Jordan Martin C, Schmitt Vanessa, Jansen Hendrik, Meffert Rainer H, Hoelscher-Doht Stefanie
Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital, Wuerzburg, Germany.
Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital, Wuerzburg, Germany.
J Hand Surg Am. 2015 Sep;40(9):1812-7. doi: 10.1016/j.jhsa.2015.05.032. Epub 2015 Jul 23.
To compare the biomechanical properties of the modified Kessler, Lahey, Adelaide, and Becker repairs, which are marked by either a locking-loop or a cross-lock configuration.
Ninety-six lacerated porcine flexor tendons were repaired using the respective core suture and an epitendinous repair. Biomechanical testing was conducted under static and cyclic loads. Parameters of interest were 2-mm gap formation force, displacement during different loads, stiffness, maximum force, and mode of failure.
The meaningful gap formation occurred in all 4 repairs at similar tension loads without any significant differences. Maximum force was highest in the Becker repair with a considerable difference compared with the modified Kessler and Lahey sutures. The Adelaide repair showed the highest stiffness. Overall, the displacement during cyclic loading demonstrated similar results with an exception between the Lahey and the Adelaide repairs at 10 N load. Failure by suture pull-out occurred in 42% in the modified Kessler, in 38% in the Lahey, and in 4% in the Adelaide repairs. The Becker repair failed only by suture rupture.
The results of our study suggest that the difference between the 4-strand repairs with a cross-lock or a locking-loop configuration is minor in regard to gap formation. A strong epitendinous suture and the application of core suture pretension might prevent differences in gapping. However, the modified Kessler and Lahey repairs had an inferior maximum tensile strength and were prone to early failure caused by the narrow locking loops with their limited locking power.
We suggest that surgeons should use pre-tension in repaired tendons to improve gap resistance and should avoid narrow locking loop anchoring to the tendon.
比较改良凯斯勒（Kessler）、拉伊（Lahey）、阿德莱德（Adelaide）和贝克尔（Becker）修复术的生物力学特性，这些修复术以锁环或交叉锁构型为特征。
使用各自的核心缝线和腱周修复术对96条猪屈肌腱撕裂伤进行修复。在静态和循环载荷下进行生物力学测试。感兴趣的参数包括2毫米间隙形成力、不同载荷下的位移、刚度、最大力和失效模式。
在所有4种修复术中，在相似的张力载荷下均出现了有意义的间隙形成，且无显著差异。贝克尔修复术的最大力最高，与改良凯斯勒和拉伊缝线相比有显著差异。阿德莱德修复术表现出最高的刚度。总体而言，循环加载期间的位移显示出相似的结果，但在10 N载荷下，拉伊和阿德莱德修复术之间存在例外情况。改良凯斯勒修复术中42%发生缝线拔出失败，拉伊修复术中38%发生缝线拔出失败，阿德莱德修复术中4%发生缝线拔出失败。贝克尔修复术仅因缝线断裂而失败。
我们的研究结果表明，交叉锁或锁环构型的4股修复术在间隙形成方面差异较小。强大的腱周缝线和核心缝线预张力的应用可能会防止间隙差异。然而，改良凯斯勒和拉伊修复术的最大拉伸强度较低，且由于锁环狭窄、锁定力有限，容易早期失效。
我们建议外科医生在修复肌腱时应使用预张力以提高抗间隙能力，并应避免将狭窄的锁环锚固到肌腱上。
