Tamboli Mallika, Hwang James, McGarry Michelle H, Kang Yangmi, Lee Thay Q, Mihata Teruhisa
Orthopaedic Biomechanics Laboratory, VA Healthcare System, Long Beach, CA, USA; University of California, Irvine, CA, USA.
Orthopaedic Biomechanics Laboratory, VA Healthcare System, Long Beach, CA, USA; University of California, Irvine, CA, USA; Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan.
J Orthop Sci. 2014 Mar;19(2):235-241. doi: 10.1007/s00776-013-0504-0. Epub 2013 Dec 12.
We investigated the effects of bite-size horizontal mattress stitch (distance between the limbs passed through the tendon) on the biomechanical properties of the repaired tendon.
We anchored 20 bovine Achilles tendons to bone using no. 2 high-strength suture and 5-mm titanium suture anchors in a mattress-suture technique. Tendons were allocated randomly into two groups of ten each to receive stitches with a 4- or 10-mm bite. Specimens underwent cyclic loading from 5 to 30 N at 1 mm/s for 30 cycles, followed by tensile testing to failure. Gap formation, tendon strain, hysteresis, stiffness, yield load, ultimate load, energy to yield load, and energy to ultimate load were compared between groups using unpaired t tests.
The 4-mm group had less (p < 0.05) gap formation and less (p < 0.05) longitudinal strain than did the 10-mm group. Ultimate load (293.6 vs. 148.9 N) and energy to ultimate load (2,563 vs. 1,472 N-mm) were greater (p < 0.001) for the 10-mm group than the 4-mm group. All tendons repaired with 4-mm suturing failed at the suture-tendon interface, with sutures pulling through the tendon, whereas the suture itself failed before the tendon did in seven of the ten specimens in the 10-mm group.
Whereas a 4-mm bite fixed the tendon more tightly but at the cost of decreased ultimate strength, a 10-mm bite conveyed greater ultimate strength but with increased gap and strain. These results suggest that for the conventional double-row repair, small mattress stitches provide a tighter repair, whereas large stitches are beneficial to prevent sutures from pulling through the tendon after surgery. For suture-bridge rotator cuff repair, large stitches are beneficial because the repaired tendon has a higher strength, and the slightly mobile medial knot can be tightened by lateral fixation.
我们研究了咬边水平褥式缝合（穿过肌腱的缝线肢端之间的距离）对修复肌腱生物力学性能的影响。
我们采用褥式缝合技术，使用2号高强度缝线和5毫米钛质缝线锚钉将20条牛跟腱固定于骨。肌腱被随机分为两组，每组10条，分别接受4毫米或10毫米咬边的缝合。标本以1毫米/秒的速度从5牛循环加载至30牛，共30个循环，随后进行拉伸直至破坏试验。使用非配对t检验比较两组之间的间隙形成、肌腱应变、滞后、刚度、屈服载荷、极限载荷、屈服载荷能量和极限载荷能量。
4毫米组的间隙形成（p < 0.05）和纵向应变（p < 0.05）均少于10毫米组。10毫米组的极限载荷（293.6牛对148.9牛）和极限载荷能量（2563牛·毫米对1472牛·毫米）大于4毫米组（p < 0.001）。所有采用4毫米缝合修复的肌腱均在缝线-肌腱界面处断裂，缝线从肌腱中拉出，而10毫米组的10个标本中有7个标本，缝线在肌腱之前先断裂。
4毫米咬边能更紧密地固定肌腱，但以降低极限强度为代价；10毫米咬边能传递更大的极限强度，但间隙和应变增加。这些结果表明，对于传统的双排修复，小褥式缝合提供更紧密的修复，而大缝合有利于防止术后缝线从肌腱中拉出。对于缝线桥肩袖修复，大缝合是有益的，因为修复后的肌腱强度更高，并且可通过外侧固定收紧稍有活动的内侧结。
