三种屈肌腱缝合方法的生物力学研究

摘要
图/表
参考文献
相关文章 (0)

全文: PDF (528 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的比较三种不同屈肌腱缝合方法的生物力学性能及操作时间，寻找一种不仅具有良好生物力学性能而且有利于临床推广的屈肌腱缝合方式。方法选取猪后足屈趾深肌腱作为实验对象，共24个，随机分为3组。横行切断肌腱后，分别采用改良kessler缝合、内锁缝合、半结锁定式缝合三种不同缝合方式并结合连续周边缝合将肌腱断端进行缝合，记录操作时间，并对修复肌腱进行生物力学测试，测定修复肌腱的2 mm裂隙抗张强度、断裂抗张强度和断裂间隙。结果与改良kessler缝合相比，内锁缝合与半结锁定式缝合均能显著提高修复肌腱的2 mm裂隙抗张强度和断裂抗张强度。内锁缝合的2 mm裂隙抗张强度(58.8±8.1)N与半结锁定式缝合(53.7±6.0)N没有明显差异，而断裂抗张强度(72.7±6.0)N明显大于半结锁定式缝合(60.4±6.6)N。内锁缝合与改良kessler缝合的断裂间隙无明显差异，两者均小于半结锁定式缝合(8.5±1.3)mm。与改良kessler缝合(11.1±1.4)min相比，内锁缝合(15.4±1.1)min与半结锁定式缝合(15.8±0.9)min的操作时间均较长，而两者之间无明显差异。结论与改良kessler缝合和半结锁定式缝合相比，内锁缝合具有更好的生物力学性能并有效阻止间隙形成，更值得临床应用推广。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章

关键词 ：改良kessler缝合, 内锁缝合, 半结锁定式缝合, 屈肌腱缝合, 生物力学分析

Abstract：Objective To perform biomechanical analysis of three flexor tendon suture techniques.Methods A total of 24 porcine flexor digitorum profundus tendons were harvested and randomly divided into 3 groups.The tendons were transversely cut and then repaired using 3 different techniques including Modified Kessler suture，Interlock Stitch Tendon suture and Semi Kessler-Loop lock suture.All of them were combined with running suture.The time required for suturing was recorded and compared among the groups.The 2 mm gap load，the ultimate failure load and the gap at failure were compared.Results Results showed that，in comparison with Modified Kessler suture，Interlock Stitch Tendon suture and Semi Kessler-Loop lock suture could significantly improve the 2 mm gap load and the ultimate failure load of tendon repair.The 2 mm gap load was not significantly different between Interlock Stitch Tendon suture(58.8±8.1)N and Semi Kessler-Loop lock suture(53.7±6.0)N.The ultimate failure load of Interlock Stitch Tendon suture(72.7±6.0)N was greater than Semi Kessler-Loop lock suture(60.4±6.6)N，while Modified Kessler suture(46.5±4.5)N was the lowest.The gap at failure was the largest in Semi Kessler-Loop lock suture(8.5±1.3)mm.The time spent in performing Modified Kessler suture(11.1±1.4)min was shorter than in performing Interlock Stitch Tendon suture(15.4±1.1)min and Semi Kessler-Loop lock suture (15.8±0.9)min.Conclusion In comparison with Modified Kessler suture and Semi Kessler-Loop lock suture，Interlock Stitch Tendon suture can remarkably improve the biomechanical properties of tendon repair and effectively prevent gap formation，which could be useful in clinical applications.

Key words： modified kessler suture interlock stitch tendon suture semi kessler-loop lock suture flexor tendon suture biomechanical study

基金资助:国家自然科学基金面上项目(81271394)
大连市科技计划项目(2015E21SF008)

通讯作者: 张铁慧

作者简介: 杨文峰(1981－ )，男，主治医师，大连市中心医院手足外一科，116033。

引用本文:

杨文峰 1，任远飞 1，梁武 1，许卫兵 2，张铁慧 1. 三种屈肌腱缝合方法的生物力学研究[J]. 实用骨科杂志, 2017, 23(1): 32-35.
Yang Wenfeng，Ren Yuanfei，Liang Wu，et al. Biomechanical Analysis of Three Flexor Tendon Suture Techniques. sygkzz, 2017, 23(1): 32-35.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2017/V23/I1/32

［1］Gelberman RH，Amiel D，Gonsalves M，et al.The influence of protected passive mobilization on the healing of flexor tendons：a biochemical and microangiographic study［J］.Hand，1989，13(2)：120-128.
［2］Rohit Singh，Rymer Peter，Theobald Peter，et al.A review of current concepts in flexor tendon repair：physiology，biomechanics，surgical technique and rehabilitation［J］.Orthop Rev(Pavia)，2015，7(4)：6125.
［3］Lawrence TM，Davis TR.A biomechanical analysis of suture materials and their influence on a four-strand flexor tendon repair［J］.J Hand Surg Am，2005，30(4)：836-841.
［4］Lee H.Double loop locking suture：a technique of tendon repair for early active mobilization.Part I：Evolution of technique and experimental study［J］.J Hand Surg (Am)，1990，15(6)：945-952.
［5］Robertson GA，Al-Quattan MM.A biomechanical analysis of a new interlock suture technique for flexor tendon repair［J］.J Hand Surg(Br)，1992，17(1)：92-93.
［6］Ramon Tahmassebi ，Tim S.Peltz，Roger Haddad ，et al.The interlocking modification of the cross locked cruciate tendon repair (Modified adelaide Repair)：A static and dynamic biomechanical assessment［J］.J Hand Microsurg，2015，7(1)：6-12.
［7］Peltz T，Haddad R，Scougall PJ，et al.Influence of locking stitch size in a four-strand cross-locked cruciate flexor tendon repair［J］.J Hand Surg (Am)，2011，36(3)：450-455.
［8］刘清和，张岑山，张凯.半结锁定式肌腱缝合法(SKLS)及其实验研究［J］.骨与关节损伤杂志，2003，18(10)：692-694.
［9］林加豪，邱海胜，吴建伟，等.一种新型肌腱缝合方法的生物力学研究［J］.浙江创伤外科，2015，20(4)：653-655.
［10］Dwyer CL，Dominy DD，Cooney TE，et al.Biomechanical comparison of double grasping repair versus cross-locked cruciate flexor tendon repair［J］.Hand，2015，10(1)：16-22.
［11］Wada A，Kubota H，Hatanaka H，et al.The mechanical properties of locking and grasping suture loop configurations in four-strand core suture techniques［J］.J Hand Surg(Br)，2000，25(6)：548-551.
［12］Hatanaka H，Manske PR.Effect of suture size on locking and grasping flexor tendon repair techniques［J］.Clin Orthop Relat Res，2000(375)：267-274.
［13］Christian Renner，Fernando Corella，Nicole Fischer.Biomechanical evaluation of 4-strand flexor tendon repairs，including a combined kessler-tsuge approach［J］.J Hand Surg(Am)，2015，40(2)：229-235.
［14］GanAW，Neo PY，HeM，et al.A biomechanical comparison of 3 loop suture materials in a 6-strand flexor tendon repair technique［J］.J Hand Surg(Am)，2012，37(9)：1830-1834.
［15］Griffin M1，Hindocha S，Jordan D，et al.An overview of the management of flexor tendon injuries［J］.Open Orthop J，2012(6)：28-35.
［16］Lister GD，Kleinert HE，Kutz JE，et al.Primary flexor tendon repair followed by immediate controlled mobilization［J］.J Hand Surg，1977，2(6)：441-451.
［17］Nelson GN，Potter R，Ntouvali E，et al.Intrasynovial flexor tendon repair：a biomechanical study of variations in suture application in human cadavera［J］.J Orthop Res，2012，30(10)：1652-1659.
［18］Lotz JC，Hariharan JS，Diao E.Analytic model to predict the strength of tendon repairs［J］.J Orthop Res，1998，16(4)：399-405.