Orthopaedic Surgery, Lenval University Children's Hospital, Nice, France; Medical School, Institute of Musculoskeletal Surgery, University of Nice, Nice, France; Aix-Marseille University, CNRS, ISM, Marseille, France.
Orthopaedic Surgery, Lenval University Children's Hospital, Nice, France.
J Hand Surg Am. 2023 Feb;48(2):194.e1-194.e9. doi: 10.1016/j.jhsa.2021.09.030. Epub 2021 Nov 27.
Flexor tendon injury continues to pose a number of challenges for hand surgeons. Improving mechanical properties of repairs should allow for earlier and unprotected rehabilitation. A 3-dimensional (3D) 4-strand suture technique has been proposed to combine high tensile strength and low gliding resistance without causing suture pullout due to tendon delamination. Our hypothesis is that the 3D technique can result in better mechanical properties than the Adelaide technique.
Four groups of 10 porcine flexor tendons were sutured using the 3D or Adelaide technique with a 3-0 polypropylene or ultrahigh molecular weight polyethylene (UHMWPE) suture. The axial traction test to failure was performed on each tendon to measure 2-mm gap force and ultimate tensile strength.
The mean 2-mm gap force was 49 N for group A (3D + polypropylene), 145 N for group B (3D + UHMWPE), 47 N for group C (Adelaide + polypropylene), and 80 N for group D (Adelaide + UHMWPE). Failure mode was caused by suture breakage for group A (10/10) and mainly by suture pullout for the other groups (8/10 up to 10/10). With the UHMWPE suture, the mean ultimate tensile strength was 145 N for the 3D technique and 80 N for the Adelaide technique.
Porcine flexor tendons repaired using the 3D technique and UHMWPE suture exceeded a 2-mm gap force and tensile strength of 140 N. The ultimate tensile strength was superior to that of the Adelaide technique, regardless of the suture material.
This in vitro study on porcine flexor tendon suture highlights that the mechanical properties of 3D repair are better than those of 3D repair using the Adelaide technique when a UHMWPE suture is used.
屈肌腱损伤仍然给手外科医生带来了许多挑战。提高修复的力学性能应该可以更早地进行无保护康复。已经提出了一种 3 维（3D）4 股缝线技术，以结合高强度和低滑动阻力，而不会因肌腱分层而导致缝线拔出。我们的假设是，3D 技术可以产生比阿德莱德技术更好的力学性能。
使用 3D 或阿德莱德技术，用 3-0 聚丙烯或超高分子量聚乙烯（UHMWPE）缝线对 4 组每组 10 个猪屈肌腱进行缝合。对每个肌腱进行轴向牵引试验至失效，以测量 2mm 间隙力和极限拉伸强度。
组 A（3D+聚丙烯）的平均 2mm 间隙力为 49N，组 B（3D+UHMWPE）为 145N，组 C（阿德莱德+聚丙烯）为 47N，组 D（阿德莱德+UHMWPE）为 80N。组 A（10/10）的失效模式是缝线断裂，而其他组（8/10 至 10/10）主要是缝线拔出。使用 UHMWPE 缝线时，3D 技术的平均极限拉伸强度为 145N，阿德莱德技术的平均极限拉伸强度为 80N。
使用 3D 技术和 UHMWPE 缝线修复的猪屈肌腱超过了 2mm 间隙力和 140N 的拉伸强度。无论缝线材料如何，极限拉伸强度均优于阿德莱德技术。
这项关于猪屈肌腱缝合的体外研究表明，当使用 UHMWPE 缝线时，3D 修复的力学性能优于使用阿德莱德技术的 3D 修复。
