Deramo David M, White Kacey L, Parks Brent G, Hinton Richard Y
Department of Orthopaedic Surgery, Union Memorial Hospital, Baltimore, Maryland, USA.
Arthroscopy. 2008 May;24(5):599-603. doi: 10.1016/j.arthro.2007.11.020. Epub 2008 Feb 1.
The purpose of this study was to biomechanically compare the Krackow stitch, an established locking stitch, with a new nonlocking premanufactured stitch for soft-tissue fixation. We evaluated suture construct elongation under loading and load to failure to compare the 2 stitches.
Twenty porcine Achilles tendons were randomly assigned to receive the locking Krackow stitch with No. 2 FiberWire or the nonlocking SpeedWhip stitch with No. 2 FiberLoop (Arthrex, Naples, FL). Each prepared tendon was mounted in a servohydraulic load frame, and the 2 free suture strands were knotted over the bar of the machine. Each tendon was pretensioned to 100 N to simulate the removal of slack, preloaded to 50 N to simulate tension applied clinically with suture tying over the post, and cyclically loaded at 200 mm/min to 200 N for 200 cycles. Total elongation of both suture strands was measured at each stage. Each tendon was loaded to failure.
During preloading, the SpeedWhip group elongated significantly more than the Krackow group (65.6 +/- 22.5 mm v 14.9 +/- 5.9 mm, P < .001). During cyclic loading, the SpeedWhip group also showed significantly higher elongation than the Krackow group (23.5 +/- 8.7 mm v 11 +/- 4.5 mm, P = .02). The load to failure for the Krackow and SpeedWhip groups was not significantly different (376.2 +/- 39.8 N and 337.3 +/- 103.8 N, respectively; P = .65). With load to failure, suture breakage at the knot occurred in every specimen without further pullout of the suture.
The nonlocking stitch applied in a manner consistent with manufacturer guidelines was significantly less secure than the locking Krackow stitch in a porcine Achilles tendon model.
On the basis of these findings, the Krackow stitch remains the preferred method for suture fixation of soft-tissue grafts.
本研究旨在对一种成熟的锁边缝合法——Krackow缝合法，与一种新型的预制成型非锁边缝合法进行软组织固定的生物力学比较。我们评估了加载过程中缝线结构的伸长情况以及断裂负荷，以比较这两种缝线。
将20条猪跟腱随机分组，分别采用2号FiberWire线行Krackow锁边缝合或2号FiberLoop线（Arthrex公司，那不勒斯，佛罗里达州）行SpeedWhip非锁边缝合。将每条制备好的跟腱安装在伺服液压加载框架中，两条游离的缝线在机器横杆上打结。每条跟腱先预加载至100 N以消除松弛，再预加载至50 N以模拟临床缝合打结时施加的张力，然后以200 mm/min的速度循环加载至200 N，持续200个循环。在每个阶段测量两条缝线的总伸长量。每条跟腱加载至断裂。
预加载期间，SpeedWhip组的伸长量显著大于Krackow组（65.6±22.5 mm对14.9±5.9 mm，P <.001）。循环加载期间，SpeedWhip组的伸长量也显著高于Krackow组（23.5±8.7 mm对11±4.5 mm，P =.02）。Krackow组和SpeedWhip组的断裂负荷无显著差异（分别为376.2±39.8 N和337.3±103.8 N；P =.65）。在断裂负荷下，每个标本的结处缝线均发生断裂，且缝线未进一步拔出。
在所建立的猪跟腱模型中，按照制造商指南应用的非锁边缝线的固定牢固程度明显低于锁边Krackow缝线。
基于这些发现，Krackow缝合法仍是软组织移植物缝合固定的首选方法。
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