Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
BMC Musculoskelet Disord. 2022 Jun 30;23(1):625. doi: 10.1186/s12891-022-05576-3.
The most commonly used approach for distal radius fractures is the traditional Henry approach. However, it requires an intraoperative incision of the pronator quadratus (PQ) muscle, which results in a series of complications if the repair of the PQ fails.
The objective of this study was to investigate the efficacy of sparing the pronator quadratus for volar plating of the distal radius fractures.
Seventy-six patients who suffered from distal radius fractures of types 23-B, 23-C1, and 23-C2 as per the AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification were treated with volar locking plate fixation using either the PQ muscle incision and repair (group A, n = 39) or the PQ muscle preservation approach (group B, n = 37). Intraoperative index, postoperative efficacy and complications of patients were recorded and evaluated.
All patients were followed up for more than one year after surgery. All fractures achieved union. There were significant differences in mean operative time, mean intraoperative blood loss, and mean fracture healing time between the two groups. Still, there were no significant differences in limb function scores between the two groups at the 12-month postoperative follow-up. Outcomes assessed at 1 week, 1 month, and 3 months after surgery demonstrated significant differences in the mean range of motion and pain-related visual analog scale (VAS) between the two groups. As the range of motion and grip strength increased, the VAS scores decreased, and there was no significant difference between the two groups at 12 months postoperatively. Although tendon irritation and delayed carpal tunnel syndrome were more common in group A than in group B (7.6% vs. 0% and 5.1% vs. 0%, respectively), the differences were not statistically significant.
The modified Henry approach with sparing pronator quadratus muscle has no significant advantage in the range of wrist motion and upper limb function in the late stage. Nevertheless, the intraoperative placement of the plate under the pronator quadratus muscle can shorten the operation time, reduce intraoperative bleeding, reduce early postoperative pain, promote early activity, and improve the patient's quality of life. It is recommended that the pronator be preserved at the time of surgery.
最常用于桡骨远端骨折的方法是传统的 Henry 入路。然而，如果修复失败，它需要切开旋前方肌（PQ），这会导致一系列并发症。
本研究旨在探讨保留旋前方肌对掌侧钢板固定桡骨远端骨折的疗效。
76 例 AO/OTA 分类 23-B、23-C1 和 23-C2 型桡骨远端骨折患者，采用掌侧锁定钢板固定，其中 39 例行 PQ 肌切开修复（A 组），37 例行 PQ 肌保留（B 组）。记录并评估患者的术中指标、术后疗效和并发症。
所有患者术后均随访 1 年以上。所有骨折均愈合。两组患者的平均手术时间、术中出血量和骨折愈合时间均有显著差异。然而，两组患者在术后 12 个月的肢体功能评分无显著差异。术后 1 周、1 个月和 3 个月评估结果显示，两组患者的平均活动范围和疼痛视觉模拟评分（VAS）存在显著差异。随着活动范围和握力的增加，VAS 评分降低，术后 12 个月两组间无显著差异。虽然 A 组肌腱激惹和迟发性腕管综合征的发生率高于 B 组（7.6%比 0%和 5.1%比 0%），但差异无统计学意义。
改良 Henry 入路保留旋前方肌在腕关节活动范围和晚期上肢功能方面没有明显优势。然而，在旋前方肌下放置钢板可缩短手术时间、减少术中出血、减轻术后早期疼痛、促进早期活动，提高患者的生活质量。建议在手术时保留旋前方肌。
