Division of Surgery, University of Franca, R: Padre Anchieta, 1128, Centro, Franca, SP, 14400-740, Brazil,
Hernia. 2014 Feb;18(1):123-9. doi: 10.1007/s10029-013-1094-7. Epub 2013 May 7.
The purpose of this study is to evaluate the tension at the aponeurotic edges after the undermining of the anterior rectus sheath associated with the classic components separation in cadavers.
Twenty fresh adult cadavers were placed supine and an incision in the anterior rectus sheath was done, thus exposing the posterior sheath. The two levels to be studied were marked 3 cm above and 2 cm below the umbilicus. An analogical dynamometer was used to measure the traction values, consecutively during four stages as follows: initial stage, no aponeurotic undermining; Stage 1, separation of the anterior rectus sheaths; Stage 2, after Stage 1 the external oblique aponeurosis were incised along the semilunaris and the external oblique muscles were undermined; Stage 3, after Stage 2 rectus muscles were completely separated from their posterior sheaths. Statistical analysis was done by Friedman's analysis of variance (p < 0.05).
There was a progressive and significant decrease in tension along the stages (Friedman's analysis of variance, p < 0.001). Traction indexes were higher in the initial stage and became gradually lower along the other stages.
The undermining of the anterior rectus sheaths helps to decrease tension during the components separation technique.
Level V, experimental study.
本研究旨在评估尸体经典腹直肌鞘分离术中前直肌鞘切开后腱膜边缘的张力。
20 具新鲜成人尸体仰卧位，在前直肌鞘做切口，暴露后鞘。标记两个研究水平，分别为脐上 3cm 和 2cm。使用模拟测力计在四个阶段连续测量牵引力值，如下：初始阶段，无腱膜切开；第 1 阶段，分离前直肌鞘；第 2 阶段，第 1 阶段后沿半月线切开外斜肌腱膜并切开外斜肌；第 3 阶段，第 2 阶段后，腹直肌完全与其后鞘分离。采用 Friedman 方差分析进行统计学分析（p < 0.05）。
随着阶段的进展，张力呈逐渐显著下降趋势（Friedman 方差分析，p < 0.001）。初始阶段的牵引指数较高，随着其他阶段的进展逐渐降低。
前直肌鞘的切开有助于降低腹直肌鞘分离技术中的张力。
5 级，实验研究。
