Brown Stephen H M, Hentzen Eric R, Kwan Alan, Ward Samuel R, Fridén Jan, Lieber Richard L
Departments of Orthopaedic Surgery and Radiology, University of California, San Diego, San Diego, CA, USA.
J Hand Surg Am. 2010 Apr;35(4):540-5. doi: 10.1016/j.jhsa.2010.01.009. Epub 2010 Mar 11.
The side-to-side (SS) tendon suture technique was designed to function as a repair that permits immediate postoperative activation and mobilization of a transferred muscle. This study was designed to test the strength and stiffness of the SS technique against a variation of the Pulvertaft (PT) repair technique.
Flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) tendons were harvested from 4 fresh cadavers and used as a model system. Seven SS and 6 PT repairs were performed, using the FDS as the donor and the FDP as the recipient tendon. For SS repairs, the FDS was woven through one incision in the FDP and was joined with 4 cross-stitch running sutures down both sides and one double-loop suture at each tendon free end. For PT repairs, the FDS was woven through 3 incisions in the FDP and joined with a double-loop suture at both ends of the overlap and 4 evenly spaced mattress sutures between the ends. Tendon repairs were placed in a tensile testing machine, preconditioned, and tested to failure.
There were no statistically significant differences in cross-sectional area (p = .99) or initial length (p = .93) between SS and PT repairs. Therefore, all comparisons between methods were made using measures of loads and deformations, rather than stresses and strains. All failures occurred in the repair region, rather than at the clamps. However, failure mechanisms were different between the 2 techniques-PT repairs failed by the suture knots either slipping or pulling through the tendon material, followed by the FDS tendon pulling through the FDP tendon; SS repairs failed by shearing of fibers within the FDS. Load at first failure, ultimate load, and repair stiffness were all significantly different between SS and PT techniques; in all cases, the mean value for SS was higher than for PT.
The SS repair using a cross-stitch suture technique was significantly stronger and stiffer than the PT repair using a mattress suture technique. This suggests that using SS repairs could enable patients to load the repair soon after surgery. Ultimately, this should reduce the risk of developing adhesions and result in improved functional outcome and fewer complications in the acute postoperative period. Future work will address the specific mechanisms (eg, suture-throw technique and tendon-weave technique) that underlie the improved strength and stiffness of the SS repair.
设计左右（SS）肌腱缝合技术，使其作为一种修复方法，允许术后立即激活和动员转移的肌肉。本研究旨在测试SS技术相对于普尔弗塔夫特（PT）修复技术变体的强度和刚度。
从4具新鲜尸体上获取指浅屈肌（FDS）和指深屈肌（FDP）肌腱，用作模型系统。使用FDS作为供体肌腱，FDP作为受体肌腱，进行了7例SS修复和6例PT修复。对于SS修复，将FDS穿过FDP上的一个切口，并通过两侧的4根连续十字缝合并在每个肌腱游离端使用一个双环缝合法进行连接。对于PT修复，将FDS穿过FDP上的3个切口，并在重叠部分的两端使用双环缝合法，在两端之间使用4根等距褥式缝合法进行连接。将肌腱修复物置于拉伸试验机中，进行预处理并测试至破坏。
SS修复和PT修复在横截面积（p = 0.99）或初始长度（p = 0.93）上无统计学显著差异。因此，方法之间的所有比较均使用载荷和变形测量值，而非应力和应变。所有破坏均发生在修复区域，而非夹具处。然而，两种技术的破坏机制不同——PT修复因缝线结滑动或从肌腱材料中拉出而失败，随后FDS肌腱从FDP肌腱中拉出；SS修复因FDS内的纤维剪切而失败。首次破坏时的载荷、极限载荷和修复刚度在SS和PT技术之间均有显著差异；在所有情况下，SS的平均值均高于PT。
使用连续十字缝合法的SS修复比使用褥式缝合法的PT修复显著更强且更硬。这表明使用SS修复可使患者在术后不久即可对修复部位施加负荷。最终，这应能降低形成粘连的风险，并在术后急性期改善功能结果并减少并发症。未来的工作将探讨构成SS修复强度和刚度提高基础的具体机制（例如，缝线投掷技术和肌腱编织技术）。
