使用两种缝线类型对邦内尔（Bunnell）、改良凯斯勒（modified Kessler）和津下（Tsuge）肌腱修复技术进行生物力学比较。
Biomechanical comparison of Bunnell, modified Kessler, and Tsuge tendon repair techniques using two suture types.
作者信息
Dündar Nuh, Güneri Bülent, Uzel Murat, Doğaner Adem
机构信息
Department of Orthopedics and Traumatology, Kahramanmaraş Sütçü İmam University, School of Medicine, Kahramanmaraş, Turkey.
Department of Biostatistics and Medical Informatics, Kahramanmaraş Sütçü İmam University, School of Medicine, Kahramanmaraş, Turkey.
出版信息
Acta Orthop Traumatol Turc. 2020 Jan;54(1):104-113. doi: 10.5152/j.aott.2020.01.411.
OBJECTIVE
The aim of this study was to compare the biomechanical properties of modified Kessler, Bunnell and Tsuge techniques in sheep Achilles tendon tear repaired using polyester and polydioxanone sutures which are also compared.
METHODS
Sixty sheep Achilles tendons were cut transversely as a substitute for rupture and repaired using modified Kessler, Bunnell and Tsuge techniques with No. 2 braided polyester and monofilament polydioxanone sutures. Specimens were loaded to failure. Four biomechanical parameters - ultimate strength (US), strength to 2 mm gap (S2G), strength to 5 mm gap (S5G) and Young's modulus (YM) - were recorded for statistical analysis.
RESULTS
The Tsuge-Polyester group demonstrated the highest results regarding S2G (21.24±4.75 N) (p=.002) and S5G (38.91±7.45 N) (p=.002). According to YM, the Bunnell-Polyester group was the most superior (1929.9±512.28 kilopascal) (p=.009). In the repairs with the polydioxanone suture, Bunnell technique achieved the best purchase with regard to S2G (18.14±6.86 N) (p=.006) and S5G (35.69±13.49 N) (p=.015). The difference between the three repair techniques with the polydioxanone suture was statistically insignificant regarding US (p=.252) and YM (p=.338). Concerning the repairs with the polyester suture, the repair techniques demonstrated no statistically significant difference in terms of US (p=.195), S2G (p=.667), S5G (p=.689) and YM (p=.195). Regarding the mean S2G and S5G values, the polyester suture was significantly superior to the polydioxanone suture in modified Kessler repairs (S2G: p<.001, S5G: p=.001) and Tsuge repairs (S2G: p<.001, S5G: p=.009). The polyester suture was also significantly superior to the polydioxanone suture in the modified Kessler repairs with respect to YM (p=.003).
CONCLUSION
This study supports the opinion that Tsuge technique is a promising procedure in Achilles tendon repair (ATR). For Tsuge and modified Kessler repairs, braided polyester suture use appears more advantageous compared to monofilament polydioxanone suture use in biomechanical terms.
目的
本研究旨在比较改良凯斯勒（Kessler）、邦内尔（Bunnell）和津下（Tsuge）技术在使用聚酯和聚二氧六环酮缝线修复绵羊跟腱撕裂时的生物力学特性，并对这两种缝线进行比较。
方法
横向切断60条绵羊跟腱以模拟断裂，采用改良凯斯勒、邦内尔和津下技术，分别用2号编织聚酯缝线和单丝聚二氧六环酮缝线进行修复。对标本加载直至破坏。记录四个生物力学参数——极限强度（US）、2毫米间隙强度（S2G）、5毫米间隙强度（S5G）和杨氏模量（YM）——进行统计分析。
结果
津下-聚酯组在S2G（21.24±4.75牛）（p = 0.002）和S5G（38.91±7.45牛）（p = 0.002）方面表现出最高值。根据杨氏模量，邦内尔-聚酯组最为优越（1929.9±512.28千帕斯卡）（p = 0.009）。在使用聚二氧六环酮缝线修复时，邦内尔技术在S2G（18.14±6.86牛）（p = 0.006）和S5G（35.69±13.49牛）（p = 0.015）方面取得了最佳效果。使用聚二氧六环酮缝线的三种修复技术在极限强度（p = 0.252）和杨氏模量（p = 0.338）方面差异无统计学意义。对于使用聚酯缝线的修复，修复技术在极限强度（p = 0.195）、S2G（p = 0.667）、S5G（p = 0.689）和杨氏模量（p = 0.195）方面无统计学显著差异。关于平均S2G和S5G值，在改良凯斯勒修复（S2G：p < 0.001，S5G：p = 0.001）和津下修复（S2G：p < 0.001，S5G：p = 0.009）中，聚酯缝线明显优于聚二氧六环酮缝线。在改良凯斯勒修复中，聚酯缝线在杨氏模量方面也明显优于聚二氧六环酮缝线（p = 0.003）。
结论
本研究支持津下技术在跟腱修复（ATR）中是一种有前景的方法这一观点。对于津下和改良凯斯勒修复，从生物力学角度来看，使用编织聚酯缝线似乎比使用单丝聚二氧六环酮缝线更具优势。
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