Washington, D.C.; and Baltimore, Md. From the Department of Plastic Surgery, Georgetown University Hospital, and the Curtis National Hand Center, Union Memorial Hospital.
Plast Reconstr Surg. 2009 Nov;124(5):1551-1558. doi: 10.1097/PRS.0b013e3181babb77.
Using barbed suture for flexor tenorrhaphy could permit knotless repair with tendon-barb adherence along the suture's entire length. The purpose of this study was to evaluate the tensile strength and repair-site profile of a technique of barbed suture tenorrhaphy.
Thirty-eight cadaveric flexor digitorum profundus tendons were randomized to polypropylene barbed suture repair in a knotless three-strand or six-strand configuration, or to unbarbed four-strand cruciate repair. For each repair, the authors recorded the repair site cross-sectional area before and after tenorrhaphy. Tendons were distracted to failure, and data regarding load at failure and mode of failure were recorded.
The mean cross-sectional area ratio of control repairs was 1.5 +/- 0.3, whereas that of three-strand and six-strand barbed repairs was 1.2 +/- 0.2 (p = 0.009) and 1.2 +/- 0.1 (p = 0.005), respectively. Mean load to failure of control repairs was 29 +/- 7 N, whereas that of three-strand and six-strand barbed repairs was 36 +/- 7 N (p = 0.32) and 88 +/- 4 N (p < 0.001), respectively. All cruciate repairs failed by knot rupture or suture pullout, whereas barbed repairs failed by suture breakage in 13 of 14 repairs (p < 0.001).
In an ex vivo model of flexor tenorrhaphy, a three-strand barbed suture technique achieved tensile strength comparable to that of four-strand cruciate repairs and demonstrated significantly less repair-site bunching. A six-strand barbed suture technique demonstrated increased tensile strength compared with four-strand cruciate controls and significantly less repair-site bunching. Barbed suture repair may offer several advantages in flexor tenorrhaphy, and further in vivo testing is warranted.
使用带倒刺的缝线进行屈肌腱吻合可以实现无结修复，并且缝线的整个长度都与肌腱的倒刺附着。本研究的目的是评估一种带倒刺缝线肌腱吻合技术的拉伸强度和修复部位的形态。
将 38 个尸体屈指深肌腱随机分为聚丙烯带倒刺的三股或六股无结缝线修复，或四股十字交叉无倒刺修复。对于每种修复，作者记录肌腱吻合前后修复部位的横截面积。肌腱被拉伸至失效，并记录失效时的负载和失效模式的数据。
对照组修复的平均横截面积比为 1.5 ± 0.3，而三股和六股带倒刺修复的横截面积比分别为 1.2 ± 0.2（p = 0.009）和 1.2 ± 0.1（p = 0.005）。对照组修复的平均失效负载为 29 ± 7 N，而三股和六股带倒刺修复的失效负载分别为 36 ± 7 N（p = 0.32）和 88 ± 4 N（p < 0.001）。所有十字交叉修复均因结破裂或缝线拉出而失效，而带倒刺的修复中有 13 个修复（p < 0.001）因缝线断裂而失效。
在屈肌腱吻合的体外模型中，三股带倒刺缝线技术的拉伸强度可与四股十字交叉修复相媲美，且修复部位的堆积明显减少。六股带倒刺缝线技术与四股十字交叉对照组相比，拉伸强度增加，修复部位的堆积明显减少。带倒刺缝线修复在屈肌腱吻合中可能具有多项优势，需要进一步的体内试验验证。
