Duprat A, Gayet L-E, Breque C, Freslon M
Service d'orthopédie traumatologie, CHU de Poitiers, rue de la Miletrie, BP 577, 86021 Poitiers cedex, France.
Service d'orthopédie traumatologie, CHU de Poitiers, rue de la Miletrie, BP 577, 86021 Poitiers cedex, France.
Hand Surg Rehabil. 2018 Feb;37(1):24-29. doi: 10.1016/j.hansur.2017.11.004. Epub 2017 Dec 13.
Tendon grafts are a component of the therapeutic arsenal for managing chronic flexor tendons injuries in the hand, especially during two-stage Hunter reconstruction. The purpose of this anatomical study was to compare the strength of the Pulvertaft weave versus the step-cut suture used for flexor tendon reconstruction to determine their role in early active mobilization. We performed a biomechanical study with cadaver specimens. Thirty-four hands were randomized and the tendons from both hands were equally assigned to each group. A comparison of the Pulvertaft weave (group 1) versus the step-cut suture (group 2) using the flexor digitorum profundus from the fourth finger and the longus palmaris was carried out. The main variable was the failure load in both repair groups. We also evaluated the cross-sectional area (CSA) and the tensile strength of the repairs. Thirty hands were included in our study. There was no significant difference in the failure load between the two groups (116N for group 1 versus 103N for group 2, P=0.2). The CSA was significantly smaller in the step-cut group compared to Pulvertaft group (19.8mm versus 35mm, P<0.01). The tensile strength was significantly higher in the step-cut group than in the Pulvertaft group (5.3N/mm versus 3.4N/mm, P<0.01). Early active mobilization requires a minimum repair strength of 75N. In our study, the step-cut suture appears strong enough and thin enough to decrease the fibrosis, which would lead to better functional results. No other study of this type has been published. The specimens in which the repair strength was less than 75N all involved a thin, weak longus palmaris. Other biomechanical studies should be done to define the anatomical criteria required for use of the palmaris longus tendon. The step-cut suture seems to be strong enough and thin enough to provide sufficient proximal attachment during flexor tendon reconstruction to allow early active mobilization.
肌腱移植是手部慢性屈肌腱损伤治疗手段的一部分，尤其是在两期亨特重建术中。这项解剖学研究的目的是比较用于屈肌腱重建的普尔弗塔夫编织法与阶梯状缝合的强度，以确定它们在早期主动活动中的作用。我们对尸体标本进行了生物力学研究。34只手被随机分组，每只手的肌腱被平均分配到每组。使用来自第四指的指深屈肌腱和掌长肌腱对普尔弗塔夫编织法（第1组）与阶梯状缝合（第2组）进行了比较。主要变量是两个修复组的破坏载荷。我们还评估了修复处的横截面积（CSA）和拉伸强度。我们的研究纳入了30只手。两组之间的破坏载荷没有显著差异（第1组为116N，第2组为103N，P = 0.2）。与普尔弗塔夫组相比，阶梯状缝合组的CSA显著更小（19.8mm对35mm，P < 0.01）。阶梯状缝合组的拉伸强度显著高于普尔弗塔夫组（5.3N/mm对3.4N/mm，P < 0.01）。早期主动活动需要最低75N的修复强度。在我们的研究中，阶梯状缝合似乎足够坚固且足够细，能够减少纤维化，从而带来更好的功能结果。尚未发表过此类其他研究。修复强度小于75N的标本均涉及纤细、脆弱的掌长肌腱。应该进行其他生物力学研究来确定使用掌长肌腱所需的解剖学标准。阶梯状缝合似乎足够坚固且足够细，能够在屈肌腱重建过程中提供足够的近端附着，以允许早期主动活动。
