Van Dyke Rufus O, Chaudhary Sejul A, Gould Gregory, Trimba Roman, Laughlin Richard T
Department of Orthopaedic Surgery, Wright State University, Dayton, Ohio, USA.
Northeast Ohio Medical University, Rootstown, Ohio, USA.
Orthop J Sports Med. 2017 May 30;5(5):2325967117707477. doi: 10.1177/2325967117707477. eCollection 2017 May.
Acute midsubstance Achilles tendon ruptures are a common orthopaedic problem for which the optimal repair technique and suture type remain controversial. Head-to-head comparisons of current fixation constructs are needed to establish which stitch/suture combination is most biomechanically favorable.
Of the tested fixation constructs, Giftbox repairs with Fiberwire will exhibit superior stiffness and strength during biomechanical testing.
Controlled laboratory study.
Two biomechanical trials were performed, isolating stitch technique and suture type, respectively. In trial 1, 12 transected fresh-frozen cadaveric Achilles tendon pairs were randomized to receive either the Giftbox-modified Krackow or the Bunnell stitch with No. 2 Fiberwire suture. Each repair underwent cyclic loading, oscillating between 10 and 100 N at 2 Hz for 1000 cycles, with repair gapping measured at 500 and 1000 cycles. Load-to-failure testing was then performed, and clinical and catastrophic failure values were recorded. In trial 2, 10 additional paired cadaveric Achilles tendons were randomized to receive a Giftbox repair with either No. 2 Fiberwire or No. 2 Ultrabraid. Testing and data collections protocols in trial 2 replicated those used in trial 1.
In trial 1, the Bunnell group had 2 failures during cyclic loading while the Giftbox had no failures. The mean tendon gapping after cyclic loading was significantly lower in the Giftbox repairs (0.13 vs 2.29 mm, = .02). Giftbox repairs were significantly stiffer than Bunnell (47.5 vs 38.7 N/mm, = .019) and showed more tendon elongation (5.9 ± 0.8 vs 4.5 ± 1.0 mm, = .012) after 1000 cycles. Mean clinical load to failure was significantly higher for Giftbox repairs (373 vs 285 N, = .02), while no significant difference in catastrophic load to failure was observed (mean, 379 vs 336 N; = .61). In trial 2, there were no failures during cyclic loading. The Giftbox + Fiberwire repairs recorded higher clinical load-to-failure values compared with Giftbox + Ultrabraid (mean, 361 vs 239 N; = .005). No other biomechanical differences were observed in trial 2.
Simulated early rehabilitation biomechanical testing showed that Giftbox-modified Krackow Achilles repair technique with Fiberwire suture was stronger and more resistant to gap formation at the repair site than combinations that incorporated the Bunnell stitch or Ultrabraid suture.
A more in-depth understanding of the biomechanical properties of the Giftbox repair will help inform surgical decision making because stronger repairs are less likely to fail during accelerated postoperative rehabilitation.
急性跟腱中段断裂是常见的骨科问题，对于其最佳修复技术和缝合线类型仍存在争议。需要对当前的固定结构进行直接比较，以确定哪种缝线/缝合组合在生物力学上最有利。
在测试的固定结构中，采用 Fiberwire 的 Giftbox 修复在生物力学测试中将表现出更高的刚度和强度。
对照实验室研究。
进行了两项生物力学试验，分别分离缝合技术和缝合线类型。在试验 1 中，将 12 对新鲜冷冻的尸体跟腱横断标本随机分为接受 Giftbox 改良 Krackow 缝合或 Bunnell 缝合，并使用 2 号 Fiberwire 缝线。每种修复方法都进行循环加载，在 2Hz 下在 10 至 100N 之间振荡 1000 个循环，在 500 和 1000 个循环时测量修复间隙。然后进行破坏载荷测试，并记录临床和灾难性破坏值。在试验 2 中，另外 10 对尸体跟腱随机接受使用 2 号 Fiberwire 或 2 号 Ultrabraid 的 Giftbox 修复。试验 2 的测试和数据收集方案与试验 1 相同。
在试验 1 中，Bunnell 组在循环加载时有 2 例失败，而 Giftbox 组没有失败。循环加载后 Giftbox 修复的平均肌腱间隙明显更低（0.13 对 2.29mm，P =.02）。Giftbox 修复比 Bunnell 修复明显更硬（47.5 对 38.7N/mm，P =.019），并且在 1000 个循环后显示出更多的肌腱伸长（5.9±0.8 对 4.5±1.0mm，P =.012）。Giftbox 修复的平均临床破坏载荷明显更高（373 对 285N，P =.02），而在灾难性破坏载荷方面未观察到显著差异（平均，379 对 336N；P =.61）。在试验 2 中，循环加载期间没有失败。与 Giftbox + Ultrabraid 相比，Giftbox + Fiberwire 修复记录的临床破坏载荷值更高（平均，361 对 239N；P =.005）。在试验 2 中未观察到其他生物力学差异。
模拟早期康复生物力学测试表明，采用 Fiberwire 缝线的 Giftbox 改良 Krackow 跟腱修复技术比采用 Bunnell 缝合或 Ultrabraid 缝线的组合在修复部位更强，更能抵抗间隙形成。
对 Giftbox 修复的生物力学特性有更深入的了解将有助于指导手术决策，因为更强的修复在加速术后康复期间失败的可能性较小。
