Bisbinas Ilias, Magnissalis Evangelos, Gigis Ioannis, Beslikas Theodoros, Hatzokos Ippokratis, Christoforidis Ioannis
A' Department in Orthopaedics and Trauma Surgery, 424 Military General Hospital, Thessaloniki, Greece.
Proc Inst Mech Eng H. 2013 May;227(5):560-70. doi: 10.1177/0954411912474781. Epub 2013 Feb 8.
The purpose of this study was to assess load to failure of sutures, suturing techniques, and suture anchors used in rotator cuff surgery in order to explore their weaknesses. Ten types of sutures (absorbable and nonabsorbable), four types of suturing techniques, and eight types of suture anchors (bioabsorbable and metallic) were tested. Material Testing Machine and attached load cell were used to test the biomaterials in ex vivo ovine tissues. The results show that the mean load to failure and stiffness were higher in nonabsorbable sutures. Massive cuff tear and modified Mason-Allen suturing techniques had higher failure strength and stiffness when compared to simple and mattress techniques, but there was no substantial difference between them. Metallic suture anchors had higher failure strength when compared to bioabsorbable ones. Often either in metallic or in bioabsorbable anchors, the eyelet fails first. The failure sequence in ovine tissues is found to be in the following order: simple and mattress suturing techniques, nonabsorbable sutures, massive cuff tear and modified Mason-Allen suturing techniques, bioabsorbable anchors, and metallic anchors. Thus, it is concluded that metallic anchors mounted with modern nonabsorbable sutures will fail last. If we use simple and mattress techniques, the tendon-suture level will fail first, but it will improve substantially using more sophisticated suturing techniques (massive cuff tear or modified Mason-Allen).
本研究的目的是评估肩袖手术中使用的缝线、缝合技术和缝合锚钉的失效负荷，以探究其薄弱环节。测试了10种类型的缝线（可吸收和不可吸收）、4种类型的缝合技术以及8种类型的缝合锚钉（生物可吸收和金属材质）。使用材料试验机及附带的测力传感器对离体羊组织中的生物材料进行测试。结果表明，不可吸收缝线的平均失效负荷和刚度更高。与简单缝合和褥式缝合技术相比，巨大肩袖撕裂和改良梅森-艾伦缝合技术具有更高的断裂强度和刚度，但两者之间没有实质性差异。与生物可吸收缝合锚钉相比，金属缝合锚钉具有更高的断裂强度。无论是金属还是生物可吸收锚钉，通常小孔首先失效。在羊组织中的失效顺序如下：简单缝合和褥式缝合技术、不可吸收缝线、巨大肩袖撕裂和改良梅森-艾伦缝合技术、生物可吸收锚钉以及金属锚钉。因此，得出的结论是，安装有现代不可吸收缝线的金属锚钉最后失效。如果我们使用简单缝合和褥式缝合技术，肌腱-缝线水平将首先失效，但使用更复杂的缝合技术（巨大肩袖撕裂或改良梅森-艾伦）会有显著改善。
