Aoki M, Kubota H, Pruitt D L, Manske P R
Department of Orthopedic Surgery, Washington University, School of Medicine, St. Louis, MO 63110, USA.
J Hand Surg Am. 1997 Jan;22(1):107-14. doi: 10.1016/S0363-5023(05)80189-3.
The purpose of this experimental study was to evaluate the mechanical and histologic healing of flexor tendon repairs using an early active motion protocol. Three different flexor tendon repair techniques in zone II were used. Forty-seven lacerated canine flexor profundus tendons from 25 dogs were repaired and evaluated at 5, 10, and 21 days after surgery. Eight of 9 Kessler repairs ruptured at days 5 and 10. None of the 19 Savage repairs or the 19 dorsal tendon splint repairs ruptured; 3 of 19 dorsal tendon splint repairs failed owing to adhesions. Smooth tendon gliding was obtained in all specimens in which repair was successful. The gap strength values for both the Savage and dorsal tendon splint repairs improved significantly for day-21 specimens compared to day-5 or day-10 specimens. The ultimate tensile strength showed no reduction during the 3-week period of tendon healing for both repairs. Histologically, there was evidence of progressive healing without surrounding adhesions. The improved suture techniques have the potential to withstand the stress produced by active digital motion protocols.
本实验研究的目的是评估采用早期主动活动方案的屈指肌腱修复的力学和组织学愈合情况。在Ⅱ区使用了三种不同的屈指肌腱修复技术。对来自25只犬的47条撕裂的犬屈指深肌腱进行修复，并在术后5天、10天和21天进行评估。9例凯斯勒（Kessler）修复中有8例在第5天和第10天发生断裂。19例萨维奇（Savage）修复或19例背侧肌腱夹板修复均未发生断裂；19例背侧肌腱夹板修复中有3例因粘连而失败。在所有修复成功的标本中均获得了肌腱的平滑滑动。与第5天或第10天的标本相比，第21天的萨维奇修复和背侧肌腱夹板修复的间隙强度值均显著提高。两种修复在肌腱愈合的3周期间极限抗拉强度均未降低。组织学上，有逐渐愈合且无周围粘连的证据。改进的缝合技术有可能承受主动手指活动方案产生的应力。
