几种屈肌腱缝合方法的即刻生物力学比较

目的比较几种临床常用肌腱缝合方法的即刻生物力学特性,为临床肌腱修复提供参考。方法成年AA白羽鸡爪60只,随机分为6组。锐刀横断Ⅱ区趾深屈肌肌腱,分别用改良Kessler法、改良Kessler加腱周连续缝合法、Cruciate法、滓下法,改良津下法,Tang法进行修复。缝合后立即取下肌腱进行拉伸—断裂测试。测定极限载荷、应变,计算出各组的肌腱韧度、极限拉伸强度、弹性模量和断裂功耗,并记录手术操作时间和断裂方式,进行统计学分析。结果Tang法组的极限载荷、极限拉伸强度、韧度和断裂功耗均大于其他五种方法（P〈0．05）,改良Kessler法的各组参数均小于其他五种方法（P〈0．05）。操作时间以改良Kessler法和Tsuge法最小（P〈0．05）。结论改良Kessler加腱周连续缝合法操作简单、强度可观、生物力学特性好、吻合端光滑,是临床中最常用的肌腱修复法。Tang法抗拉强度高,可以胜任术后早期功能锻炼,为一种可靠的肌腱修复方法。     

屈肌腱愈合早期在曲线模型中生物力学变化的实验研究

目的比较握持缝合法(改良Kessler法)和锁扣缝合法(Tsuge法)修复屈肌腱在术后不同时间曲线模型下的生物力学变化规律和特点。方法分别以改良Kessler法和Tsuge法缝合三黄鸡的第3趾屈趾深肌腱各42条,分别于术后即刻,1,4,7,10,14,21d取材,进行生物力学测试。测试内容包括拉伸断裂负荷和功耗。结果拉伸断裂负荷：改良Kessler法在术后10d出现明显降低(13N),术后21d恢复到即刻水平;Tsuge法术后10d以后持续性降低(21N);Tsuge法术后即刻组和术后7d组较改良Kessler。法能承受更高的拉伸断裂负荷。拉伸断裂功耗：改良Kessler法术后10d(65mJ),14d(40mJ)组较术后即刻(170mJ),1(222mJ),4(188mJ),7d(196mJ)组明显降低,术后21d恢复到即刻水平;Tsuge法术后14d(72mJ),21d组(59mJ)较术后即刻(283mJ),1(219mJ),4(216mJ),7(279mJ),10d(191mJ)组明显降低;Tsuge法术后即刻组(283mJ)较改良Kessler法(170mJ)具有更高的拉伸断裂功耗。结论两种缝合方法都是在术后10d以后生物力学性能显著下降,改良Kessler法在术后21d恢复到即刻水平,而Tsuge法则不能在术后21d恢复到即刻水平。两种缝合方法的力学性能在术后10d以后无差异。     

屈指肌腱损伤修复后早期生物力学性能的变化

目的以改良Kessler法和Tsuge法修复鸡趾深屈肌腱,观察术后早期肌腱生物力学性能的变化特点,并探讨两种缝合方法修复屈指肌腱损伤后早期主动或被动功能锻炼的可行性。方法取42只三黄鸡,随机分成两组,每组21只(42趾)。选用改良Kessler法和Tsuge法修复鸡右足第二、四趾趾深屈肌腱,分别于术后即刻、1、4、7、10、14、21d取材,进行生物力学测试,检测肌腱的拉伸断裂负荷、拉伸断裂伸长率。结果改良Kessler法拉伸断裂负荷在术后10d～两周降到最低,3周时恢复到即刻水平;Tsuge法在术后10d降至最低,2周后开始恢复,3周时尚未恢复到即刻水平;Tsuge法的拉伸断裂负荷在术后即刻和1d较改良Kessler法高,差异有非常显著性(P<0.01)。改良Kessler法拉伸断裂伸长率在术后1周逐渐下降,Tsuge法在术后4d逐渐下降,两者均在术后3周达到最低点,两种缝合方法之间不同时间点差异均无显著性。结论Tsuge法较高的力学特性术后丢失快,恢复慢;改良Kessler法的力学特性仅在术后10d有显著降低,2周后即可恢复。     

肌腱损伤修复后早期最大抗拉力与功耗变化的实验研究

目的 探讨鸡的趾深屈肌腱断伤后用改良Kessler法和Tsuge法修复后早期缝合1：3最大抗拉力和功耗变化的特点。方法 选用三黄鸡42只，分成2组：改良Kessler法缝合组和Tsuge法缝合组，每组各21只实验鸡。将鸡的右侧第2．4趾趾深屈肌腱切断后用上述方法缝合。分别于术后即刻、1、4,7、10、14、21d取材(7个时间组)。检测肌腱的最大抗拉力和达到最大力点的功耗。结果 最大抗拉力：改良Kessler法组在术后第10天降到最低点，术后14d恢复到术后即刻的水平。Tsuge法组在术后4d开始降低，术后21d还未恢复到即刻水平。达到最大力点的功耗：Tsuge法组在术后即刻和1d、7d比改良Kessler法组高；但在术后4d(Tsuge法组)和7d(改良Kessler法组)开始，就比术后即刻显著下降并持续到术后21d。结论 肌腱缝合后早期两种缝合方法的生物力学变化并不相同，对修复后的肌腱施加拉力直至拉断时所需的能量随术后时间的增加呈进行性下降。     

指屈肌腱双环圈套缝合法的实验研究与临床应用

肌腱修复后早期活动要求缝合部必须有足够的抗张强度。。为了满足主动活动的要求,作者设计了一种新的肌腱缝合方法:双环圈套缝合法。用人离体肌腱将该方法与改良Kessler法,Bunnell法,Tsuge法进行生物力学比较,表明该方法有抗张强高度、拉伸刚度高及不易出现间隙等优点。临床应用58例,获得满意效果。     

肌腱立体缝合法的实验研究

[目的]设计一种操作简单的新的肌腱缝合方法.[方法]40支leghom鸡爪随机分成4组,分别用Kessler法、Bunnell法、Tang法和立体缝合法修复鸡爪中趾Ⅱ区深屈肌腱,记录每组操作时间,生物力学测定仪测定不同缝合方法的最大负荷.[结果]立体缝合法最大负荷最大(P<0.05);缝合时间:除Kessler法缝合时间最短(P<0.05),其他三组比较差异无显著性意义(P>0.05).[结论]立体缝合法抗拉强度较大,可满足肌腱吻合术后早期主动活动的强度要求.     

五种肌腱缝合方法的生物力学研究

目的　通过比较5 种肌腱缝合方法的生物力学特性,以指导临床工作。方法　将新鲜成年猪后足50 只,随机分成5 组,解剖暴露第二趾深屈肌肌腱后,并在Ⅱ区横断,第1 组行改良Kessler缝合,第2 组行津下缝合,第3 组行双改良Kessler 缝合,第4 组行津下加双改良Kessler 缝合,第5 组行汤氏缝合。用Instron 力学测定仪测定每组缝合方法的2 m m 间隙形成的负荷、最大负荷及功耗,并行统计学分析(ANOVA) 。结果　汤氏缝合法的2 m m 间隙形成的负荷、最大负荷及功耗最大,改良Kessler 及津下缝合法最小。汤氏缝合法与其他4 组相比较统计学差异有显著性意义( P< 0 .01) 。结论　汤氏缝合法修复的肌腱抗张强度最大     

屈肌腱损伤后愈合早期粘连功耗变化的实验研究

目的探讨在术后不同时间拉断粘连带所需功耗的变化特点。方法分别以改良Kessler法和Tsuge法缝合三黄鸡的第3趾趾深屈肌腱各42条,于术后即刻、1、4、7、10、14、21d取材,将肌腱标本进行生物力学测试,测试内容包括趾深屈肌腱完成屈曲动作的滑动距离,拉断粘连带的功耗。测试结束后,检查肌腱缝合口与周围组织的粘连带是否被完全拉断。结果拉断粘连带的功耗：改良Kessler法在术后7、10、14d组较术后即刻,1、4d组显著增高,术后21d组较术后即刻和术后1d组显著增高;Tsuge法在术后10d以后各组较术后7d以前各组显著增高;改良Kessler法只在术后7d较Tsuge法显著增高。术后21d,粘连带不能被完全拉断。结论术后7～10d,肌腱滑动克服粘连带所需的功耗开始逐渐增加;术后21d,趾深屈肌腱完全屈曲并不能有效的拉断粘连带。     

改良津下缝合法即刻生物力学实验和在动物模型中的应用

目的比较津下缝合法改良前后在肌腱修复后的即刻生物力学特征,研究肌腱修复后的局部病理学变化及其变化规律。方法将80只成年三黄鸡右足第3趾Ⅱ区建立趾深屈肌腱横断模型,随机分为4组,每组20只。将A1组(采用津下缝合法)、A2组(采用改良津下缝合法)修复好的肌腱等速拉伸至完全断裂,并用电子万能试验机测定2 mm间隙形成负荷、极限载荷、韧度、最大断裂应力。将B1组(采用津下缝合法)、B2组(采用改良津下缝合法)修复好的肌腱石膏固定4周,处死动物后获取标本,记录缝合时间、观察肌腱粘连度、进行羟脯氨酸含量和Ⅰ、Ⅲ型胶原蛋白的测定。结果 (1) 2 mm间隙形成负荷、极限载荷、最大断裂应力A1组与A2组比较差异均有统计学意义(P 0. 05)。韧度A1、A2组比较差异无统计学意义(P 0. 05)。A1组的切割发生率为10%,缝线断裂部位是最后打结处的单线; A2组的切割发生率为0,缝线断裂部位是"+"形状的缝线。(2) B1、B2组缝合时间比较差异无统计学意义(P 0. 05)。B1组吻合端瘢痕较B2组明显; B1、B2组腱周粘连度分级比较差异有统计学意义(P 0. 05)。羟脯氨酸含量、每高倍镜视野下Ⅰ、Ⅲ型胶原所占的百分比B1、B2组比较差异均有统计学意义(P 0. 05)。结论改良津下缝合法是一种可靠的肌腱修复方法。     

锁式肌腱缝合的生物力学研究

目的本实验通过比较Strickland、Augmented Becker、Savage及Tang法四种锁式缝合的生物力学特性,以期指导临床肌腱修复.方法将40根新鲜成年猪后蹄Ⅱ区屈肌腱随机分成4组,分别用Strickland、Augmented Becker、Savage及Tang法进行修复.用材料力学测定仪测定2-mm间隙形成负荷、最大负荷、弹性模量及断裂功耗,同时记录中心缝合的操作时间.结果Tang法的2-mm间隙形成负荷、最大负荷、断裂功耗与Savage法相近,弹性模量为各组中最高,中心缝合的操作时间明显短于Augmented Becker及Savage法.结论Tang法能提供较大的抗张强度、有效抵御间隙形成、操作简便,有利于肌腱早期活动.     

A biomechanical study of Tang's multiple locking techniques for flexor tendon repair

This study was designed to biomechanically compare Tang's multiple looped locking techniques with various suture techniques for flexor tendon repair in the hand. Fifty flexor digitorum profondus tendons taken from pig toes were used as models; The tendons were transected in the middle part of zone 2 defined as the area beneath bifurcation of the flexor digitorum superficialis tendons, and were repaired by five different suture methods: (1) modified Kessler, (2) Tsuge's suture, (3) double Kessler, (4) modified Kessler plus Tsuge, and (5) Tang's suture. The repaired tendons were placed in an Instron tensile testing machine to determine the tensile properties of the repair. 2 mm gap formation force and ultimate tensile strength were measured during the test. Maximal work to failure were calculated according to area under the load-displacement curve of the test. 2 mm gap formation force was 21.5 N for the Kessler, 20.6 N for the Tsuge, 31.6 N for double Kessler, 30.9 N for the Kessler plus Tsuge and 41.4 N for the Tang. Ultimate tensile strength was 23.5 N for the Kessler, 22.9 N for the Tsuge, 34.5 N for the Kessler plus Tsuge and 45.6 N for the Tang. Statistically, Tang's suture had the greatest gap formation force, ultimate strength and energy for failure among the five techniques (p < 0.01 or p < 0.001). Gap formation force, ultimate strength and energy to failure for double Kessler or the Kessler plus Tsuge were significantly greater than those for the Kessler or the Tsuge (p < 0.05 or < 0.01). The tendons repaired by Tang's method tolerated a significantly higher tensile load (133 to 198% of the other techniques) than the other methods. Among the methods tested, Tang's multiple looped locking suture provides sufficient gap resistance and tensile strength that may be able to withstand early active mobilization after primary flexor tendon repair.     

A biomechanical analysis of the modified Tsuge suture technique for repair of flexor tendon lacerations

Thirty-six flexor tendons from fresh frozen cadavers were randomized to three types of repairs: a Kessler-Tajima, a 4-strand modified Tsuge, and a 6-strand modified Tsuge. All repairs were accompanied by a standard epitendinous suture. The repaired tendons were then tested to initial gap and ultimate failure in an Instron machine. The average forces to ultimate failure were 31.8 N (SD, 8.8), 48.4 N (SD, 10.7), and 64.2 N (SD, 11.0) respectively. The 6-strand modified Tsuge suture was significantly stronger than the other repairs and the 4-strand modified Tsuge was significantly stronger than the 2-strand Kessler-Tajima. The 6-strand and 4-strand modified Tsuge repairs appear strong enough to withstand the forces generated during early active range of motion flexor tendon rehabilitation protocols. Clinical trials are required to evaluate the usefulness of these repairs.     

指屈肌腱IIc亚区损伤的修复

目的探讨IIC亚区指屈肌腱损伤的治疗方法和疗效。方法对32例38指67条肌腱采用汤氏法或双津下法缝合,进行早期修复,并行早期功能锻炼。结果本组随访时间4个月～2年半,平均8个月,采用TAM评定标准评价疗效,优良率为73.7%。结论对于整齐轻度损伤的指深、浅屈肌腱,可以同时修复;而不整齐、比较严重的损伤,则可采用切除指浅屈肌腱只缝合深屈肌腱的方法。     

In vitro biomechanical analysis of suture methods for flexor tendon repair

This study was designed to compare five different suture methods that are used clinically for tendon repair. The flexor digitorum profundus tendons from the digits of adult mongrel dogs and adult human cadavers were used as models. The tendons in zone II of the hand, defined as the region from the distal palmar crease to the insertion of the flexor digitorum superficialis tendon at the middle phalanx, were transected and then were repaired by one of the suture methods developed by Kessler, Tsuge, Tajima, Savage, or Lee. The gliding function and tensile properties of the repaired tendons were evaluated biomechanically at time zero. The Tajima and Savage methods produced better gliding function than the other techniques. In the canine specimens that had been repaired by one of these two methods, the rotation of the distal interphalangeal joint was more than 60% of the rotation of the canine control specimens; only the Savage technique produced a rotation 124% that of the human control specimens. After the Tajima repair, the rotation of the proximal interphalangeal joint was 113% that of the canine control specimens and 157% that of the human controls. In the canine specimens that had had the Tajima or Savage repair, excursion of the tendon was greater than 55% that of the controls. The tendons repaired by the Savage method tolerated a significantly higher ultimate load to failure (14 and 25% that of the canine and human control specimens, respectively) than the other methods. Of the suture methods that were tested, the Savage technique provides sufficiently satisfactory gliding function and has enough initial stiffness and strength that it may be able to withstand early active mobilization following primary repair of flexor tendons.     

Comparative biomechanical performances of 4-strand core suture repairs for zone II flexor tendon lacerations

To compare the biomechanical performances of six 4-strand flexor tendon repairs at zone II, we used an in situ testing model in 54 cadaver profundus tendons. The techniques studied were the modified Becker, modified double Tsuge, Lee, locked cruciate, Robertson, and Strickland. Prerepair and postrepair comparisons for work of flexion to a 3.9-N pulp pinch (equal to 12.6 N tendon force) showed the greatest interference to gliding in the modified Becker repair and the least in the modified double Tsuge repair. Mean gaps after 1,000 load-unload cycles to a 3.9-N pulp pinch did not approach the clinically important limit of 3 mm in all groups. Ultimate tensile strength was highest in the modified Becker (69.4 +/- 8.2 N) but not significantly higher than the modified double Tsuge (60.3 +/-15.3 N) and locked cruciate (64.1 +/- 16.2 N). In all repair groups the mean pulp pinch forces upon failure were well above values recommended for active mobilization protocols that use external load guides. The locked cruciate, modified double Tsuge, and modified Becker repairs were strong enough for an early active motion protocol after surgery. Locked cruciate and modified double Tsuge were easier to perform and provided less interference to tendon gliding than the modified Becker repair.     

A new method in tendon repair: angular technique of interlocking (ATIK)

BACKGROUND: The risk of adhesion following flexor tendon repair, despite provision of rehabilitation by mobilization of the tendon with passive exercises without the risk of rupture, is not negligible. Active mobilization of tendons has recently been more frequently recommended to prevent adhesions of tendons. The tendon repair zone, which should withstand active traction forces, should maintain its strength until complete recovery of the tendon. For this purpose, a new treatment method named angular technique of interlocking (ATIK) has been developed. This method was compared with the Modified Kessler method, in vivo and in vitro. MATERIALS AND METHODS: In four groups, each consisting of 10 chickens, severed flexor tendons repaired with the Modified Kessler and ATIK techniques were compared for biomechanical properties. RESULTS: Although there were no differences between these techniques in vitro, this new technique's superiority was statistically significant in in vivo studies. CONCLUSIONS: The second and third postoperative weeks are periods during which the number of fibroblasts and the amount of collagen are the highest. In these periods, edema resolves and sutures begin to loosen. In this situation, the force withstanding the active movements is the support of the suture materials and the degree of recovery of the tendon. Following this recommended suture technique and active movements, the healing potential of the tendon increases and the risk of tendon rupture owing to decrease in the force exerted per unit area decreases.