Howard R F, Ondrovic L, Greenwald D P
Section of Hand Surgery, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, TX, USA.
J Hand Surg Am. 1997 Sep;22(5):838-42. doi: 10.1016/S0363-5023(97)80078-0.
Experience with flexor tendon repairs has suggested the superiority of the augmented Becker (MGH) technique for strength, toughness, and gap resistance. In an effort to apply these findings to the extensor tendons, 3 four-strand extensor tendon repair techniques were biomechanically tested in fresh human cadaver limbs: modified Bunnell, modified Krackow-Thomas, and MGH. Repairs were performed in Verdan's zone VI. Repaired tendons were distracted at constant speed until rupture. Tendon load and tendon distraction were continuously monitored. Benchmark values for load were measured as fingers were pulled from full metacarpophalangeal (MP) joint flexion to full extension, to 1-mm gap formation at the tenorrhaphy, and to complete rupture of the repair. The MGH repair proved significantly more resistant to gap formation (stronger and tougher) than the Bunnell and Krackow-Thomas repairs (p < .02). No differences were seen between groups in repair performance at MP joint extension and at complete rupture. This study suggests that the MGH technique has superior gap resistance to the other four-strand methods tested for extensor tendon repair in Verdan's zone VI. The MGH repair is recommended for extensor tendon repairs in zone VI when early postoperative motion regimens are considered.
屈肌腱修复的经验表明，改良贝克尔（MGH）技术在强度、韧性和抗间隙形成方面具有优势。为了将这些发现应用于伸肌腱，在新鲜人体尸体肢体上对三种四股伸肌腱修复技术进行了生物力学测试：改良邦内尔法、改良克拉科夫-托马斯法和MGH法。修复在韦尔丹VI区进行。以恒定速度拉伸修复后的肌腱直至断裂。持续监测肌腱负荷和肌腱拉伸情况。在手指从掌指（MP）关节完全屈曲拉伸至完全伸展、腱缝处形成1毫米间隙以及修复完全断裂时，测量负荷的基准值。结果证明，MGH修复在抗间隙形成方面（更强且更坚韧）明显优于邦内尔法和克拉科夫-托马斯法修复（p < 0.02）。在MP关节伸展和完全断裂时，各组之间的修复性能没有差异。本研究表明，对于韦尔丹VI区的伸肌腱修复，MGH技术在抗间隙形成方面优于其他测试的四股方法。当考虑术后早期活动方案时，推荐使用MGH修复法进行VI区伸肌腱修复。
