University Hospitals Case Medical Center, Case Comprehensive Hernia Center, Cleveland, OH.
University Hospitals Case Medical Center, Case Comprehensive Hernia Center, Cleveland, OH.
Surgery. 2014 Jul;156(1):176-82. doi: 10.1016/j.surg.2014.04.010.
One of the goals of modern ventral hernia repair (VHR) is restoring the linea alba by returning the rectus muscles to the midline. Although this practice presumably restores native abdominal wall function, improvement of abdominal wall function has never been measured in a scientific fashion. We hypothesized that a dynamometer could be used to demonstrate an improvement in rectus muscle function after open VHR with restoration of the midline, and that this improvement would be associated with a better quality-of-life.
Thirteen patients agreed to dynamometric analysis before and 6 months after an open posterior component separation (Rives-Stoppa technique complimented with a transversus abdominis muscle release) and mesh sublay. Analysis done using a dynamometer (Biodex 3, Corp, Shirley, NY) included measurement of peak torque (PT; N*m) and PT per bodyweight (BW; %) generated during abdominal flexion in 5 settings: Isokinetic analysis at 45°/s and 60°/s as well as isometric analysis at 0°, -15°, and +15°. Power (W) was calculated during isokinetic settings. Quality-of-life was measured using our validated HerQles survey at the time of each dynamometric analysis.
Thirteen patients (mean age, 54 ± 9 years; mean body mass index, 31 ± 7 kg/m(2)) underwent repair with restoration of the midline using the aforementioned technique. Mean hernia width was 12.5 cm (range, 5-19). Improvements in PT and PT/BW were significant in all 5 settings (P < .05). Improvement in power during isokinetic analyses at 45°/s and 60°/s was also significant (P < .05). All patients reported an improvement in quality-of-life, which was associated positively with each dynamometric parameter.
Restoration of the linea alba during VHR is associated with improved abdominal wall functionality. Analysis of rectus muscle function using a dynamometer showed statistical improvement by isokinetic and isometric measurements, all of which were associated with an improvement in quality-of-life.
现代腹疝修复（VHR）的目标之一是通过将腹直肌返回到中线来恢复白线。尽管这种做法推测可以恢复腹部自然的壁功能，但从未以科学的方式测量腹壁功能的改善。我们假设可以使用测力计来证明在开放 VHR 后中线恢复时腹直肌功能的改善，并且这种改善与生活质量的提高相关。
13 名患者同意在开放后腹部分离（Rives-Stoppa 技术辅以腹横肌释放）和网片下放置后 6 个月进行测力计分析。使用测力计（Biodex 3，Corp，Shirley，NY）进行分析，包括在 5 种设置下进行腹部弯曲时的峰值扭矩（PT；N*m）和 PT 与体重（BW；%）的测量：45°/s 和 60°/s 的等速分析以及 0°、-15°和+15°的等长分析。在等速设置期间计算功率（W）。在每次测力计分析时使用我们经过验证的 HerQles 调查来测量生活质量。
13 名患者（平均年龄，54 ± 9 岁；平均体重指数，31 ± 7 kg/m²）接受了上述技术修复，并恢复了中线。平均疝宽为 12.5 cm（范围，5-19）。在所有 5 种设置中，PT 和 PT/BW 均显著提高（P <.05）。在 45°/s 和 60°/s 的等速分析中功率的提高也很显著（P <.05）。所有患者均报告生活质量得到改善，且与每个测力计参数呈正相关。
在 VHR 期间恢复白线与腹壁功能的改善相关。使用测力计分析腹直肌功能显示出等速和等长测量的统计学改善，所有这些都与生活质量的改善相关。
