Lee Jasmin Shimin, Wong Yoke-Rung, Tay Shian-Chao
Department of Hand Surgery, Singapore General Hospital, Singapore.
Biomechanics Laboratory, Singapore General Hospital, Singapore.
J Hand Surg Asian Pac Vol. 2019 Sep;24(3):297-302. doi: 10.1142/S2424835519500371.
This study investigates the biomechanical performance of the Asymmetric flexor tendon repair technique using barbed suture. The Asymmetric repair technique using monofilament nylon suture was previously reported to have a higher tensile strength than the modified Lim-Tsai repair technique, but its repair stiffness and load to gap force were significantly lower. There is hence an unmet need to improve this technique and the substitution of nylon suture with barbed sutures may be the solution. Two groups consisting of 10 porcine tendons each were repaired with the six-strand Asymmetric repair technique using V-Loc 3-0 and Supramid 4-0 respectively. The repairs were subjected to a mechanical tester for static testing. The ultimate tensile strength, load to 2 mm gap force, repair stiffness, time taken to complete a repair and failure mechanism of the repairs were recorded and analyzed. All the repairs using V-Loc 3-0 sutures had significantly higher median values of ultimate tensile strength (64.1 N; 56.9 N), load to 2 mm gap force (39.2 N; 19.7 N), repair stiffness (6.4 N/mm; 4.7 N/mm) and time taken to complete a repair (9.4 mins; 7.7 mins). All the repairs using V-Loc sutures failed by suture breakage while 80% of repairs using Supramid sutures failed by suture pullout. The use of the barbed sutures in the Asymmetric repair technique, whilst more time consuming, has shown promising improvement to its biomechanical performance (i.e. better ultimate tensile strength, stiffness and resistance to gap formation).
本研究调查了使用倒刺缝线的不对称屈肌腱修复技术的生物力学性能。先前报道，使用单丝尼龙缝线的不对称修复技术比改良的Lim-Tsai修复技术具有更高的拉伸强度，但其修复刚度和间隙力负荷显著更低。因此，改进该技术存在未满足的需求，用倒刺缝线替代尼龙缝线可能是解决方案。两组各由10根猪肌腱组成，分别使用V-Loc 3-0和Supramid 4-0缝线通过六股不对称修复技术进行修复。对修复后的肌腱进行机械测试仪静态测试。记录并分析修复的极限拉伸强度、2毫米间隙力负荷、修复刚度、完成修复所需时间以及修复的失效机制。所有使用V-Loc 3-0缝线的修复在极限拉伸强度（64.1牛；56.9牛）、2毫米间隙力负荷（39.2牛；19.7牛）、修复刚度（6.4牛/毫米；4.7牛/毫米）和完成修复所需时间（9.4分钟；7.7分钟）的中位数上均显著更高。所有使用V-Loc缝线的修复均因缝线断裂而失败，而80%使用Supramid缝线的修复因缝线拔出而失败。在不对称修复技术中使用倒刺缝线，虽然更耗时，但已显示出其生物力学性能有令人鼓舞的改善（即更好的极限拉伸强度、刚度和抗间隙形成能力）。
