2.1 Inclusion criteria
2.1.1 Type of study
randomized controlled trials (RCTs) and comparative experimental trials will be included in this SR. Patients should be randomly assigned into with PQ repair and without PQ repair groups. The language of the literature will be limited in English or Chinese.
2.1.2 Participants
All patients were clearly diagnosed as fresh closed distal radius fractures by X-ray or CT. Patients with metachronous fractures, open fractures, or combined with vascular and nerve injury were excluded.
2.1.3 Interventions
Under brachial plexus anesthesia or general anesthesia, the patient is in a supine position, and the radial styloid process is taken from the transverse carpal striae, and an incision extending about 8 cm proximally is exposed from the approach between the flexor carpi radialis muscle and the radial artery and vein. The lateral flexor carpi tendon is pulled to the ulnar side, and the radial artery and vein are properly pulled to the radial side. Properly bluntly separated along the direction of the muscle fibers to expose the distal and proximal ends of the PQ muscle covering the distal radius, and run longitudinally in 1/3 of the radial side[9, 13]. The PQ muscle was incised to expose the fractured radius for reduction and internal fixation with plate screws. After the internal fixation operation is completed, the incision is flushed with saline. In group A, the incised PQ muscle was sutured carefully with absorbable sutures, and then the skin was sutured layer by layer, while in group B, the incised PQ muscle was stretched to cover the steel plate and the tissue was directly sutured layer by layer[12-14].
Postoperative treatment generally does not require plaster fixation. After 24, the extension and flexion function exercises of the affected metacarpophalangeal joint and interphalangeal joint will be started. After 2 days, postoperative X-ray photography will be performed to check the fracture reduction and internal fixation[7, 12].
2.1.4 Outcomes
The primary outcomes will include the wrist pain intensity measurement via a Visual Analogue Scale (VAS) or a Numerical Rating Scale (NRS) within 2 weeks after surgery.
The range of motion (ROM) of the wrist on the affected side and the disabilities of the Arm, Shoulder and Hand (DASH) score will be collected within 1year after surgery.Secondary results include operation time, intraoperative blood loss, and adverse events (vascular and nerve damage and compartment syndrome).
2.2 Date sources
We will search the following databases from establishment to February 2021: PubMed, Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI),and Wanfang databases from the beginning to February 2021.
2.3 Serarch strategy
Search strategy will follow the Cochrane handbook. The search strategy for PubMed is shownin Table 1, and similar strategies will be built and applied forother electronic databases.The search strategy is listed in Table 1.
Table 1 search strategy used in PubMed database
Number
|
Search termse
|
#1
|
distal radi*[Title/Abstract]
|
#2
|
volar plat*[Title/Abstract]
|
#3
|
pronator quadratus[Title/Abstract]
|
#4
|
#1 AND #2 AND #3
|
2.4 Study selection and data extraction
After selecting the study based on the inclusion criteria according to the above-mentioned,two independent reviewers will read the full texts of each article to extract pertinent data using a data extraction form. Any disagreements will be solved by discussion or consultation with another researcher. If the primary data is missing,incomplete,or reported in the form of graphs,we will contact the author by email or phone calls for raw data. If the author of the paper has lost the relevant data,or does not agree to provide data,we will give a statistical description in the results section instead of meta-analysis.The research summary of the screening flow chart is shown in Fig. 1.
2.5 Quality assessment of included studies
Two independent assessment of risk of bias researchers will individually use the risk of bias (RoB) tool proposed by Cochrane Handbook V.5.2.0 to assess the quality risk of bias (RoB) for randomized controlled trials (RCTs),which included six aspects: (1) Random sequence generation, (2) Allocation concealment, (3) Blinding of patients and personnel, (4) Incomplete outcome data, (5) Selective reporting, (6) Other bias. The RoB in each field is divided into “Low risk,” “High risk,” or “Unclear risk.” . If the RoB of the research included in the meta-analysis is different, we will conduct a hierarchical analysis based on the RoB to show readers different results under different RoBs.
2.6 Subgroup analysis
If heterogeneity is detected, a subgroup analysis will be performed to explore differences in methodological quality, age, and AO fracture classification.
2.7 Data synthesis and analysis
The meta-analysis in this review will use RevMan 5.3 and Stata 13.0 software. For the outcome index of two categorical variables, relative risk will be used, and for the outcome index of continuous variables, the average difference or standardized average difference will be used, with a confidence interval of 95%. The heterogeneity test will be used for the included studies, and these studies will be tested by the Higgins I2 test. If there is a low heterogeneity (I2≤25%),a fixed-effect model will be used;otherwise, a random effects model (I2 >25%) will be used[15]. If the I2 value of the combined results is greater than 75%, we will abandon the meta-analysis and only give a general statistical description of the results[15].Further analyze the source of heterogeneity and, if necessary, perform subgroup analysis. There are clinical and methodological differences in experimental research. Therefore, this study will choose the random effects model. Finally, a funnel chart will be drawn to assess the publication bias of the literature. If enough research is included, sensitivity analysis will be performed to test the robustness of the results. We will conduct a sensitivity analysis by exclusion. Studies with high risk of bias and outliers that are numerically far away from the rest of the data.
2.8 Publication deviation
If the results of the meta-analysis include more than 10 articles, we will use a funnel chart to test whether there is publication bias. If the number of articles included in the study is less than 10, the publication bias is not significant.
2.9 Quality of evidence
The quality evidence of the included studies will use the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach, classified evidence as high, moderate, low or very low quality based on considerations of RoB, consistency, directness, precision and publication bias[16].
2.10 Patient and public involvement
Patients and the public were not involved in the design or planning of systematic review protocol.