Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA.
J Am Coll Surg. 2011 Jan;212(1):68-79. doi: 10.1016/j.jamcollsurg.2010.09.012. Epub 2010 Nov 5.
For meshes to be used effectively for hernia repair, it is imperative that engineers and surgeons standardize the terminology and techniques related to physicomechanical evaluation of these materials. The objectives of this study were to propose standard techniques, perform physicomechanical testing, and classify materials commonly used for inguinal hernia repair.
Nine meshes were evaluated: 4 polypropylene, 1 polyester, 1 polytetrafluoroethylene, and 3 partially absorbable. Physical properties were determined through image analysis, laser micrometry, and density measurements. Biomechanical properties were determined through suture retention, tear resistance, uniaxial, and ball burst testing with specimens tested in 2 different orientations. A 1-way ANOVA with Tukey's post-test or a t-test were performed, with p < 0.05.
Significant differences were observed due to both mesh type and orientation. Areas of interstices ranged from 0.33 ± 0.01 mm² for ProLite (Atrium Medical Corp) and C-QUR Lite (Atrium Medical Corp) Large to 4.10 ± 0.06 mm² for ULTRAPRO (Ethicon), and filament diameters ranged from 99.00 ±8.1 μm for ProLite Ultra (Atrium Medical Corp) and C-QUR Lite Small to 338.8 ± 3.7 μm for Parietex Flat Sheet TEC (Covidien). These structural characteristics influenced biomechanical properties such as tear resistance and tensile strength. ProLite Ultra, C-QUR Lite Small, ULTRAPRO and INFINIT (WL Gore & Associates) did not resist tearing as effectively as the others. All meshes exhibited supraphysiologic burst strengths except INFINIT and ULTRAPRO.
Significant differences exist between the physicomechanical properties of polypropylene, polyester, polytetrafluoroethylene, and partially absorbable mesh prostheses commonly used for inguinal hernia repair. Orientation of the mesh was also shown to be critical for the success of meshes, particularly those demonstrating anisotropy.
为了使网片能够有效地用于疝修补，工程师和外科医生必须使与这些材料的物理机械评估相关的术语和技术标准化。本研究的目的是提出标准技术，进行物理机械测试，并对常用于腹股沟疝修补的材料进行分类。
评估了 9 种网片：4 种聚丙烯、1 种聚酯、1 种聚四氟乙烯和 3 种部分可吸收。通过图像分析、激光测微术和密度测量来确定物理性能。通过缝线保持力、撕裂阻力、单轴和球爆裂试验来确定生物力学性能，用两种不同取向的试件进行试验。采用单因素方差分析和 Tukey 事后检验或 t 检验，p<0.05。
由于网片类型和取向的不同，观察到显著差异。网孔面积从 ProLite（Atrium Medical Corp）和 C-QUR Lite（Atrium Medical Corp）大网孔的 0.33±0.01mm²到 ULTRAPRO（Ethicon）的 4.10±0.06mm²不等，而纤维直径从 ProLite Ultra（Atrium Medical Corp）和 C-QUR Lite 小网孔的 99.00±8.1μm到 Parietex Flat Sheet TEC（Covidien）的 338.8±3.7μm不等。这些结构特征影响了撕裂阻力和拉伸强度等生物力学性能。ProLite Ultra、C-QUR Lite 小网孔、ULTRAPRO 和 INFINIT（WL Gore & Associates）不如其他网片有效地抵抗撕裂。除了 INFINIT 和 ULTRAPRO 外，所有网片的爆裂强度均高于生理范围。
用于腹股沟疝修补的常用聚丙烯、聚酯、聚四氟乙烯和部分可吸收网片的物理机械性能存在显著差异。网片的取向也被证明对网片的成功至关重要，特别是那些表现出各向异性的网片。
