Haddad Roger, Scherman Peter, Peltz Tim, Nicklin Sean, Walsh William R
Surgical and Orthopaedic Research Laboratories, University of New South Wales, Prince of Wales Hospital, Sydney, Australia.
J Hand Surg Am. 2010 Apr;35(4):546-51. doi: 10.1016/j.jhsa.2009.12.039. Epub 2010 Mar 2.
The benefit of repairing a 75% partial flexor tendon laceration remains controversial. The purpose of this study was to assess the degree of gap formation with and without repair when the 75% lacerated tendon is subjected to cyclic loading. Repair with only a peripheral suture was compared to that using a core and peripheral repair technique.
Sixteen deep flexor tendons from sheep hind limbs were lacerated to 75% of the tendon diameter. The cut tendons were loaded for 100 cycles from 3 N up to 30 N and then back to 3 N, at a rate of 0.2 Hz. Gap formation was measured at 0 and 100 cycles. Tendons were then randomized into 2 repair groups of 8 each: group 1 was repaired with only a simple, running peripheral suture (6-0 polypropylene monofilament), whereas group 2 was repaired with a modified Kessler core suture (4-0 silicone-coated braided polyester) plus a peripheral suture (6-0 polypropylene monofilament). Repaired tendons were tested for 500 cycles, and the gap was measured at 0, 100, and 500 cycles. After cycling, gap was measured at 100 N load, and the peak loads were determined on static failure testing.
The 75% partially lacerated tendons had >2 mm gap at 100 cycles. This gap was significantly reduced by peripheral or peripheral plus core repairs (p < .001). There was no difference in gap formation between tendons with peripheral repair only and those with both peripheral and core repairs. Gap formation in repaired tendons remained <or=1 mm at 500 cycles. After cycling, neither gap formation at 100 N load or the peak loads on failure testing differed between the 2 repair groups.
There is a large gap when an unrepaired 75% partial laceration is cyclically loaded. This gap is significantly reduced with a peripheral repair whether or not a core suture is used.
修复75%的部分屈肌腱撕裂伤的益处仍存在争议。本研究的目的是评估75%撕裂的肌腱在承受循环载荷时，修复与未修复情况下的间隙形成程度。将仅采用周边缝合的修复方法与采用核心和周边修复技术的方法进行比较。
将16条来自羊后肢的指深屈肌腱撕裂至肌腱直径的75%。将切断的肌腱以0.2Hz的速率从3N加载至30N，然后再回到3N，加载100个循环。在0和100个循环时测量间隙形成情况。然后将肌腱随机分为2个修复组，每组8条：第1组仅用简单的连续周边缝合（6-0聚丙烯单丝）进行修复，而第2组用改良的凯斯勒核心缝合（4-0硅胶涂层编织聚酯）加周边缝合（6-0聚丙烯单丝）进行修复。对修复后的肌腱进行500个循环的测试，并在0、100和500个循环时测量间隙。循环后，在100N载荷下测量间隙，并在静态失效测试中确定峰值载荷。
75%部分撕裂的肌腱在100个循环时间隙>2mm。通过周边缝合或周边加核心缝合，该间隙显著减小（p<0.001）。仅采用周边缝合的肌腱与采用周边和核心缝合的肌腱在间隙形成方面没有差异。修复后的肌腱在500个循环时间隙形成仍≤1mm。循环后，两个修复组在100N载荷下的间隙形成或失效测试中的峰值载荷均无差异。
未修复的75%部分撕裂伤在承受循环载荷时会出现较大间隙。无论是否使用核心缝合，通过周边缝合可显著减小该间隙。
