Kim Sae Hoon, Chung Moon Sang, Baek Goo Hyun, Lee Young Ho, Lee Sanglim, Gong Hyun Sik
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
J Hand Surg Am. 2007 Mar;32(3):367-72. doi: 10.1016/j.jhsa.2006.12.007.
We present a loop-tendon suture technique that was designed for easy tension adjustment and early postoperative rehabilitation in tendon transfer or graft surgeries. This study tested the biomechanical strength of the loop-tendon suture by using chicken flexor tendons and we report the preliminary clinical results.
We tested the ultimate strength of the loop-tendon suture against the end-weave suture technique in chicken flexor tendons. Forty flexor digitorum longus tendons of chickens were divided into 2 groups according to the suture technique, loop-tendon suture and end-weave suture groups, and then were subjected to linear loading in a tensile load testing machine. From 2000 to 2002 we performed 27 tendon transfer surgeries clinically, including 4 interpositional tendon grafts in 15 patients, using this technique followed by immediate passive motion exercise after surgery. The mean follow-up time was 20 months.
The ultimate tensile load of chicken flexor tendons was 31 +/- 6 N for the loop-tendon suture group and 23 +/- 8 N for the end-weave suture group, and the difference was statistically significant. Clinically, 6 patients with an extensor indicis proprius to an extensor pollicis longus transfer showed more than good results in the Geldmacher scheme. Three patients with an extensor indicis proprius to a central tendon transfer achieved proximal interphalangeal extension of less than 15 degrees of extension lag. One patient with a flexor digitorum profundus reconstruction obtained total active motion of 210 degrees. The 5 patients with triple transfers for radial nerve palsy showed more than neutral extension of the wrist and metacarpal joint. There were no tendon ruptures.
The loop-tendon suture method has greater strength than the conventional end-weave technique, and can be used for secondary tendon reconstruction surgery with favorable clinical outcomes.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
我们介绍一种环肌腱缝合技术，该技术设计用于肌腱转移或移植手术中轻松调整张力和术后早期康复。本研究通过使用鸡屈肌腱测试了环肌腱缝合的生物力学强度，并报告了初步临床结果。
我们在鸡屈肌腱中测试了环肌腱缝合相对于端-编织缝合技术的极限强度。将40条鸡趾长屈肌腱根据缝合技术分为两组，即环肌腱缝合组和端-编织缝合组，然后在拉伸试验机中进行线性加载。2000年至2002年，我们临床上进行了27例肌腱转移手术，包括15例患者中的4例间置肌腱移植，采用该技术，术后立即进行被动运动锻炼。平均随访时间为20个月。
环肌腱缝合组鸡屈肌腱的极限拉伸负荷为31±6N，端-编织缝合组为23±8N，差异具有统计学意义。临床上，6例示指固有伸肌转移至拇长伸肌的患者在盖尔德马赫方案中显示出良好以上的结果。3例示指固有伸肌转移至中央腱的患者近端指间关节伸展滞后小于15度。1例指深屈肌重建患者获得了210度的总主动活动度。5例因桡神经麻痹进行三联转移的患者腕关节和掌指关节伸展超过中立位。没有肌腱断裂。
环肌腱缝合方法比传统的端-编织技术具有更大的强度，可用于二期肌腱重建手术，临床效果良好。
研究类型/证据水平：治疗性IV级。
