Deeken Corey R, Thompson Dominic M, Castile Ryan M, Lake Spencer P
Department of Surgery, Section of Minimally Invasive Surgery, Washington University in St. Louis, St. Louis, MO, USA.
Department of Mechanical Engineering & Materials Science, Washington University in St. Louis, St. Louis, MO, USA.
J Mech Behav Biomed Mater. 2014 Oct;38:6-16. doi: 10.1016/j.jmbbm.2014.06.001. Epub 2014 Jun 14.
BACKGROUND: Over the past 60 years, the soft tissue repair market has grown to include over 50 types of hernia repair materials. Surgeons typically implant these materials in the orientation that provides maximum overlap of the mesh over the defect, with little regard for mechanical properties of the mesh material. If the characteristics of the meshes were better understood, an appropriate material could be identified for each patient, and meshes could be placed to optimize integration with neighboring tissue and avoid the mechanical mis-match that can lead to impaired graft fixation. The purpose of this study was to fully characterize and compare the mechanical properties of thirteen types of hernia repair materials via planar biaxial tensile testing. METHODS: Equibiaxial (i.e., equal simultaneous loading in both directions) and strip biaxial (i.e., loading in one direction with the other direction held fixed) tests were utilized as physiologically relevant loading regimes. After applying a 0.1N pre-load on each arm, samples were subjected to equibiaxial cyclic loading using a triangular waveform to 2.5mm displacement on each arm at 0.1Hz for 10 cycles. Samples were then subjected to two strip biaxial tests (using the same cyclic loading protocol), where extension was applied along a single axis with the other axis held fixed. RESULTS: The thirteen evaluated mesh types exhibited a wide range of mechanical properties. Some were nearly isotropic (C-QUR™, DUALMESH(®), PHYSIOMESH™, and PROCEED(®)), while others were highly anisotropic (Ventralight™ ST, Bard™ Mesh, and Bard™ Soft Mesh). Some displayed nearly linear behavior (Bard™ Mesh), while others were non-linear with a long toe region followed by a sharp rise in tension (INFINIT(®)). These materials are currently utilized in clinical settings as if they are uniform and interchangeable, and clearly this is not the case. The mechanical properties most advantageous for successful hernia repairs are currently only vaguely described in the clinical literature. The characteristics of the human abdominal wall must be extensively characterized to provide a thorough understanding of the tissue being reinforced/replaced by these meshes. A better understanding of these mechanical differences would enable matching of patient characteristics to a specific mesh with the properties best suited to that particular repair.
背景:在过去60年里,软组织修复市场不断发展,疝修补材料已超过50种。外科医生通常以能使补片在缺损处实现最大程度重叠的方向植入这些材料,而很少考虑补片材料的机械性能。如果能更好地了解补片的特性,就能为每位患者确定合适的材料,并以优化与邻近组织整合的方式放置补片,避免可能导致移植物固定受损的机械不匹配。本研究的目的是通过平面双轴拉伸试验全面表征和比较13种疝修补材料的机械性能。 方法:采用等双轴(即两个方向同时施加相等载荷)和条带双轴(即一个方向加载而另一个方向保持固定)试验作为生理相关的加载方式。在每条臂上施加0.1N的预载荷后,使用三角波形对样品进行等双轴循环加载,每条臂在0.1Hz频率下位移至2.5mm,共进行10个循环。然后对样品进行两次条带双轴试验(使用相同的循环加载方案),其中沿单轴施加拉伸,另一轴保持固定。 结果:所评估的13种补片类型表现出广泛的机械性能。有些几乎是各向同性的(C-QUR™、DUALMESH(®)、PHYSIOMESH™和PROCEED(®)),而其他的则是高度各向异性的(Ventralight™ ST、Bard™ Mesh和Bard™ Soft Mesh)。有些表现出近乎线性的行为(Bard™ Mesh),而其他的则是非线性的,有一个长的趾部区域,随后张力急剧上升(INFINIT(®))。这些材料目前在临床环境中被当作是统一且可互换的来使用,但显然并非如此。临床文献中目前对成功进行疝修补最有利的机械性能只是模糊地有所描述。必须广泛表征人腹壁的特性,以便透彻了解这些补片所增强/替代的组织。更好地理解这些机械差异将能够使患者特征与具有最适合特定修补的性能的特定补片相匹配。
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