Putnam Jill G, Adamany Damon
Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona.
The Center for Orthopaedic Research and Education, Phoenix, Arizona.
J Wrist Surg. 2019 Aug;8(4):312-316. doi: 10.1055/s-0039-1685470. Epub 2019 Apr 22.
Multiple repair techniques have been investigated for flexor digitorum profundus (FDP) tendon avulsions. The purpose of this study is to compare the biomechanical characteristics of a new fully threaded titanium suture anchor with previously examined fixation techniques. Repair of FDP tendon avulsions was performed in 18 fresh-frozen cadavers using one of three implants: Nano Corkscrew FT 1.7 mm suture anchor (Group 1; Arthrex, Inc., Naples, FL; = 6), Mitek Micro 1.3 mm suture anchor (Group 2; Mitek Surgical Products, Westwood, MA; = 6), or pullout suture button fixation (Group 3; = 6). Constructs were preloaded before testing load to failure. For each trial, elongation at 20 N and maximum load, mean load to failure, stiffness, and failure mechanism were recorded. Load to failure occurred in all trials. Mean load to failure was significantly greater for Group 1 (61.6 ± 18.9 N) compared to Group 2 (42.5 ± 4.2 N; < 0.05) and Group 3 (41.6 N ± 8.0 N; < 0.05). Stiffness was significantly greater in Groups 1 and 2 compared to Group 3 (6.9 ± 2.2 N/mm vs. 6.1 ± 0.8 N/mm vs. 3.1 N/mm ± 0.5 N/mm, respectively, < 0.01). Mechanism of failure differed between the groups: Group 1 broke at the anchor in two trials and tore through the tendon in three trials, Group 2's suture universally broke at the anchor, and Group 3's trials mainly failed at the button. The Nano Corkscrew anchor (Group 1) has a significantly higher load to failure when compared with the other techniques. The higher load to failure of the corkscrew anchor provides a secure method for flexor tendon repair in zone I. A fully threaded titanium suture anchor used for FDP tendon avulsion injuries is likely to withstand early active range of motion protocols.
针对指深屈肌腱（FDP）撕脱伤，人们研究了多种修复技术。本研究的目的是比较一种新型全螺纹钛制缝合锚钉与先前研究的固定技术的生物力学特性。
在18具新鲜冷冻尸体上使用以下三种植入物之一进行FDP肌腱撕脱伤的修复：1.7毫米纳米螺旋FT缝合锚钉（第1组；Arthrex公司，那不勒斯，佛罗里达州；n = 6）、Mitek Micro 1.3毫米缝合锚钉（第2组；Mitek外科产品公司，韦斯特伍德，马萨诸塞州；n = 6）或拔出缝合纽扣固定（第3组；n = 6）。在测试破坏载荷之前对构建物进行预加载。对于每次试验，记录20牛时的伸长量、最大载荷、平均破坏载荷、刚度和破坏机制。
所有试验均出现破坏载荷。与第2组（42.5±4.2牛；p < 0.05）和第3组（41.6牛±8.0牛；p < 0.05）相比，第1组的平均破坏载荷显著更高（61.6±18.9牛）。与第3组相比，第1组和第2组的刚度显著更高（分别为6.9±2.2牛/毫米、6.1±0.8牛/毫米和3.1牛/毫米±0.5牛/毫米，p < 0.01）。各组的破坏机制不同：第1组在两次试验中锚钉处断裂，在三次试验中肌腱撕裂；第2组的缝线在锚钉处普遍断裂；第3组的试验主要在纽扣处失败。
与其他技术相比，纳米螺旋锚钉（第1组）的破坏载荷显著更高。螺旋锚钉更高的破坏载荷为I区屈肌腱修复提供了一种可靠的方法。
用于FDP肌腱撕脱伤的全螺纹钛制缝合锚钉可能能够承受早期主动活动范围方案。
