中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (15): 2423-2429.doi: 10.3969/j.issn.2095-4344.3820

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    下一篇

桡骨远端骨折掌侧钢板固定后是否需要修复旋前方肌的Meta分析

何祥忠1，陈海云2，吕  阳2，刘  军2，黄俊翰1，高世华1，管建豪1，王养发1    

  1. 1广州中医药大学第二临床医学院，广东省广州市   510000；2广州中医药大学第二附属医院/广东省中医院，广东省广州市   510000
  • 收稿日期:2020-07-01 修回日期:2020-07-04 接受日期:2020-07-29 出版日期:2021-05-28 发布日期:2021-01-05
  • 通讯作者: 陈海云，硕士，主任医师，广州中医药大学第二临床医学院/广东省中医院，广东省广州市 510000
  • 作者简介:何祥忠，男，1991年生，江西省赣州市人，汉族，广州中医药大学第二临床医学院在读硕士，医师，主要从事创伤骨科和运动创伤方向的研究。
  • 基金资助:
    广东省财政厅项目([2014]157号，[2018]8号)，项目负责人：刘军；广东省中医院中医药科学技术研究专项(YN2019M07号)，项目负责人：陈海云

Meta-analysis of repairing pronator muscle after metacarpal plate fixation of distal radius fracture

He Xiangzhong1, Chen Haiyun2, Lü Yang2, Liu Jun2, Huang Junhan1, Gao Shihua1, Guan Jianhao1, Wang Yangfa1   

  1. 1The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China; 2The Second Affiliated Hospital of Guangzhou University of Chinese Medicine/Guangdong Hospital of Traditional Chinese Medicine, Guangzhou 510000, Guangdong Province, China
  • Received:2020-07-01 Revised:2020-07-04 Accepted:2020-07-29 Online:2021-05-28 Published:2021-01-05
  • Contact: Chen Haiyun, Master, Chief physician, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine/Guangdong Hospital of Traditional Chinese Medicine, Guangzhou 510000, Guangdong Province, China
  • About author:He Xiangzhong, Master candidate, Physician, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
  • Supported by:
    the Project of Department of finance of Guangdong Province, No. [2014]157, [2018]8 (to LJ); the Special Research Project on Science and Technology of Traditional Chinese Medicine in Guangdong Hospital of Traditional Chinese Medicine, No. YN2019M07 (to CHY) 

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摘要：

文题释义：
旋前方肌：位于前臂远端掌侧的四边形肌肉，肌纤维起自尺骨下1/5前侧和内侧，止于桡骨下1/5掌侧及前缘，紧贴尺桡骨和骨间膜，它是前臂旋前动作的原发肌，对维持下尺桡关节的稳定性也至关重要。
桡骨远端骨折：桡骨远端骨折非常常见，约占平时骨折的1/10，多见于老年妇女，青壮年发生均为外伤暴力较大者。桡骨远端骨折发生在桡骨远端2.0-3.0 cm，常伴桡腕关节及下尺桡关节的损坏。

目的：近年来大量文献对于桡骨远端骨折掌侧钢板固定后是否修复旋前方肌进行报道，对于修复旋前方肌带来的有效性和临床获益尚存在争议。为此，文章系统评价桡骨远端骨折掌侧钢板固定后修复旋前方肌的临床效果。
方法：应用计算机检索中国知网、万方、维普、中国生物医学文献、PubMed、Embase及Cochrane Library数据库中有关桡骨远端骨折掌侧钢板固定后修复旋前方肌的随机对照试验，日期为2001年1月至2020年1月。对所有符合纳入的文献进行资料提取和质量评价，采用改良Jadad量表对14项随机对照试验进行方法学质量评价。采用RevMan 5.3软件对其DASH评分、目测类比评分、尺偏角度、背伸角度、旋前角度、旋后角度及旋前肌力进行Meta分析。
结果：①共纳入11个随机对照试验；②文章限定随访时间3个月内为短期，3-12个月为中期，大于1年为长期；③Meta分析显示，桡骨远端骨折掌侧钢板固定后修复旋前方肌组在术后中期的DASH评分(MD=-0.79，95%CI：-1.50至-0.09，P=0.03)，短中期的目测类比评分(MD= -3.04，95%CI：-3.53至-2.55，P < 0.000 01；MD=-1.69，95%CI：-1.99至-1.39，P < 0.000 01)，长期的背伸角度(MD=5.15，95%CI：2.50-7.80，P=0.000 1)，中长期的旋前角度(MD=1.83，95%CI：0.69-2.96，P=0.002；MD=1.81，95%CI：0.32-3.30，P=0.02)，中期的旋前肌力(MD=1.35，95%CI：0.90-1.80，P < 0.000 01)及尺偏角度(MD=4.28，95%CI：3.26-5.31，P < 0.000 01)方面均优于不修复旋前方肌组；两组在长期的DASH评分、短期的背伸角度、短长期的旋后角度方面均无显著性意义(P > 0.05)。
结论：桡骨远端骨折掌侧钢板固定后，在内固定的基础上联合修复旋前方肌可能可以进一步增强中长期的关节活动角度，减轻患者的短中期的疼痛，增强患者术后短中期的关节功能，提升患者术后体验感。但由于纳入的文献数量有限，故未来需要更多大样本、高质量的随机对照试验来进一步提供有效数据。
https://orcid.org/0000-0003-1912-3572 (何祥忠)

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程


关键词: 骨, 桡骨, 骨折, 肌肉, 钢板, 内固定, 修复, Meta分析

Abstract: OBJECTIVE: In recent years, a large number of articles have reported whether to repair pronator muscle after metacarpal plate fixation of distal radius fracture, but the effectiveness and clinical benefits of repairing pronator muscle are still controversial. Thus, this meta-analysis evaluated the clinical effect of repairing pronator muscle after metacarpal plate fixation of distal radius fracture. 
METHODS: We searched the related randomized controlled trials on the repair of pronator muscle after metacarpal plate fixation of distal radius using the computer in CNKI, Wanfang, VIP, China Biology Medicine disc, PubMed, Embase, and Cochrane Library. The search date was from January 2001 to January 2020. Data extraction and quality evaluation to all the documents that are in accordance with the inclusion were carried out. The methodological quality of 14 randomized controlled trials was evaluated by modified Jadad scale. The DASH score, visual analogue scale score, ulnar deviation angle, dorsal extension angle, pronation angle, supination angle and pronation muscle strength were analyzed by RevMan 5.3 software for meta-analysis.
RESULTS: (1) A total of 11 randomized controlled trials were included. (2) The follow-up time of 3 months is short-term, 3-12 months is medium-term, and longer than 1 year is long-term. (3) Meta-analysis results demonstrated that the DASH score (MD=-0.79, 95%CI:-1.50 to -0.09, P=0.03), short-and medium-term  visual analogue scale score (MD=-3.04, 95%CI:-3.53 to -2.55, P < 0.000 01; MD=-1.69, 95%CI:-1.99 to -1.39, P < 0.000 01), long-term dorsal extension angle (MD=5.15, 95%CI:2.50-7.80, P=0.000 1), medium-and long-term pronation angle (MD=1.83, 95%CI:0.69-2.96, P=0.002; MD=1.81, 95%CI:0.32-3.30, P=0.02), mid-term pronation muscle strength (MD=1.35, 95%CI:0.90-1.80, P < 0.000 01) and ulnar deviation angle (MD=4.28, 95%CI:3.26-5.31, P < 0.000 01) in the group of repairing pronator muscle after metacarpal plate fixation were better than those in the group without repairing pronator muscle. There was no significant difference in long-term DASH score, short-term dorsal extension angle and short- and long-term supination angle between the two groups (P > 0.05). 
CONCLUSION: After metacarpal plate fixation of distal radius fracture, combined repair of pronator muscle on the basis of internal fixation may further enhance the medium-and long-term joint motion angle, reduce the patients’ medium-and short-term pain, and enhance the patients’ medium-and short-term joint function after operation, and enhance the patient’s sense of experience after operation. However, due to the limited number of literature included, more large samples and high-quality randomized controlled trials are needed to provide further effective data.

Key words: bone, radius, fracture, muscle, plate, internal fixation, repair, meta-analysis

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