Tomaszewska A, Lubowiecka I, Szymczak C, Smietański M, Meronk B, Kłosowski P, Bury K
Gdańsk University of Technology, Faculty of Civil and Environmental Engineering, Department of Structural Mechanics and Bridge Structures, Narutowicza 11/12, 80-233 Gdańsk, Poland.
Clin Biomech (Bristol). 2013 Aug;28(7):743-51. doi: 10.1016/j.clinbiomech.2013.06.009. Epub 2013 Jul 23.
This paper describes an investigation of biomechanical behaviour of hernia repair, which is focused on the selection of safe linking of certain type of implant with fascia in laparoscopic operation. The strength of various fixations of the implant to the fascia is analysed.
The research is based on experimental observations of operated hernia model behaviour during a dynamic impulse load corresponding to post-operative cough. Fifty seven different types of models of implanted mesh are considered. Five types of implants and five types of connectors are used. Mechanical properties of the implants as well as limit tearing forces of joints are identified in uni-axial tensile tests. Mathematical model of implanted mesh based on finite element method is proposed. The identified mechanical properties of the materials are applied and the model is calibrated using quantities measured during experiments.
The presented results point at trans-abdominal sutures and ProTacks (connectors) and at DynaMesh (implant) as the most reliable materials used in ventral hernia operation, in the tested materials group. Desired properties of implants seem to be: elastic properties similar to the properties of tissues and high local strength, as fixation have a local character. The proposed mathematical model can be applied to simulate real behaviour of an implant with appropriate accuracy and to estimate the number of tacks for the implantation of hernia meshes.
The presented results may help in the deeper understanding of the fascia-mesh system behaviour, and thus may lead to improve the fixation methods.
本文描述了一项关于疝修补生物力学行为的研究，重点在于腹腔镜手术中特定类型植入物与筋膜安全连接方式的选择。分析了植入物与筋膜各种固定方式的强度。
该研究基于对手术疝模型在对应术后咳嗽的动态脉冲载荷作用下行为的实验观察。考虑了57种不同类型的植入网片模型。使用了5种类型的植入物和5种类型的连接件。通过单轴拉伸试验确定植入物的力学性能以及接头的极限撕裂力。提出了基于有限元法的植入网片数学模型。应用所确定的材料力学性能，并使用实验过程中测量的量对模型进行校准。
在测试的材料组中，所呈现的结果表明经腹缝线和ProTacks（连接件）以及DynaMesh（植入物）是腹疝手术中最可靠的材料。植入物的理想特性似乎是：与组织特性相似的弹性特性和较高的局部强度，因为固定具有局部特性。所提出的数学模型可用于以适当的精度模拟植入物的实际行为，并估计疝修补网片植入所需的钉数。
所呈现的结果可能有助于更深入地理解筋膜 - 网片系统的行为，从而可能有助于改进固定方法。
