Moriya Tamami, Zhao Chunfeng, An Kai-Nan, Amadio Peter C
Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN 55905, USA.
J Hand Surg Am. 2010 Apr;35(4):552-8. doi: 10.1016/j.jhsa.2009.12.025. Epub 2010 Feb 26.
To investigate the effects of motion following repair with a modified Kessler core suture and 5 different epitendinous suture designs on the gliding resistance, breaking strength, 2-mm gap force, and stiffness of flexor digitorum profundus tendons in a human in vitro model.
The flexor digitorum profundus tendons of the index, middle, ring, and little fingers of 50 human cadavers were transected and repaired with a 2-strand modified Kessler suture and assigned to 5 groups based on type of epitendinous suture design. The 5 epitendinous designs tested were a simple, running epitendinous suture whose knot was outside the repair (simple running KO); a simple, running epitendinous suture whose knot was inside the repair (simple running KI); a cross-stitch epitendinous suture; an interlocking, horizontal mattress (IHM) epitendinous suture; and a running-locking epitendinous suture. The tendon repair strength and 2-mm gap force were measured after 1,000 cycles of tendon motion. The resistance to gap formation, a measure of repair stiffness, was obtained from the force versus gap data.
None of the repairs showed any gap formation after 1,000 cycles of tendon motion. The cross-stitch epitendinous suture, IHM epitendinous suture, and running-locking epitendinous suture all had significantly lower gliding resistance than the simple running KO epitendinous suture after 1 cycle. The simple running KI epitendinous suture had significantly lower gliding resistance than the simple running KO epitendinous suture after 100 cycles and 1,000 cycles. The differences for gap force at 2 mm and stiffness of the repaired tendon evaluation were not statistically significant. The cross-stitch epitendinous suture, IHM epitendinous suture, and running-locking epitendinous suture all had significantly higher maximal failure strength after 1,000 cycles than the simple running KI epitendinous suture.
The cross-stitch, IHM, and running-locking epitendinous sutures had the best combination of higher strength and lower gliding resistance in this study. Although these findings suggest a potential for these suture types to be preferred as epitendinous sutures, these repairs should first be investigated in vivo to address their effect on tendon healing and adhesion formation.
在人体体外模型中，研究采用改良凯斯勒核心缝合线及5种不同的腱周缝合设计进行修复后，运动对指深屈肌腱滑动阻力、断裂强度、2毫米间隙力和刚度的影响。
将50具人体尸体示指、中指、环指和小指的指深屈肌腱切断，用双股改良凯斯勒缝合线修复，并根据腱周缝合设计类型分为5组。所测试的5种腱周设计分别为：结在修复部位外侧的简单连续腱周缝合线（简单连续KO）；结在修复部位内侧的简单连续腱周缝合线（简单连续KI）；十字交叉腱周缝合线；锁边水平褥式（IHM）腱周缝合线；连续锁边腱周缝合线。在肌腱运动1000个周期后，测量肌腱修复强度和2毫米间隙力。从力与间隙数据中获得对间隙形成的阻力，这是修复刚度的一种度量。
在肌腱运动1000个周期后，所有修复均未显示出任何间隙形成。十字交叉腱周缝合线、IHM腱周缝合线和连续锁边腱周缝合线在1个周期后，其滑动阻力均显著低于简单连续KO腱周缝合线。简单连续KI腱周缝合线在100个周期和1000个周期后，其滑动阻力显著低于简单连续KO腱周缝合线。修复肌腱评估的2毫米间隙力和刚度差异无统计学意义。十字交叉腱周缝合线、IHM腱周缝合线和连续锁边腱周缝合线在1000个周期后的最大破坏强度均显著高于简单连续KI腱周缝合线。
在本研究中，十字交叉、IHM和连续锁边腱周缝合线在强度较高和滑动阻力较低方面具有最佳组合。尽管这些发现表明这些缝合线类型有可能被优先用作腱周缝合线，但这些修复首先应在体内进行研究，以探讨它们对肌腱愈合和粘连形成的影响。
