Barrie K A, Tomak S L, Cholewicki J, Merrell G A, Wolfe S W
Yale University Department of Orthopedics, New Haven, CT.
J Hand Surg Am. 2001 Mar;26(2):340-6. doi: 10.1053/jhsu.2001.22926.
The objectives of this cadaveric study were 2-fold: to determine the effect of different locking configurations on the cyclical fatigue strength of flexor tendon repairs and to assess the differences between each repair when a 3-0 or 4-0 suture is used. One hundred twenty flexor digitorum profundus tendons were cut and repaired using nonlocked, simple locked, and cross-stitch locked variations of 2- and 4-strand flexor tendon repairs. Using an incremental cyclical loading protocol we performed 10 trials of each repair with both 3-0 and 4-0 sutures and analyzed the number of Newton-cycles to failure using a 3-way ANOVA. The use of a 3-0 suture led to a 2- to 3-fold increase in fatigue strength in all repairs tested and the fatigue strength of the 4-strand repairs was significantly greater than the 2-strand repairs. All repairs performed with 4-0 suture failed by suture rupture. Of the 3-0 suture repairs, the three 2-strand repairs and the 4-strand cross-stitch locked repair failed by suture rupture. In contrast, 6 of 10 of the 4-strand simple locked and nonlocked repairs failed by suture pullout. There was no significant difference in fatigue strength between the 2 locked and the nonlocked 2-strand repairs using either 3-0 or 4-0 suture. There also was no significant difference in holding capacity or fatigue strength between the simple locked or nonlocked 4-strand repairs. However, the 4-strand cross-stitch locked repair with a 3-0 suture had significantly improved fatigue strength and holding capacity compared with the other repairs tested. Based on the consistently inferior biomechanical performance of 4-0 suture, we recommend that 3-0 suture be considered for 2- or 4-strand tendon repairs when early active motion is planned. The orientation of the transverse and longitudinal components of simple locked repairs did not significantly influence their holding capacity or fatigue strength. The cross-stitch type of locked repair provides better holding capacity and fatigue strength compared with simple locked or nonlocked 4-stranded flexor tendon repairs.
确定不同锁定构型对屈指肌腱修复的循环疲劳强度的影响，并评估使用3-0或4-0缝线时每种修复之间的差异。120条指深屈肌腱被切断，并使用2股和4股屈肌腱修复的非锁定、简单锁定和十字缝合法锁定变体进行修复。使用递增循环加载方案，我们对每种修复分别用3-0和4-0缝线进行了10次试验，并使用三因素方差分析分析了至失效的牛顿循环数。使用3-0缝线导致所有测试修复的疲劳强度增加2至3倍，并且4股修复的疲劳强度显著高于2股修复。所有用4-0缝线进行的修复均因缝线断裂而失败。在用3-0缝线进行的修复中，三种2股修复和4股十字缝合法锁定修复因缝线断裂而失败。相比之下，4股简单锁定和非锁定修复中有10个中的6个因缝线拔出而失败。使用3-0或4-0缝线时，2股锁定和非锁定修复之间的疲劳强度没有显著差异。简单锁定或非锁定的4股修复之间的握持力或疲劳强度也没有显著差异。然而，与其他测试修复相比，用3-0缝线进行的4股十字缝合法锁定修复具有显著提高的疲劳强度和握持力。基于4-0缝线始终较差的生物力学性能，我们建议在计划早期主动活动时，2股或4股肌腱修复考虑使用3-0缝线。简单锁定修复的横向和纵向组件的方向对其握持力或疲劳强度没有显著影响。与简单锁定或非锁定的4股屈肌腱修复相比，十字缝合法锁定修复具有更好的握持力和疲劳强度。
