Chauhan Aakash, Schimoler Patrick, Miller Mark C, Kharlamov Alexander, Merrell Gregory A, Palmer Bradley A
1 Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA.
2 University of Pittsburgh, PA, USA.
Hand (N Y). 2018 May;13(3):313-318. doi: 10.1177/1558944717701238. Epub 2017 Apr 19.
The aim of the study was to compare biomechanical strength, repair times, and repair values for zone II core flexor tendon repairs.
A total of 75 fresh-frozen human cadaveric flexor tendons were harvested from the index through small finger and randomized into one of 5 repair groups: 4-stranded cross-stitch cruciate (4-0 polyester and 4-0 braided suture), 4-stranded double Pennington (2-0 knotless barbed suture), 4-stranded Pennington (4-0 double-stranded braided suture), and 6-stranded modified Lim-Tsai (4-0 looped braided suture). Repairs were measured in situ and their repair times were measured. Tendons were linearly loaded to failure and multiple biomechanical values were measured. The repair value was calculated based on operating room costs, repair times, and suture costs. Analysis of variance (ANOVA) and Tukey post hoc statistical analysis were used to compare repair data.
The braided cruciate was the strongest repair ( P > .05) but the slowest ( P > .05), and the 4-stranded Pennington using double-stranded suture was the fastest ( P > .05) to perform. The total repair value was the highest for braided cruciate ( P > .05) compared with all other repairs. Barbed suture did not outperform any repairs in any categories.
The braided cruciate was the strongest of the tested flexor tendon repairs. The 2-mm gapping and maximum load to failure for this repair approached similar historical strength of other 6- and 8-stranded repairs. In this study, suture cost was negligible in the overall repair cost and should be not a determining factor in choosing a repair.
本研究的目的是比较Ⅱ区屈指肌腱修复的生物力学强度、修复时间和修复价值。
从示指至小指共采集75条新鲜冷冻的人尸体屈指肌腱，并随机分为5个修复组之一：4股十字缝合法（4-0聚酯线和4-0编织缝线）、4股双彭宁顿缝合法（2-0无结倒刺缝线）、4股彭宁顿缝合法（4-0双链编织缝线）和6股改良林-蔡氏缝合法（4-0环形编织缝线）。在原位测量修复情况并记录修复时间。对肌腱进行线性加载直至断裂，并测量多个生物力学值。根据手术室成本、修复时间和缝线成本计算修复价值。采用方差分析（ANOVA）和Tukey事后统计分析来比较修复数据。
编织十字缝合法是最强的修复方法（P>.05），但也是最慢的（P>.05），而使用双链缝线的4股彭宁顿缝合法操作最快（P>.05）。与所有其他修复方法相比，编织十字缝合法的总修复价值最高（P>.05）。倒刺缝线在任何类别中均未优于其他任何修复方法。
编织十字缝合法是所测试的屈指肌腱修复方法中最强的。该修复方法的2毫米间隙和断裂最大负荷接近其他6股和8股修复方法的类似历史强度。在本研究中，缝线成本在总体修复成本中可忽略不计，不应成为选择修复方法的决定因素。
