Wallace Stephen J, Mioton Lauren M, Havey Robert M, Muriuki Muturi G, Ko Jason H
Department of Orthopedic Surgery, Loyola University-Chicago, Maywood, IL.
Division of Plastic and Reconstructive Surgery, Northwestern University, Chicago, IL.
J Hand Surg Am. 2019 Mar;44(3):208-215. doi: 10.1016/j.jhsa.2018.11.016. Epub 2019 Jan 16.
Conventional suture repairs, when stressed, fail by suture rupture, knot slippage, or suture pull-through, when the suture cuts through the intervening tissue. The purpose of this study was to compare the biomechanical properties of flexor tendon repairs using a novel mesh suture with traditional suture repairs.
Sixty human cadaveric flexor digitorum profundus tendons were harvested and assigned to 1 of 3 suture repair groups: 3-0 and 4-0 braided poly-blend suture or 1-mm diameter mesh suture. All tendons were repaired using a 4-strand core cruciate suture configuration. Each tendon repair underwent linear loading or cyclic loading until failure. Outcome measures included yield strength, ultimate strength, the number of cycles and load required to achieve 1-mm and 2-mm gap formation, and failure.
Mesh suture repairs had significantly higher yield and ultimate force values when compared with 3-0 and 4-0 braided poly-blend suture repairs under linear testing. The average force required to produce repair gaps was significantly higher in mesh suture repairs than in conventional suture. Mesh suture repairs endured a significantly greater number of cycles and force applied before failure compared with both 3-0 and 4-0 conventional suture.
This ex vivo biomechanical study of flexor tendon repairs using a novel mesh suture reveals significant increases in average yield strength, ultimate strength, and average force required for gap formation and repair failure with mesh suture repairs compared with conventional sutures.
Mesh suture-based flexor tendon repairs could lead to improved healing at earlier time points. The findings could allow for earlier mobilization, decreased adhesion formation, and lower rupture rates after flexor tendon repairs.
传统缝线修复在受力时会因缝线断裂、结滑开或缝线拉穿（即缝线割穿中间组织）而失败。本研究的目的是比较使用新型网状缝线进行屈指肌腱修复与传统缝线修复的生物力学特性。
收集60条人尸体的指深屈肌腱，并将其分配到3个缝线修复组中的1组：3-0和4-0编织聚混纺缝线组或直径1毫米的网状缝线组。所有肌腱均采用4股核心十字缝线构型进行修复。对每个肌腱修复进行线性加载或循环加载直至失败。结果测量包括屈服强度、极限强度、形成1毫米和2毫米间隙所需的循环次数和载荷，以及失败情况。
在直线测试中，与3-0和4-0编织聚混纺缝线修复相比，网状缝线修复的屈服力和极限力值显著更高。网状缝线修复产生修复间隙所需的平均力明显高于传统缝线。与3-0和4-0传统缝线相比，网状缝线修复在失败前承受的循环次数和施加的力明显更多。
这项使用新型网状缝线进行屈指肌腱修复的体外生物力学研究表明，与传统缝线相比，网状缝线修复的平均屈服强度、极限强度以及形成间隙和修复失败所需的平均力均显著增加。
基于网状缝线的屈指肌腱修复可能会在更早的时间点促进愈合。这些发现可能有助于更早进行活动，减少粘连形成，并降低屈指肌腱修复后的断裂率。
