Li Yibo, Beaudry Eric, Besada Nader, Chan Robert, Westover Lindsey
Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, Alberta, Canada.
J Wrist Surg. 2023 Jun 12;13(1):38-43. doi: 10.1055/s-0043-1769909. eCollection 2024 Feb.
Graft preparation techniques for the Adams-Berger distal radioulnar joint (DRUJ) reconstruction vary among surgeons with insufficient evidence to support any specific technique. We compared survival with cyclic loading, absolute elongation, elongation rate, and modes of failure of four graft preparation techniques. Fifteen porcine extensor tendons were divided into three equal groups: tendon only; tendon augmented along its full length with nonlocking 2-0 FiberLoop suture spaced at 6 mm intervals; and tendon with suture at 12 mm intervals. Suture only was also tested. Samples were woven through custom radius- and ulna-simulating jigs mounted on a mechanical testing machine. Samples underwent a staircase cyclic loading protocol and were then inspected visually for the mode of failure. Survival with cyclic loading, absolute elongation, and elongation rate was compared. Average survival with cyclic loading of suture-augmented tendon was significantly higher than tendon only. All tendon groups had significantly higher survival compared with suture only. Absolute elongation was subject to variability due to initial nonlinear elongation behavior of samples. The elongation rate was significantly lower with suture compared with all tendon groups. Modes of failure included rupture of the tendon and/or suture at the simulated graft-bone interface and elongation of the entire construct without rupture. In this biomechanical study, augmentation of porcine tendons with suture spaced at either 6 or 12 mm for DRUJ reconstruction significantly increased survival to a staircase cyclic loading protocol For the Adams-Berger reconstruction, tendon grafts augmented along their entire length by nonabsorbable braided suture are biomechanically superior to tendon alone.
亚当斯-伯杰远侧桡尺关节（DRUJ）重建的移植物制备技术在外科医生中各不相同，且缺乏足够证据支持任何特定技术。我们比较了四种移植物制备技术在循环加载下的存活率、绝对伸长率、伸长率和失效模式。15条猪伸肌腱被平均分为三组：仅肌腱组；用间隔6毫米的非锁定2-0 FiberLoop缝线沿肌腱全长增强的肌腱组；以及缝线间隔为12毫米的肌腱组。还测试了仅缝线组。样本穿过安装在机械试验机上的定制桡骨和尺骨模拟夹具进行编织。样本经历阶梯式循环加载方案，然后目视检查失效模式。比较了循环加载下的存活率、绝对伸长率和伸长率。缝线增强肌腱在循环加载下的平均存活率显著高于仅肌腱组。与仅缝线组相比，所有肌腱组的存活率均显著更高。由于样本的初始非线性伸长行为，绝对伸长率存在变异性。与所有肌腱组相比，缝线的伸长率显著更低。失效模式包括模拟移植物-骨界面处的肌腱和/或缝线断裂以及整个结构伸长而未断裂。在这项生物力学研究中，用间隔6或12毫米的缝线增强猪肌腱用于DRUJ重建可显著提高阶梯式循环加载方案下的存活率。对于亚当斯-伯杰重建，用不可吸收编织缝线沿肌腱全长增强的肌腱移植物在生物力学上优于单独的肌腱。
