Wieskötter B, Herbort M, Langer M, Raschke M J, Wähnert D
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany.
Institute of Experimental Musculoskeletal Medicine, Westfaelische-Wilhelms-University Muenster, Domagkstraße 3, 58149, Muenster, Germany.
Arch Orthop Trauma Surg. 2018 Jan;138(1):139-145. doi: 10.1007/s00402-017-2836-2. Epub 2017 Nov 13.
Flexor tendon repair consists of circumferential peripheral sutures in combination with core sutures to avoid fraying and reduces the exposure of suture material on tendon surface. The peripheral suture adds up to a tenfold increase of the biomechanical stability compared to the core suture alone. The purpose of our study was to determine the most favourable peripheral repair technique for tendon repair.
Seventy-two porcine flexor tendons underwent standardized tenotomy and repair using one of the following six methods (n = 12): simple-running (SR), simple-locking (SL), Halsted-mattress (HM), lin-locking (LL), Lembert-mattress (LM), and Silfverskiöld cross-stich (SCS) suture technique. The SL- suture was placed 2 mm; the HM, LM, SC, and LL suture were placed 5 mm from the tendon gap. The SR suture was placed 1, 2, and 3 mm from tendon ends; no additional core suture was applied. For cyclic testing (1000 cycles), elongation was calculated; for load to failure construct stiffness, yield load and maximum load were determined.
The mean cyclic elongation for all tested suture techniques was less than 2 mm; there was no significant difference between the groups regarding elongation as well as yield load. The HM, LM, SCS, and LL suture techniques presented significantly higher maximum loads compared to the SR- and SL-sutures. The 3 mm SR showed significantly higher maximum loads compared to the 2 and 1 mm SR.
Beside the distance from tendon gap, the type of linkage of the suture material across and beneath the epitendineum is important for biomechanical stability. Simple-running suture is easy to use, even with a slight increase of the distance from tendon gap significantly increases biomechanical strength. For future repairs of flexor tendon injuries, 3 mm stitch length is highly recommended for simple peripheral suture, while the Halsted-mattress suture unites the most important qualities: biomechanically strong, most part of suture material placed epitendinous, and not too complicated to perform.
屈肌腱修复包括环形外周缝合与核心缝合相结合，以避免磨损并减少缝合材料在肌腱表面的暴露。与单独的核心缝合相比，外周缝合可使生物力学稳定性提高十倍。我们研究的目的是确定最有利于肌腱修复的外周修复技术。
72条猪屈肌腱接受标准化肌腱切断术，并采用以下六种方法之一进行修复（n = 12）：简单连续缝合（SR）、简单锁定缝合（SL）、哈氏褥式缝合（HM）、林氏锁定缝合（LL）、伦伯特褥式缝合（LM）和西尔弗斯基öld十字缝合（SCS）技术。SL缝合线距肌腱断端2 mm；HM、LM、SC和LL缝合线距肌腱间隙5 mm。SR缝合线距肌腱末端1、2和3 mm；未应用额外的核心缝合线。进行循环测试（1000次循环），计算伸长率；测定破坏载荷、结构刚度、屈服载荷和最大载荷。
所有测试缝合技术的平均循环伸长率均小于2 mm；各组在伸长率和屈服载荷方面无显著差异。与SR和SL缝合相比，HM、LM、SCS和LL缝合技术表现出显著更高的最大载荷。3 mm的SR缝合线显示出比2 mm和1 mm SR缝合线显著更高的最大载荷。
除了距肌腱间隙的距离外, 缝合材料在上皮肌腱上下的连接类型对生物力学稳定性很重要。简单连续缝合易于使用，即使距肌腱间隙的距离略有增加也会显著提高生物力学强度。对于未来的屈肌腱损伤修复，强烈推荐3 mm的缝合长度用于简单外周缝合, 而哈氏褥式缝合兼具最重要的特性：生物力学强度高、大部分缝合材料置于上皮肌腱外、操作不太复杂。
