Galvez Michael G, Comer Garet C, Chattopadhyay Arhana, Long Chao, Behn Anthony W, Chang James
Stanford University School of Medicine, Stanford, CA; Division of Plastic & Reconstructive Surgery, Stanford University, Stanford, CA; Division of Plastic & Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
Stanford University School of Medicine, Stanford, CA; Division of Plastic & Reconstructive Surgery, Stanford University, Stanford, CA; Division of Plastic & Reconstructive Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Department of Orthopedic Surgery, Stanford University, Stanford, CA.
J Hand Surg Am. 2017 Aug;42(8):662.e1-662.e9. doi: 10.1016/j.jhsa.2017.04.013. Epub 2017 May 11.
The importance of flexor tendon repair with both core and epitendinous suture placement has been well established. The objective of this study was to determine whether suture placement order affects gliding resistance and bunching in flexor digitorum profundus tendons in a human ex vivo model.
The flexor digitorum profundus tendons of the index, middle, ring, and little fingers of paired cadaver forearms were tested intact for excursion and mean gliding resistance in flexion and extension across the A2 pulley. Tendons were subsequently transected and repaired with either an epitendinous-first (n = 12) or a control (n = 12) repair. Gliding resistance of pair-matched tendons were analyzed at cycle 1 and during the steady state of tendon motion. The tendon repair breaking strength was also measured.
The mean steady state gliding resistance was less for the epitendinous-first repair than for the control repair in flexion (0.61 N vs 0.72 N) and significantly less in extension (0.68 N vs 0.85 N). Similar results were seen for cycle 1. None of the repairs demonstrated gap formation; however, control repairs exhibited increased bunching. Load to failure was similar for both groups.
The order of suture placement for flexor tendon repair is important. Epitendinous-first repair significantly decreased mean gliding resistance, allowed for easier placement of core sutures, and resulted in decreased bunching.
Epitendinous-first flexor tendon repairs may contribute to improved clinical outcomes compared with control repairs by decreasing gliding resistance and bunching.
采用核心缝合和腱周缝合进行屈指肌腱修复的重要性已得到充分证实。本研究的目的是在人体离体模型中确定缝合顺序是否会影响指深屈肌腱的滑动阻力和束状聚集。
对成对尸体前臂的示指、中指、环指和小指的指深屈肌腱进行完整测试，以测量其在A2滑车处屈伸时的滑动距离和平均滑动阻力。随后将肌腱切断，分别采用先腱周缝合（n = 12）或对照（n = 12）修复方法进行修复。在第1个周期和肌腱运动的稳定状态下分析配对肌腱的滑动阻力。同时测量肌腱修复的断裂强度。
在屈曲时，先腱周缝合修复的平均稳定状态滑动阻力低于对照修复（0.61 N对0.72 N），在伸展时显著更低（0.68 N对0.85 N）。第1个周期也观察到类似结果。所有修复均未出现间隙形成；然而，对照修复出现了更多的束状聚集。两组的破坏负荷相似。
屈指肌腱修复的缝合顺序很重要。先腱周缝合修复显著降低了平均滑动阻力，便于核心缝合的放置，并减少了束状聚集。
与对照修复相比，先腱周缝合的屈指肌腱修复可能通过降低滑动阻力和束状聚集而有助于改善临床效果。
