Morgantown, W.Va.; Durham, N.C.; Philadelphia, Pa. From the Department of Surgery, Section of Plastic Surgery, West Virginia University School of Medicine, the Department of Orthopaedic Surgery, Duke University School of Medicine, and the Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania.
Plast Reconstr Surg. 2011 Oct;128(4):322e-327e. doi: 10.1097/PRS.0b013e3182268c1f.
Flexor tendon repairs using conventional suture require knots that enlarge the cross-sectional area at the repair site. This enlargement increases the force of finger flexion and jeopardizes the integrity of a nascent tendon repair during rehabilitation. The authors hypothesized that a knotless flexor tendon repair using bidirectional barbed suture has similar strength and with reduced cross-sectional area compared with traditional techniques.
Sixty-six fresh porcine flexor digitorum profundus tendons were divided randomly into three groups. Tendons were transected and repaired with one of the following techniques: two-strand Kessler technique, four-strand Savage technique, or four-strand knotless technique. The cross-sectional area of each tendon was calculated at the repair site before and after repair. All tendons underwent mechanical testing to assess the 2-mm-gap formation force and ultimate strength.
The 2-mm-gap formation force and ultimate strength of the Savage and knotless technique groups were not significantly different; however, both were significantly greater than those of the Kessler repair group (p<0.05). The repair-site cross-sectional area of tendons repaired with the knotless technique was significantly smaller than that of tendons repaired with the Kessler or Savage technique (p<0.01). Tendons repaired with the knotless technique also had a significantly smaller change in repair-site cross-sectional area (p<0.01).
The authors demonstrate that knotless flexor tendon repair with barbed suture has equivalent strength and reduced repair-site cross-sectional area compared with traditional techniques. The smaller tendon profile may decrease gliding resistance, thus reducing the risk for postsurgical tendon rupture during rehabilitation.
使用传统缝线进行屈肌腱修复需要打结，这会增加修复部位的横截面积。这种增大增加了手指弯曲的力量，并在康复期间危及新生肌腱修复的完整性。作者假设使用双向带倒刺缝线的无结屈肌腱修复具有与传统技术相似的强度，并且横截面积减小。
将 66 根新鲜猪的屈趾深肌腱随机分为三组。肌腱被横断并用以下技术之一修复：双股 Kessler 技术、四股 Savage 技术或四股无结技术。在修复前后计算每个肌腱在修复部位的横截面积。所有肌腱都进行了机械测试，以评估 2-mm 间隙形成力和极限强度。
Savage 和无结技术组的 2-mm 间隙形成力和极限强度没有显著差异；然而，两者均显著大于 Kessler 修复组（p<0.05）。使用无结技术修复的肌腱的修复部位横截面积明显小于使用 Kessler 或 Savage 技术修复的肌腱（p<0.01）。使用无结技术修复的肌腱的修复部位横截面积变化也明显较小（p<0.01）。
作者证明，与传统技术相比，带倒刺缝线的无结屈肌腱修复具有等效的强度和减小的修复部位横截面积。较小的肌腱轮廓可能会减少滑动阻力，从而降低康复期间术后肌腱断裂的风险。
