Gulihar Abhinav, Whitehead-Clarke Thomas, Hajipour Ladan, Dias Joe J
* Department of Orthopaedic Surgery, Leicester General Hospital, Leicester, LE5 4PW, UK.
† Department of Orthopaedic Surgery, Darent Valley Hospital, Dartford, DA2 8DA, UK.
J Hand Surg Asian Pac Vol. 2017 Mar;22(1):18-22. doi: 10.1142/S0218810417500034.
Surgical repair is advocated for flexor tendon lacerations deeper than 70%. Repair can be undertaken with different suturing techniques and using different materials. Different materials used for tendon repair will have a different gliding resistance (GR) at the joint. Previous studies have compared strength of repair and gliding resistance for various braided suture materials and for 100% laceration of flexor tendons. We directly compare the GR of two monofilament sutures when used for a peripheral running suture repair of partially lacerated tendons.
Sixteen flexor tendons and A2 pulleys were harvested from Turkey feet. They were prepared, partially lacerated to 50% depth, and then repaired with a core suture (modified Kessler technique with 4-0 Ethibond) as well as an additional superficial running suture of either 6-0 Prolene or Nylon (half randomised to each). Gliding resistance was measured for all tendons before and after repair, at different flexion angles (40 and 60 degrees) and for different loads (2N and 4N).
After surgical repair, gliding resistance was increased for all tendons (P < 0.01). The tendons repaired with Prolene had a higher mean gliding resistance than those repaired with Nylon (P = 0.02). Increased flexion angle and load amplified the gliding resistance (both P < 0.01).
6-0 Nylon was associated with a lower gliding resistance than 6-0 Prolene but the minor differences bare unknown clinical significance.
对于深度超过70%的屈指肌腱撕裂伤，主张进行手术修复。修复可采用不同的缝合技术并使用不同的材料。用于肌腱修复的不同材料在关节处会有不同的滑动阻力（GR）。先前的研究比较了各种编织缝线材料用于屈指肌腱100%撕裂伤时的修复强度和滑动阻力。我们直接比较了两种单丝缝线用于部分撕裂肌腱的周边连续缝合修复时的滑动阻力。
从火鸡足部获取16条屈指肌腱和A2滑车。对其进行处理，部分撕裂至50%深度，然后用一根核心缝线（采用4-0爱惜邦缝线的改良Kessler技术）以及一根额外的6-0普理灵或尼龙浅表连续缝线进行修复（每种随机分配一半）。在修复前后，于不同的屈曲角度（40度和60度）以及不同的负荷（2N和4N）下测量所有肌腱的滑动阻力。
手术修复后，所有肌腱的滑动阻力均增加（P<0.01）。用普理灵修复的肌腱平均滑动阻力高于用尼龙修复的肌腱（P = 0.02）。屈曲角度和负荷增加会放大滑动阻力（两者P<0.01）。
6-0尼龙的滑动阻力低于6-0普理灵，但这种微小差异的临床意义尚不清楚。
