Renner Christian, Corella Fernando, Fischer Nicole
Department of Distal Extremities and Product Engineering, Arthrex GmbH, Munich, Germany; Hand Surgery Unit, Department of Orthopedics and Traumatology, Infanta Leonor University Hospital, Madrid, Spain; Department of Hand Surgery, Beata María Ana Hospital, Madrid, Spain.
Department of Distal Extremities and Product Engineering, Arthrex GmbH, Munich, Germany; Hand Surgery Unit, Department of Orthopedics and Traumatology, Infanta Leonor University Hospital, Madrid, Spain; Department of Hand Surgery, Beata María Ana Hospital, Madrid, Spain.
J Hand Surg Am. 2015 Feb;40(2):229-35. doi: 10.1016/j.jhsa.2014.10.055.
To test the ultimate tensile strength and stiffness of 3 flexor tendon repair techniques using looped suture material.
Seventeen fresh porcine flexor tendons were randomized to a single-throw, 4-strand Kessler technique with a looped structure, a double-throw, 4-strand Tsuge technique with 2 looped structures, or a single-throw, 4-strand Kessler-Tsuge technique with a looped structure. Thirty additional fresh porcine flexor tendons were randomized to the same techniques but with a running epitendinous repair. We measured ultimate tensile strength to failure and stiffness and recorded the cause of failure.
The Tsuge technique had the highest mean ultimate tensile strength at 75 N (SD, 14 N) versus 63 N (SD, 13 N) for the Kessler-Tsuge method and 46 N (SD, 11 N) for the Kessler technique. Differences between the Tsuge and Kessler-Tsuge, the Kessler-Tsuge and Kessler, and the Tsuge and Kessler techniques were significant. Mean suture stiffness was 6.8 N/mm for the Tsuge technique, 5.7 N/mm for the Kessler-Tsuge technique, and 4.6 N/mm for the Kessler technique. The difference between the Tsuge and Kessler techniques was significant. Analyzing the tests with or without an epitendinous suture separately did not affect the significance of the differences.
The modified double-throw, 4-strand Tsuge was the strongest suture technique in this study. It may be a clinically acceptable, albeit slightly weaker alternative to the more complicated Tsuge method.
A combined Kessler-Tsuge approach might be an option for flexor tendon repair.
使用环形缝合材料测试三种屈指肌腱修复技术的极限抗拉强度和刚度。
将17条新鲜猪屈指肌腱随机分为采用环形结构的单股四股凯斯勒技术、采用两个环形结构的双股四股津下技术或采用环形结构的单股四股凯斯勒 - 津下技术。另外30条新鲜猪屈指肌腱随机分为相同技术，但采用连续腱周修复。我们测量了直至断裂的极限抗拉强度和刚度，并记录了断裂原因。
津下技术的平均极限抗拉强度最高，为75 N（标准差14 N），凯斯勒 - 津下法为63 N（标准差13 N），凯斯勒技术为46 N（标准差11 N）。津下技术与凯斯勒 - 津下技术、凯斯勒 - 津下技术与凯斯勒技术以及津下技术与凯斯勒技术之间的差异均具有显著性。津下技术的平均缝线刚度为6.8 N/mm，凯斯勒 - 津下技术为5.7 N/mm，凯斯勒技术为4.6 N/mm。津下技术与凯斯勒技术之间的差异具有显著性。分别分析有无腱周缝线的测试结果并不影响差异的显著性。
改良的双股四股津下技术是本研究中最强的缝合技术。它可能是一种临床上可接受的替代方法，尽管比更复杂的津下法稍弱。
联合凯斯勒 - 津下方法可能是屈指肌腱修复的一种选择。
