Engel Jamie L, Gabra Joseph N, Esterle Andrew R, Lanzinger William D, Elias John J
Department of Orthopaedic Surgery, Cleveland Clinic Akron General, Akron, Ohio, United States.
Department of Research, Cleveland Clinic Akron General, Akron, Ohio, United States.
J Hand Microsurg. 2017 Dec;9(3):126-130. doi: 10.1055/s-0037-1606628. Epub 2017 Nov 6.
The current study compares the strength of a previously studied technique for flexor tendon repair with barbed sutures to an experimental approach that aligns all the barbs to oppose distraction. Twelve flexor tendons from cadaveric specimens were mechanically tested following repair of simulated zone II tendon injuries. Two repair techniques utilizing barbed sutures were studied: the Marrero-Amadeo four-core barbed suture approach and the experimental configuration with all barbs on four cores opposing distraction. Maximum applied load at failure, that is, ultimate load, and 2-mm gap force were compared between the two repair techniques, both as raw values and after normalization to cross-sectional area of the intact tendon. Statistical testing was performed using -tests and Mann-Whitney -tests, where appropriate, with a significance level of 0.05. The ultimate loads, raw (58.2 N) and normalized (4.8 N/mm ), were significantly larger for the Marrero-Amadeo repair than the proposed experimental approach (35.6 N and 2.7 N/mm ; < 0.05). No significant differences were identified for 2-mm gap force. The innovation of suturing to align all barbs to oppose distraction does not improve strength of the repaired tendon. The Marrero-Amadeo technique was found to have superior strength for use in traumatic zone II flexor tendon injuries.
本研究将先前研究的使用带倒刺缝线修复屈指肌腱的技术强度与一种使所有倒刺对齐以对抗牵张的实验方法进行了比较。对12条来自尸体标本的屈指肌腱进行模拟Ⅱ区肌腱损伤修复后的力学测试。研究了两种使用带倒刺缝线的修复技术：马雷罗 - 阿马德奥四芯带倒刺缝线法和所有倒刺在四个芯上对抗牵张的实验构型。比较了两种修复技术在失效时的最大施加负荷（即极限负荷）和2毫米间隙力，包括原始值和根据完整肌腱横截面积归一化后的值。在适当情况下，使用t检验和曼 - 惠特尼U检验进行统计分析，显著性水平为0.05。马雷罗 - 阿马德奥修复法的极限负荷，原始值（58.2 N）和归一化值（4.8 N/mm²），显著大于所提出的实验方法（35.6 N和2.7 N/mm²；P < 0.05）。在2毫米间隙力方面未发现显著差异。使所有倒刺对齐以对抗牵张的缝合创新方法并不能提高修复肌腱的强度。发现马雷罗 - 阿马德奥技术在创伤性Ⅱ区屈指肌腱损伤修复中具有更强的强度。
