Latendresse K, Dona E, Scougall P J, Schreuder F B, Puchert Emma, Walsh William R
Orthopaedic Research Laboratories, University of New South Wales, Prince of Wales Hospital, Randwick, New South Wales, Australia.
J Hand Surg Am. 2005 May;30(3):471-8. doi: 10.1016/j.jhsa.2004.10.014.
Little data exist comparing the strength of traditional methods of fixation in a flexor digitorum profundus tendon with the use of a suture anchor. In vitro cyclic testing simulating a passive mobilization protocol was used to compare the repair of a flexor digitorum profundus tendon using a single micro-Mitek anchor (Mitek, Westwood, MA) or a modified Bunnell 2-strand pullout technique using a monofilament or a braided polyester suture.
Twenty-four fresh-frozen cadaveric fingers were divided randomly into 4 repair groups (n = 6 each): a micro-Mitek with a 3-0 braided polyester suture or a 3-0 monofilament suture, or a modified Bunnell technique with a 3-0 braided polyester suture or a 3-0 monofilament suture. After repair the specimens were loaded cyclically from 2 to 15 N at 5 N/s, for a total of 500 cycles. Gap formation at the tendon-bone interface was assessed every 100 cycles. Samples were tested to failure at the completion of 500 cycles.
No specimens failed catastrophically during cyclic testing. A significantly greater gap formed using the monofilament sutures compared with the braided polyester sutures with both repair techniques. Load to failure in the modified Bunnell technique was superior to the micro-Mitek with both suture types. The modified Bunnell technique using a braided polyester suture was superior to the monofilament suture whereas the suture type did not alter the properties of the micro-Mitek repair.
Significant gap formation with the use of a monofilament suture may be of concern. The use of a braided polyester suture when removal of the pullout suture is required as in the Bunnell technique also needs to be considered.
关于屈指深肌腱传统固定方法与使用缝线锚钉固定强度的比较数据较少。采用模拟被动活动方案的体外循环测试，比较使用单个微型Mitek锚钉（Mitek，韦斯特伍德，马萨诸塞州）或使用单丝或编织聚酯缝线的改良Bunnell双股拔出技术修复屈指深肌腱的效果。
将24根新鲜冷冻尸体手指随机分为4个修复组（每组n = 6）：使用3-0编织聚酯缝线或3-0单丝缝线的微型Mitek组，或使用3-0编织聚酯缝线或3-0单丝缝线的改良Bunnell技术组。修复后，标本以5 N/s的速度从2 N循环加载至15 N，共500个循环。每100个循环评估肌腱-骨界面处的间隙形成情况。在500个循环结束时对样本进行破坏测试。
在循环测试期间，没有标本发生灾难性失败。与两种修复技术使用编织聚酯缝线相比，使用单丝缝线形成的间隙明显更大。两种缝线类型下，改良Bunnell技术的破坏载荷均优于微型Mitek。使用编织聚酯缝线的改良Bunnell技术优于单丝缝线，而缝线类型并未改变微型Mitek修复的性能。
使用单丝缝线时形成的明显间隙可能令人担忧。在Bunnell技术中，当需要拆除拔出缝线时，也需要考虑使用编织聚酯缝线。
