Jiang Jackson, Mat Jais Ita Suzana, Yam Andrew Kean Tuck, McGrouther Duncan Angus, Tay Shian Chao
* Department of Hand Surgery, Singapore General Hospital, Singapore, Singapore.
† Biomechanics Laboratory, Singapore General Hospital, Singapore, Singapore.
J Hand Surg Asian Pac Vol. 2017 Mar;22(1):65-69. doi: 10.1142/S0218810417500113.
Synthetic sutures such as Fiberwire used in flexor tendon repairs have high tensile strength. Proper application allows early mobilisation, decreasing morbidity from repair rupture and adhesions while preserving range of motion. Suture stiffness can cause poorer knot holding, contributing to gapping, peritendinous adhesions or rupture. Previous studies recommended more throws in knots tied on Fiberwire to prevent knot slippage. These larger knots are voluminous and prominent. In tendon repairs they can cause "catching", increase friction and work of flexion. Other studies advocated certain complicated knots as being more secure. We evaluated several knots and their biomechanical properties with the aim of finding a compact knot with less potential for slippage to maximise strength potential of flexor tendon repairs using Fiberwire.
A series of different knots tied on Fiberwire 4-0 sutures were pulled to failure on a mechanical tester. Mean tensile strengths, knot volumes and tensile strength to knot volume ratios were compared.
Tensile strengths and knot volume increased with more throws and loops. Four variations of the square knot (the 4=4=1, 2=2=2=2, 1=1=1=1=1, 2=1=1=1=1 knots) had tensile strengths greater than 35N. The specialised anti-slip knot had highest tensile strength and suture volume but lower strength-to-volume ratio.
The anti-slip knot had highest tensile strength but it also had the highest volume. The greater strength of repair may not translate into improved clinical outcome. The 1=1=1=1=1 knot has superior knot strength-to-volume ratio with good knot strength adequate for early active mobilisation in flexor tendon repairs.
用于屈指肌腱修复的合成缝线，如 Fiberwire，具有较高的抗张强度。正确应用可实现早期活动，降低修复断裂和粘连的发病率，同时保留活动范围。缝线的刚度可能导致结的固定性较差，从而导致间隙形成、腱周粘连或断裂。先前的研究建议在 Fiberwire 上打结时增加打结次数以防止结滑动。这些较大的结体积大且突出。在肌腱修复中，它们可能会导致“卡顿”，增加摩擦力和屈曲功。其他研究主张某些复杂的结更牢固。我们评估了几种结及其生物力学特性，目的是找到一种紧凑且不易滑动的结，以最大限度地发挥使用 Fiberwire 进行屈指肌腱修复的强度潜力。
在机械测试仪上对一系列用 4-0 Fiberwire 缝线打的不同结进行拉伸直至断裂。比较平均抗张强度、结体积和抗张强度与结体积之比。
抗张强度和结体积随着打结次数和环数的增加而增加。方结的四种变体（4=4=1、2=2=2=2、1=1=1=1=1、2=1=1=1=1 结）的抗张强度大于 35N。专门的防滑结具有最高的抗张强度和缝线体积，但强度与体积之比更低。
防滑结具有最高的抗张强度，但它的体积也最大。修复强度的提高可能不会转化为更好的临床结果。1=1=1=1=1 结具有优异的结强度与体积之比，其良好的结强度足以在屈指肌腱修复中进行早期主动活动。
