Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, USA.
Spine (Phila Pa 1976). 2012 Apr 20;37(9):E535-9. doi: 10.1097/BRS.0b013e31824cf756.
Biomechanics.
To compare the hydrostatic strength of suture and nonpenetrating titanium clip repairs of standard spinal durotomies.
Dural tears are a frequent complication of spine surgery and can be associated with significant morbidity. Primary repair of durotomies with suture typically is attempted, but a true watertight closure can be difficult to obtain because of leakage through suture tracts. Nonpenetrating titanium clips have been developed for vascular anastomoses and provide a close apposition of the tissues without the creation of a suture tract.
Twenty-four calf spines were prepared with laminectomies and the spinal cord was evacuated leaving an intact dura. After Foley catheters were inserted from each end and inflated adjacent to a planned dural defect, the basal flow rate was measured and a 1-cm longitudinal durotomy was made with a scalpel. Eight repairs were performed for each material, which included monofilament suture, braided suture, and nonpenetrating titanium clips. The flow rate at 30, 60, and 90 cm of water and the time needed for each closure were measured.
There was no statistically significant difference in the baseline leak rate for all 3 groups. There was no difference in the leakage rate of durotomies repaired with clips and intact specimens at any pressure. Monofilament and braided suture repairs allowed significantly more leakage than both intact and clip-repaired specimens at all pressures. The difference in leak rate increased as the pressure increased. Closing the durotomy with clips took less than half the time of closure with suture.
Nonpenetrating titanium clips provide a durotomy closure with immediate hydrostatic strength similar to intact dura whereas suture repair with either suture was significantly less robust. The use of titanium clips was more rapid than that of suture repair.
生物力学。
比较缝合和非穿透钛夹修复标准脊柱硬脊膜切开术的液压强度。
硬脊膜撕裂是脊柱手术的常见并发症，可能与显著的发病率相关。硬脊膜切开术通常采用缝合进行初步修复，但由于通过缝合道渗漏，很难获得真正的防水闭合。非穿透钛夹已开发用于血管吻合术，并在不形成缝合道的情况下提供组织的紧密贴合。
24 个小牛脊柱进行椎板切除术，脊髓排空后留下完整的硬脊膜。在每个末端插入 Foley 导管并在计划的硬脊膜缺损处相邻充气后，测量基础流量，并使用手术刀制作 1 厘米长的纵向硬脊膜切开术。每种材料进行 8 次修复，包括单丝缝线、编织缝线和非穿透钛夹。测量 30、60 和 90 厘米水位的流量和每个闭合所需的时间。
所有 3 组的基础泄漏率均无统计学差异。在任何压力下，夹闭和完整标本修复的硬脊膜切开术的泄漏率均无差异。单丝缝线和编织缝线修复的硬脊膜切开术在所有压力下的泄漏率均显著高于完整标本和夹闭修复标本。泄漏率的差异随着压力的增加而增加。用夹闭修复硬脊膜切开术所需的时间不到缝线修复的一半。
非穿透钛夹提供的硬脊膜切开术闭合具有类似于完整硬脊膜的即刻液压强度，而使用任何一种缝线的缝线修复均显著不牢固。钛夹的使用比缝线修复更快。
