The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD.
The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
J Hand Surg Am. 2023 Dec;48(12):1276.e1-1276.e7. doi: 10.1016/j.jhsa.2022.05.003. Epub 2022 Jun 29.
We compared 2 suturing techniques for reattachment of the flexor digitorum profundus (FDP) via all-suture anchor.
We used fresh, matched-pair, cadaveric hands. We disarticulated the fingers at the proximal interphalangeal joints, preserving the proximal FDP. We released the FDPs at their distal insertion and placed an all-suture, 1.0-mm anchor at the center of each FDP footprint. Each anchor's sutures were used to reattach each FDP using 1 of 2 techniques: group H (n = 14) via horizontal mattress; group H + K (n = 12) via horizontal mattress with knots thrown and, with each suture tail, 3 proximal, running-locking, Krackow-type passes on the radial and ulnar FDP sides with the suture ends tied together. We excluded 2 specimens from the H + K group because of improper anchor placement. All other fingers in both groups were individually mounted in an MTS machine for FDP loading in the following sequence for 500 cycles each: (1) to 15 N to simulate passive motion forces; (2) to 19 N for short-arc active motion forces; and (3) to 28 N for full active motion forces. Specimens that had not failed during cyclic testing were then loaded to failure. We measured FDP-to-bone gapping via a digital transducer. We defined failure as >3-mm gapping.
The H + K group had significantly less gapping during cyclic loading up to 19 N and significantly higher load to failure. The H + K group failed exclusively at the anchor-bone level; the H group failed mostly by suture-tendon pullout.
The H + K group performed significantly better regarding cyclic and load-to-failure testing after FDP reattachment.
The H + K technique combines the benefits of horizontal-mattress tendon-to-bone apposition and Krackow-tendon locking. It converts the point of failure to the bone level rather than the suture-tendon level.
我们比较了两种通过全缝线锚钉修复屈指深肌腱（FDP）的缝合技术。
我们使用新鲜的配对尸体手。我们在近节指间关节处离断手指，保留近节 FDP。我们在 FDP 的远端插入处释放 FDP，并在每个 FDP 足印的中心放置一个全缝线、1.0mm 的锚钉。每个锚钉的缝线采用以下两种技术之一来修复每个 FDP：H 组（n=14）通过水平褥式缝合；H+K 组（n=12）通过水平褥式缝合加结，每条缝线尾端用 3 条近端、连续锁定、Krackow 型缝线穿过桡侧和尺侧 FDP 侧，缝线末端系在一起。由于锚钉放置不当，H+K 组中有 2 个标本被排除。两组的所有其他手指都单独安装在 MTS 机器上，以 FDP 加载的以下顺序进行 500 次循环，每次循环各为 500 次：（1）15N 模拟被动运动力；（2）19N 短弧主动运动力；（3）28N 全主动运动力。在循环测试中没有失效的标本随后加载至失效。我们通过数字换能器测量 FDP 与骨之间的间隙。我们将失效定义为>3mm 的间隙。
在 19N 以下的循环加载和更高的失效负载下，H+K 组的间隙明显更小。H+K 组仅在锚钉与骨交界处失效；H 组主要因缝线与肌腱的拉出而失效。
在 FDP 修复后的循环和失效负载测试中，H+K 组的表现明显更好。
H+K 技术结合了水平褥式缝线与骨的腱骨贴合和 Krackow 缝线锁定的优点。它将失效点转换到骨水平而不是缝线与肌腱的水平。
