Nahas F X, Ishida J, Gemperli R, Ferreira M C
Division of Plastic Surgery, University of São Paulo School of Medicine, Hospital Jaraguá, Brazil.
Ann Plast Surg. 1998 Dec;41(6):606-13; discussion 613-7. doi: 10.1097/00000637-199812000-00005.
The tension required to pull the anterior and the posterior rectus sheaths toward the midline was studied in 20 fresh cadavers at two levels: 3 cm above and 2 cm below the umbilicus. The quotient of the force used to mobilize the aponeurotic site to the midline and its resulting displacement was called the traction index. These indices were compared in three situations: (1) prior to any aponeurotic undermining, (2) after the incision of the anterior rectus sheath and the undermining of the rectus muscle from its posterior sheath, and (3) after additionally releasing and undermining the external oblique muscle. A significant decrease in aponeurotic resistance was observed after each dissection. The anterior sheath showed higher resistance to traction compared with the posterior sheath on both levels. No statistical difference was noted in the comparison of the values of the aponeurosis above and below the umbilicus. These results suggest that these procedures are effective in assisting in the closure of abdominal wall defects because these maneuvers decrease substantially the tension required for advancement of the aponeurotic edges.
在20具新鲜尸体上，于脐上3厘米和脐下2厘米两个水平研究了将腹直肌前鞘和后鞘拉向中线所需的张力。将用于将腱膜部位向中线移动的力与其产生的位移的商称为牵引指数。在三种情况下比较了这些指数：（1）在任何腱膜下分离之前；（2）在前侧腹直肌鞘切开以及腹直肌与其后鞘分离之后；（3）在额外松解和分离腹外斜肌之后。每次解剖后均观察到腱膜阻力显著降低。在两个水平上，前鞘对牵引的阻力均高于后鞘。脐上和脐下腱膜值的比较未发现统计学差异。这些结果表明，这些操作在协助闭合腹壁缺损方面是有效的，因为这些操作大大降低了腱膜边缘推进所需的张力。
