Moriya Koji, Maki Yutaka, Koda Hisao, Kuroda Takuma, Tsubokawa Naoto
Niigata Hand Surgery Foundation, Niigata, Japan.
J Hand Surg Glob Online. 2024 Mar 25;6(4):488-493. doi: 10.1016/j.jhsg.2024.02.013. eCollection 2024 Jul.
The placement of multistrand sutures during flexor tendon repair is complex and challenging. We developed a new, simpler, nine-strand suture, which we term the Tajima nines. The Tajima nines repair method is a new odd-numbered strand tendon technique.
Fourteen porcine flexor tendons were transected and repaired using the Tajima nines repair method, without placement of peripheral sutures. This technique is a modification of the Lim and Tsai repair method; it uses a 4-0 monofilament nylon, 3-strand line, and two needles. The repaired tendons were tested for linear, noncyclic, load-to-failure tensile strength. The initial gap, 2-mm gap-formation force, and ultimate strength were measured.
The initial gap-formation force was 27.9 ± 7.5 newtons (N), the 2-mm gap-formation force was 39.2 ± 4.7 N, and the ultimate strength was 76.7 ± 17.2 N. Eight, three, and three of the 14 tendons repaired using the Tajima nines method demonstrated failure because of thread breakage, knot failure, and suture pull-out, respectively.
This biomechanical study demonstrated that Tajima nines repair was associated with particularly high initial tension at the repair site; there were minor variations in the initial load and 2-mm gap-formation load. Our results suggest that Tajima nines repair with peripheral suturing allows the repaired flexor tendon to tolerate the stresses encountered during early active mobilization.
This simple nine-strand technique will be particularly useful for inexperienced surgeons who perform early active mobilization after primary flexor tendon repair because the technique is a modification of the Lim and Tsai repair method using a triple strand instead of a double strand.
在屈肌腱修复过程中放置多股缝线复杂且具有挑战性。我们开发了一种新的、更简单的九股缝线，我们称之为田岛九股缝线。田岛九股缝线修复方法是一种新的奇数股肌腱技术。
14条猪屈肌腱被切断并采用田岛九股缝线修复方法进行修复，未放置周边缝线。该技术是对林和蔡修复方法的改良；它使用4-0单丝尼龙线、三股线和两根针。对修复后的肌腱进行线性、非循环、至断裂负荷的拉伸强度测试。测量初始间隙、2毫米间隙形成力和极限强度。
初始间隙形成力为27.9±7.5牛顿（N），2毫米间隙形成力为39.2±4.7 N，极限强度为76.7±17.2 N。采用田岛九股缝线方法修复的14条肌腱中，分别有8条、3条和3条因缝线断裂、结失败和缝线拔出而出现失败。
这项生物力学研究表明，田岛九股缝线修复与修复部位特别高的初始张力相关；初始负荷和2毫米间隙形成负荷存在微小差异。我们的结果表明，采用周边缝合的田岛九股缝线修复能使修复后的屈肌腱耐受早期主动活动期间遇到的应力。
这种简单的九股技术对于在一期屈肌腱修复后进行早期主动活动的经验不足的外科医生将特别有用，因为该技术是对林和蔡修复方法的改良，使用三股线而非两股线。
