Moriya Koji, Maki Yutaka, Koda Hisao, Tsubokawa Naoto
Department of Orthopedic Surgery, Niigata Hand Surgery Foundation, Niigata, Japan.
Indian J Plast Surg. 2022 Sep 25;55(3):294-298. doi: 10.1055/s-0042-1756132. eCollection 2022 Jun.
The placement of multistrand sutures during flexor tendon repair requires complicated surgical skills; such suturing is difficult. We developed a new, simpler eight-strand suture, which we term the Yoshizu cross-lock. This reduces the numbers of suture passages through the tendons, as well as the numbers of knots. Fourteen porcine flexor tendons were transected and repaired using the Yoshizu cross-lock system; no peripheral sutures were placed. Our system is a modification of the published, exposed cross-lock repair method that employs a 4-0 monofilament nylon two-strand line and two needles. The repaired tendons were subjected to linear, noncyclic load-to-failure tensile testing. The initial gap, the 2-mm gap force, and the ultimate strength were measured. The initial gap force was 12.6 ± 5.6 Newtons (N), the 2-mm gap force was 33.9 ± 10.9 N, and the ultimate strength was 70.1 ± 17.0 N. All tendons subjected to Yoshizu cross-lock repair failed due to suture rupture rather than pullout. Our biomechanical study revealed that Yoshizu cross-lock repair had sufficient tensile strength but was associated with wide variation in the 2-mm gap load (standard deviation = 10.9 N). This study is clinically relevant, showing that the Yoshizu cross-lock repair combined with peripheral suturing may allow a repaired flexor tendon to withstand the stresses encountered during early active mobilization. This simple eight-strand technique will be particularly useful to surgeons who commonly employ the cross-lock stitch for primary flexor tendon repair following early mobilization.
在屈指肌腱修复过程中放置多股缝线需要复杂的手术技巧，这种缝合操作难度较大。我们研发了一种新的、更简单的八股缝线，我们将其称为吉津交叉锁缝合法。这减少了缝线穿过肌腱的次数以及打结的数量。
使用吉津交叉锁缝合法对14条猪的屈指肌腱进行横断和修复，未放置周边缝线。我们的方法是对已发表的外露交叉锁缝合法的改良，后者采用4-0单丝尼龙两股线和两根针。对修复后的肌腱进行线性、非循环的直至失效的拉伸试验，测量初始间隙、2毫米间隙力和极限强度。
初始间隙力为12.6±5.6牛顿（N），2毫米间隙力为33.9±10.9 N，极限强度为70.1±17.0 N。所有接受吉津交叉锁缝合法修复的肌腱均因缝线断裂而非拔出而失效。
我们的生物力学研究表明，吉津交叉锁缝合法具有足够的拉伸强度，但2毫米间隙负荷存在较大差异（标准差=10.9 N）。这项研究具有临床相关性，表明吉津交叉锁缝合法结合周边缝合可能使修复后的屈指肌腱能够承受早期主动活动期间遇到的应力。这种简单的八股技术对于在早期活动后通常采用交叉锁缝法进行一期屈指肌腱修复的外科医生来说将特别有用。
