Wolfe Scott W, Willis Andrew A, Campbell Deidre, Clabeaux Jonathan, Wright Timothy M
Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY, USA.
J Hand Surg Am. 2007 Mar;32(3):356-66. doi: 10.1016/j.jhsa.2006.10.004.
To compare the mechanical behavior of a novel internal tendon repair device with commonly used 2-strand and 4-strand repair techniques for zone II flexor tendon lacerations.
Thirty cadaveric flexor digitorum profundus tendons were randomized to 1 of 3 core sutures: (1) cruciate locked 4-strand technique, (2) modified Kessler 2-strand core suture technique, or (3) Teno Fix multifilament wire tendon repair device. Each repair was tested in the load control setting on a Instron controller coupled to an MTS materials testing machine load frame by using an incremental cyclic linear loading protocol. A differential variable reluctance transducer was used to record displacement across the repair site. Cyclic force (n-cycles) to 1-mm gap and repair failure was recorded using serial digital photography.
There was no significant difference in differential variable reluctance transducer displacement between the cruciate, modified Kessler, and Teno Fix repairs. The cruciate repair had greater resistance to visual 1-mm repair-site gap formation and repair-site failure when compared with the Kessler and Teno Fix repairs. No significant difference was found between the modified Kessler repair and the Teno Fix repair. In all specimens, the epitenon suture failed before the core suture. Repair failure occurred by suture rupture in the 7 cruciate specimens that failed, with evidence of gap formation before failure. Seven of 10 modified Kessler repairs failed by suture rupture. All of the Teno Fix repairs failed by pullout of the metal anchor.
The Teno Fix repair system did not confer a mechanical advantage over the locked cruciate or modified Kessler suture techniques for zone II lacerations in cadaveric flexor tendons during cyclic loading in a linear testing model. This information may help to define safe boundaries for postoperative rehabilitation when using this internal tendon repair device.
比较一种新型内部肌腱修复装置与常用的2股和4股修复技术在Ⅱ区屈指肌腱裂伤修复中的力学行为。
将30条尸体指深屈肌腱随机分为3种核心缝合方法之一：（1）十字锁定4股技术，（2）改良凯斯勒2股核心缝合技术，或（3）Teno Fix多丝金属丝肌腱修复装置。每种修复方法在与MTS材料试验机加载框架相连的Instron控制器上采用增量循环线性加载方案进行负载控制设置测试。使用差动可变磁阻传感器记录修复部位的位移。通过连续数码摄影记录达到1毫米间隙和修复失败的循环力（n次循环）。
十字缝合、改良凯斯勒缝合和Teno Fix修复之间的差动可变磁阻传感器位移无显著差异。与凯斯勒缝合和Teno Fix修复相比，十字缝合对肉眼可见的1毫米修复部位间隙形成和修复部位失败具有更大的抵抗力。改良凯斯勒修复与Teno Fix修复之间未发现显著差异。在所有标本中，腱周缝合在核心缝合之前失败。7条十字缝合标本因缝合线断裂而修复失败，失败前有间隙形成的证据。10条改良凯斯勒修复中有7条因缝合线断裂而失败。所有Teno Fix修复均因金属锚钉拔出而失败。
在尸体屈指肌腱Ⅱ区裂伤的线性测试模型中，在循环加载过程中，Teno Fix修复系统在力学方面并不优于锁定十字缝合或改良凯斯勒缝合技术。这些信息可能有助于确定使用这种内部肌腱修复装置时术后康复的安全界限。
