Bernstein Derek T, Alexander Jamie J, Petersen Nancy J, Lambert Bradley S, Noble Philip C, Netscher David T
Department of Orthopaedic Surgery, Houston Methodist Hospital, Houston, TX.
Department of Orthopaedic Surgery, Houston, TX.
J Hand Surg Am. 2019 Feb;44(2):156.e1-156.e8. doi: 10.1016/j.jhsa.2018.04.029. Epub 2018 Jun 8.
To evaluate the impact of suture caliber and looped configurations on the integrity of 4-strand modified Kessler zone II flexor tendon repairs during progressive cyclic loading.
Seventy-two flexor digitorum profundus tendons from 18 fresh human cadaver hands were divided into 4 repair groups. Thirty-six matched tendons underwent repair using either a 4-0 looped or 4-0 single-stranded suture, and an additional 36 tendons underwent 3-0 looped or 3-0 single-stranded repairs. Repair strength was tested by progressive cyclic loading. The force generating 2-mm gap formation, ultimate failure, and the mechanism of failure were recorded for each test. The impact of looped versus single-stranded configurations and the effect of tendon cross-sectional area on repair integrity were analyzed for each suture caliber.
There was no statistically significant difference between groups regarding the force to 2-mm gap formation or ultimate failure, and all values exceeded the minimum threshold of 27 N required to withstand an early active range of motion rehabilitation protocol. The use of a 3-0 caliber suture resulted in a significantly higher proportion of repairs failing by suture pullout through the tendon substance, including 63.5% of looped and 38.9% of single-stranded core sutures. By comparison, this occurred in 11.1% of 4-0 looped and 0% of 4-0 single-stranded sutures. Larger tendon cross-sectional areas were associated with more robust repairs, particularly in the 3-0 looped group.
In a human cadaver flexor tendon repair model, there was no significant difference in the mean force to failure between all 4 flexor tendon repair constructs under progressive cyclic loading. However, the 3-0 caliber suture failed more frequently by suture pullout, particularly with the use of a looped suture.
Four-strand flexor tendon repairs using a 3-0 caliber suture are more prone to early failure by suture pullout under progressive cyclic loading compared with a 4-0 caliber suture.
评估缝线直径和环行构型对改良KesslerⅡ区四股屈指肌腱修复在渐进性循环加载过程中完整性的影响。
取自18只新鲜人尸体手的72条指深屈肌腱被分为4个修复组。36条匹配的肌腱分别使用4-0环行或4-0单股缝线进行修复，另外36条肌腱进行3-0环行或3-0单股修复。通过渐进性循环加载测试修复强度。记录每次测试中产生2毫米间隙形成的力、最终失败力以及失败机制。分析每种缝线直径下环行与单股构型的影响以及肌腱横截面积对修复完整性的影响。
在形成2毫米间隙的力或最终失败力方面，各修复组之间无统计学显著差异，且所有数值均超过了早期主动活动范围康复方案所需的27牛的最低阈值。使用3-0直径缝线导致通过肌腱实质的缝线拔出而失败的修复比例显著更高，包括63.5%的环行和38.9%的单股核心缝线。相比之下，4-0环行缝线中这一情况占11.1%，4-0单股缝线中为0%。较大的肌腱横截面积与更稳固的修复相关，尤其是在3-0环行组。
在人体尸体屈肌腱修复模型中，在渐进性循环加载下，所有4种屈肌腱修复结构的平均失败力无显著差异。然而，3-0直径缝线因缝线拔出而失败的情况更频繁，尤其是使用环行缝线时。
与4-0直径缝线相比，使用3-0直径缝线进行四股屈肌腱修复在渐进性循环加载下更易因缝线拔出而早期失败。
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