旋前方肌修复对于改善桡骨远端骨折掌侧钢板固定后的疗效是否必要？系统评价和荟萃分析。
Is pronator quadratus repair necessary to improve outcomes after volar plate fixation of distal radius fractures? A systematic review and meta-analysis.
机构信息
Department of Orthopaedics, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, 266035 Qingdao, Shandong, China.
Department of Rehabilitation, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, 266035 Qingdao, Shandong, China.
出版信息
Orthop Traumatol Surg Res. 2020 Dec;106(8):1627-1635. doi: 10.1016/j.otsr.2020.06.003. Epub 2020 Nov 11.
PURPOSE
This systematic review and meta-analysis was conducted to compare functional outcomes with or without pronator quadratus (PQ) repair after volar plate fixation of distal radius fractures.
METHODS
An electronic search was conducted for PubMed, Embase, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials) and Google Scholar databases up to 15th January 2020. Both retrospective case-control and randomised control trials (RCTs) were included.
RESULTS
A total of 6 studies met the inclusion criteria. 4 were RCTs and 2 were retrospective studies. The primary outcome was the difference in the Disabilities of the Arm, Shoulder, and Hand (DASH) scores between the two groups. On analysis of 203 patients with PQ repair and 180 patients with no repair, our results indicated no statistical significant difference in DASH scores between the two groups (SMD: 0.43, 95% CI: -0.12 to 0.98, I=85%, p=0.12). Also, meta-analysis did not demonstrate any difference in grip strength (SMD: -0.10, 95% CI: -0.53 to 0.33, I=64%, p=0.64) and pronation strength (SMD: -0.02, 95% CI: -0.82 to 0.78, I=82%, p=0.96) with or without PQ repair. The pooled analysis did not demonstrate any benefit of PQ repair in improving postoperative ROM.
CONCLUSION
Our results indicate that repair of PQ muscle may not be necessary after volar plate fixation of distal radius fractures. Further large scale RCTs shall validate our conclusions.
LEVEL OF EVIDENCE
II, systematic review and meta-analysis.
目的
本系统评价和荟萃分析旨在比较掌侧钢板固定桡骨远端骨折后修复旋前方肌与不修复旋前方肌的功能结果。
方法
对 PubMed、Embase、Scopus、CENTRAL（Cochrane 对照试验中心注册库）和 Google Scholar 数据库进行电子检索，检索时间截至 2020 年 1 月 15 日。纳入回顾性病例对照研究和随机对照试验（RCT）。
结果
共纳入 6 项研究符合纳入标准。其中 4 项为 RCT，2 项为回顾性研究。主要结局为两组之间的残疾程度（手臂、肩和手）（DASH）评分差异。对 203 例接受旋前方肌修复和 180 例未修复的患者进行分析，结果表明两组间 DASH 评分无统计学差异（SMD：0.43，95%CI：-0.12 至 0.98，I=85%，p=0.12）。此外，meta 分析也未显示在握力（SMD：-0.10，95%CI：-0.53 至 0.33，I=64%，p=0.64）和旋前肌力（SMD：-0.02，95%CI：-0.82 至 0.78，I=82%，p=0.96）方面，修复与不修复旋前方肌有任何差异。汇总分析也未显示修复旋前方肌对术后 ROM 有任何改善作用。
结论
我们的结果表明，掌侧钢板固定桡骨远端骨折后修复旋前方肌可能不是必需的。需要进一步开展大规模 RCT 来验证我们的结论。
证据等级
II，系统评价和荟萃分析。
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