Kakar Sanjeev, Greene Ryan M, Denbeigh Janet, Van Wijnen Andre
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
J Wrist Surg. 2019 Jun;8(3):250-254. doi: 10.1055/s-0038-1670682. Epub 2018 Sep 18.
Twelve paired fresh frozen cadaveric wrists were randomized to a 360-degree tenodesis repair group or the 360-degree tenodesis repair with an internal brace (suture tape) construct. The specimens were preloaded to 5 N and subsequently biomechanically loaded to failure, at a rate of 0.1 mm/s on a jig that allowed for axial load. The maximum load and mode of failure were recorded. Load to failure in the 360 tenodesis group with internal brace was 283.47 ± 100.25 N, compared with the 360 tenodesis group only, whose yield strength was 143.61 ± 90.54 N. The mode of failure within the internal brace construct was either through knot slippage, graft disruption, or bone separation from strength testing construct. The 360 tenodesis group tended to fail via graft slippage or graft rupture. The management of scapholunate instability can be a difficult problem to treat. Traditionally, many of the surgical reconstructions have focused upon dorsal ligament reconstruction with Kirschner (K) wire fixation. This results in prolonged immobilization of the wrist with varied outcomes, in part due to the multiaxial instability that may persist due to concomitant volar ligament disruption. To address this instability, surgical techniques have been devised that address both the volar and dorsal ligament injuries. Scapholunate reconstruction with a 360-degree tenodesis and internal brace augmentation (SLITT procedure) provided superior biomechanical stability than tenodesis alone.
十二对新鲜冷冻的尸体手腕被随机分为360度腱固定修复组或采用内部支撑（缝合带）结构的360度腱固定修复组。标本先预加载至5 N，随后在允许轴向加载的夹具上以0.1 mm/s的速率进行生物力学加载直至破坏。记录最大载荷和破坏模式。采用内部支撑的360度腱固定组的破坏载荷为283.47±100.25 N，而仅360度腱固定组的屈服强度为143.61±90.54 N。内部支撑结构的破坏模式为结滑脱、移植物断裂或与强度测试结构的骨分离。360度腱固定组倾向于因移植物滑脱或移植物破裂而失效。舟月关节不稳定的治疗可能是一个难题。传统上，许多手术重建都集中在使用克氏针固定进行背侧韧带重建。这会导致手腕长时间固定，结果各异，部分原因是由于掌侧韧带断裂可能持续存在的多轴不稳定。为了解决这种不稳定，已经设计出了同时处理掌侧和背侧韧带损伤的手术技术。采用360度腱固定和内部支撑增强的舟月关节重建术（SLITT手术）比单纯腱固定提供了更好的生物力学稳定性。
