，旋前方肌的缝线能够长时间承受拉力。掌侧钢板固定后修复旋前方肌是预防屈肌腱断裂的方法之一。外移缝线是修复旋前方肌的有效技术。超声检查可能有助于在随访中发现无症状的屈肌腱激惹。
