Department of Orthopaedic Surgery, Tominaga Kusano Hospital, Sanjo, Niigata, Japan.
Department of Orthopaedic Surgery, Barnes-Jewish Hospital at Washington University, St. Louis, Missouri, USA.
J Orthop Sci. 2024 Sep;29(5):1214-1219. doi: 10.1016/j.jos.2023.09.007. Epub 2023 Oct 14.
Biomechanical analysis using cyclic testing for repaired flexor tendons is a clinically relevant method. The aim of this study was to evaluate the tensile properties of two six-strand suture techniques, the triple looped suture and Yoshizu #1 suture techniques using cyclic testing under simulating early active mobilization conditions.
Twenty-five flexor digitorum profundus tendons harvested from fresh frozen human cadaver hands were repaired in zone 2 utilizing one of three repair techniques: the 2-strand modified Kessler (MK) technique as a control, the triple looped suture (TLS) and Yoshizu #1 suture (Y1) techniques. In each suture technique, 4-0 monofilament nylon sutures were used for core sutures and 6-0 monofilament nylon sutures for circumferential running sutures. Cyclic testing was performed using 20 N with 600 cycles at 1 Hz.
Five out of eight specimens in the MK group ruptured during cyclic testing. Thus, this group was excluded from analysis. On the other hand, all tendons in the TLS and Y1 groups tolerated cyclic testing. Average gaps of the TLS and Y1 groups were 0.5 ± 0.8 mm and 1.9 ± 2.2 mm, respectively. All tendons in the TLS group and six out of nine tendons in the Y1 group formed gaps less than 2 mm. Two tendons in the Y1 group formed a gap of 3.8 and 6.6 mm had breakage of peripheral sutures at the first cycle. Mean ultimate tensile force of the TLS and Y1 group measured after cyclic tensing, were 66.2 ± 9.0 N and 65.9 ± 13.1 N, respectively. No statistical difference between the two groups was found in gap and ultimate tensile forces.
This study suggested that the TLS and Y1 techniques have tensile properties to allow early active mobilization. None of tendons repaired with the TLS technique had gaps more than 2 mm.
使用循环测试对修复后的屈肌腱进行生物力学分析是一种具有临床相关性的方法。本研究旨在评估两种六股缝线技术，即三圈缝线和 Yoshizu#1 缝线技术在模拟早期主动活动条件下的拉伸性能。
从新鲜冷冻的人尸手中采集 25 个屈指深肌腱，在 2 区利用三种修复技术之一进行修复：作为对照的 2 股改良 Kessler（MK）技术、三圈缝线（TLS）和 Yoshizu#1 缝线（Y1）技术。在每种缝线技术中，使用 4-0 单丝尼龙缝线作为芯缝线，6-0 单丝尼龙缝线作为环行缝线。循环测试使用 20N 的力和 1Hz 的频率进行 600 次循环。
MK 组的 8 个标本中有 5 个在循环测试中破裂。因此，该组被排除在分析之外。另一方面，TLS 和 Y1 组的所有肌腱都耐受循环测试。TLS 和 Y1 组的平均间隙分别为 0.5±0.8mm 和 1.9±2.2mm。TLS 组的所有肌腱和 Y1 组的 9 根肌腱中的 6 根肌腱形成的间隙小于 2mm。Y1 组的两根肌腱在第一循环时形成了 3.8mm 和 6.6mm 的间隙，外周缝线断裂。循环拉伸后测量的 TLS 和 Y1 组的最大拉伸力分别为 66.2±9.0N 和 65.9±13.1N，两组之间的间隙和最大拉伸力没有统计学差异。
本研究表明，TLS 和 Y1 技术具有允许早期主动活动的拉伸性能。TLS 技术修复的肌腱中没有间隙超过 2mm 的。
