两种肌腱缝合方法的对比研究

目的 对两种肌腱缝合方法的生物力学特性进行对比研究,为临床肌腱修复术对缝合方法的选择提供理论依据.方法 收集30根完整的废弃肌腱,随机分为两组,从中间锐性切断.A组:采用新创ZM缝合法缝合肌腱;B组:采用改良Kessler缝合法缝合肌腱,缝合后立即进行生物力学测试.测定2mm间隙形成负荷、最大负荷、最大间隙、断裂方式,计算所修复肌腱的强度,所得数据进行统计学分析.结果 A组的2mm间隙形成负荷为(46.13±1.57)N、最大负荷为(57.18±1.84)N、强度为(8.45±0.34) N/mm,均大于B组的2 mm间隙形成负荷(15.02±0.67)N、最大负荷(28.63±1.95)N、强度(2.47±0.22) N/mm;A组的最大间隙(6.77± 0.29)mm小于B组的最大间隙(11.62± 0.94) mm;A组的缝线抽出率(0)小于B组缝线抽出率(100％).结论 ZM缝合法具有良好的抓持作用和强大的抗张力强度,可以满足屈肌腱修复术后早期无抗阻主动功能锻炼的需要.     

采用不同缝线及缝合位点缝合内侧半月板后根部损伤的生物力学研究

目的:比较不同高强度缝线及不同缝合位点缝合固定内侧半月板后根部损伤的生物力学特性.方法:取新鲜猪(雌性,月龄5～9个月,平均7个月)膝关节内侧半月板标本48个,采用Mason-Allen缝合方法建立实验模型.根据缝合位点不同随机分为红区固定组、红-白区固定组,每组24例.再根据固定材料不同将每组随机分为3个亚组,每组8...     

关节镜下经肌腱缝线桥技术治疗肱骨大结节骨折

目的:探讨关节镜下经肌腱缝线桥技术治疗肱骨大结节撕脱性骨折的临床疗效。方法 :自2014年3月至2020年3月采用肩关节镜下经肌腱缝线桥技术治疗39例肱骨大结节撕脱骨折患者,男22例,女17例;年龄23～67(46.0±11.9)岁,病程3～11(3.9±2.4) d。分别于术前、术后12个月采用Constant-Murley肩关节功能评分及加利福尼亚大学洛杉矶分校(University of California,Los Angeles,UCLA)肩关节评分评估临床疗效。结果:所有患者获得随访,时间8～21(11.5±3.8)个月。骨折愈合时间2～4(3.3±0.9)个月。所有患者术后未出现切口愈合不良、关节粘连等并发症。Constant-Murley评分由术前的(56.20±1.50)分提高至术后12个月的(94.80±2.60)分(t=-55.42,P<0.01);其中优38例,良1例。UCLA评分由术前的(9.24±1.48)分提高至术后12个月的(32.82±1.37)分(t=-65.67,P<0.01);优37例,良2例。结论:肩关节镜下经肌腱缝线桥技术治疗肱骨...     

兔颈动脉无缝线胶黏吻合与传统缝线吻合的对比研究

目的　对比研究兔颈动脉无缝线胶黏吻合与传统缝线吻合的手术操作情况和吻合口通畅情况。方法　将 16只新西兰大白兔随机分为对照组和实验组 ,记录每个吻合口的吻合时间及出血量 ,术后 1、2、4、12周分别取材观察其通畅情况 ,并对吻合口内膜增生情况行病理切片和计算机图像分析。结果　与对照组相比 ,实验组的手术时间明显缩短 [(8.19± 6.5 1)min比 (2 0 .5 0± 14 .3 5 )min] ,术中出血量明显减少 [(2 .44± 5 .83 )ml比 (10 .3 8± 17.49)ml] ,通畅率也较高 (93 .8%比87.5 % ) ,内膜增生程度明显减轻 ,术后 1、2、4、12周时其内膜厚度分别降低了 3 1.4%、2 4.5 %、2 3 .9%和 3 1.9% (P <0 .0 1) ,其内膜面积分别降低了 3 6.2 %、2 9.1%、3 1.3 %和 40 .0 % (P <0 .0 1)。结论　中小血管的无缝线胶黏吻合较传统的缝线吻合操作省时省力 ,术中出血少 ,避免了缝针和缝线对血管吻合口处的透壁性损伤 ,消除了缝线等异物对管壁的持续性刺激所致的增生性反应 ,使吻合口处内膜增生减轻 ,吻合口通畅率提高。     

介绍一种缝合新材料——可吸收缝线的临床应用

介绍一种缝合新材料──可吸收缝线的临床应用邹声泉合成可吸收性缝线在外科临床的广泛应用是现代外科技术中的一项重大革新。这类缝合线以Ｄｅｘｏｎ（聚羟基乙酸线）为主要代表，动物实验和临床应用研究的结果表明，它具有满意的抗张力强度、良好的操作性能，并具有材料...     

衍生肌腱支架材料的细胞相容性研究

目的 探讨衍生肌腱支架材料（tendon derivation biomaterials，TDBM）与肌腱细胞的细胞相容性及肌腱细胞在此三维支架上培养的生物学行为，为肌腱组织工程新型支架材料的应用提供依据。方法将肌腱细胞与TDBM体外复合培养，设置单纯肌腱细胞培养为对照组，进行形态学观察，并检测细胞增殖、细胞周期、细胞DNA倍体水平及肌腱细胞凋亡率。通过^3H-脯氨酸（^3H-Proline）掺入试验了解材料对肌腱细胞胶原合成的影响。结果 肌腱细胞在TDBM上呈梭形生长，TDBM组细胞第2天进入对数增长期，倍增时间为3d，而单纯肌腱细胞培养对照组倍增时间为3．75d。TDBM组与单纯肌腱细胞培养对照组比较，^3H-Proline掺入值差异无统计学意义（P〉0．05），说明细胞功能未受影响。与支架材料复合培养的肌腱细胞DNA指数为0．96，增殖指数较对照组高10．1％，提示肌腱细胞在三维胶原支架上生长速度快，增殖能力强。结论TDBM具有良好的细胞相容性，可作为肌腱细胞的有效载体应用于组织工程化肌腱的构建。     

聚酯缝线联合锁骨钩钢板1期治疗肩锁关节脱位疗效分析

[目的]探讨5号聚酯缝线联合锁骨钩钢板治疗肩锁关节脱位的临床疗效.[方法] 2010年9月～2012年9月间收治RockwoodⅢ～Ⅴ型肩锁关节脱位患者32例,应用锁骨钩钢板复位肩锁关节,4股5号聚酯缝线经锁骨、喙突,无张力状态下缝合喙锁韧带残端.所有患者采用视觉类比评分(VAS)、HSS肩关节评分系统及Constant -Murley评分.[结果]术后切口愈合好,无臂丛神经损伤、感染及内固定物断裂等并发症的出现.32例获得随访,随访时间6 ～ 20个月,平均16个月,VAS评分为(0.94±0.88)分;HSS评分为(86.44±8.94)分;Constant-Murley评分为(87.72±5.21)分.本组优17例,良13例,一般2例.[结论]5号聚酯缝线联合锁骨钩钢板治疗肩锁关节脱位,可以有效避免喙锁韧带断端缝合后张力过大和缝线骨道内磨损,有利于喙锁韧带无张力下愈合.     

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     

脱细胞天然支架生物力学性能变化及预处理改善组织相容性的实验研究

目的观察脱细胞猪主动脉瓣的生物力学性能变化,探讨不同预处理改善天然支架组织相容性的效果。方法新鲜猪主动脉瓣经酶加去污剂法去除细胞,力学测试仪检测其最大负荷、最大应力、最大应变和弹性模量的变化,苏木精-伊红（HE）染色、Ⅰ型胶原免疫组化染色和扫描电镜观察其病理形态学变化;将脱细胞瓣膜分别予磷酸缓冲液、多聚赖氨酸和未灭活胎牛血清包被处理,然后种植大鼠主动脉肌成纤维细胞,甲基噻唑基四唑试验检测细胞黏附率,HE染色和扫描电镜观察形态学变化。结果酶加去污剂法能完全脱去瓣膜细胞,基本维持胶原纤维的空间结构,但其最大负荷、最大应力及弹性模量下降,最大应变上升（P〈0．05）;胎牛血清预处理去细胞瓣能显著提高肌成纤维细胞的黏附率,促进细胞生长、分化和增殖,并在瓣膜表面形成连续的细胞层（F值=129．26,P=0．000）。结论酶加去污剂法可较完全去除猪主动脉瓣膜细胞并保持细胞外基质的三维结构,但其生物力学性能有所下降;胎牛血清预处理能改善脱细胞瓣天然支架的细胞黏附、生长和繁殖。     

不同缝线实施无张力疝修补术的临床对比研究

目的观察运用两种不同缝线固定修补材料对疝修补术后的复发、切口感染、慢性疼痛等并发症发生情况。方法对2008年4月至2010年4月期间笔者所在科室收治的250例腹股沟疝患者行无张力疝修补手术时,采用多股丝线或可吸收合成缝线固定修补材料进行前瞻性对比研究。结果 2组患者术后疝复发、切口感染和切口疼痛(包括慢性疼痛)发生率间的差异均无统计学意义(P>0.05)。结论腹股沟疝无张力修补术后的复发、切口感染、慢性疼痛等并发症的发生与缝线选择无关。术者的操作技巧、严格的无菌操作原则、彻底止血以及组织损伤小才是防止术后感染、慢性疼痛等并发症发生的重要因素。     

Biomechanical trial of modified flexor tendon sutures: An in vitro study

Abstract

Proven benefits of early active mobilisation for intra-synovial flexor tendon repairs have inducted new criteria for a ‘perfect suture’. This study has examined different variations of modified Kessler's suture, which could fulfil the new criteria. A total of 93 swine extensor tendons were transected, repaired and tested using a dynamometer with constant rate of extension. The first part of study tested clinically the most used modified Kessler suture, a variation of double modified Kessler suture and intact tendons as a control group. Further variations in the second part of study were due to type of suture, location and number of the knots and type of peripheral suture. According to the results, the tested version of double modified Kessler suture with crossed peripheral suture was the strongest one among all tested variations. The ultimate force for the authors preferred modification of the double modified Kessler (DMK) is significantly higher than modified Kessler suture. The version of DMK with crossed peripheral suture is the strongest one among all tested variations. The lowest strength manifests variation with two knots between tendon ends. The variations with interlocked and outsided knot or monofilament tread are not statistically significant regarding ultimate force. The frequency of suture failure events (suture pull out or tendon and/or suture rupture) is equal respecting braided or monofilament suture. The preferred modification of the double modified Kessler (DMK) suture with crossed peripheral suture is the strongest one among all tested variations and could achieve, concerning range of force, early active mobilisation. Further variations due to the type of thread and location, type and number of the knots did not show statistical significance.     

A comparative analysis of the biomechanical behaviour of five flexor tendon core sutures

Five core suture techniques were compared by static tensile testing in vitro. Fifty porcine tendons were used. The core sutures were performed with 3-0 or 4-0 braided polyester suture (Ticron) and the over-and-over running peripheral sutures with 6-0 monofilament polypropylene (Prolene). The core sutures were: (1) Pennington modified Kessler (3-0), (2) Double Pennington modified Kessler (3-0), (3) 4-strand Savage (3-0), (4) 4-strand Savage (4-0), and (5) 6-strand Savage (4-0). Repairs were compared as paired in regard to one variable: the number of core suture strands, the suture calibre, or the suture configuration. Biomechanical differences between the repair groups started during the linear region, with the yield force and stiffness increasing along with the number of core suture strands. All three variables influenced the strain at the yield point. Thus, the strength of the intact repair can be improved by modifying the core suture. In all repairs gap formation started near the yield point after failure of the peripheral suture. The yield force represents the strength of the intact repair composite and should be considered the strength of the tendon repair.     

Systematic review of absorbable vs non-absorbable sutures used for the closure of surgical incisions

AIM: To report a systematic review of published randomized controlled trials (RCTs) investigating the role of absorbable suture (AS) against non-AS (NAS) used for the closure of surgical incisions.METHODS: RCTs investigating the use of AS vs NAS for the closure of surgical incisions were statistically analysed based upon the principles of meta-analysis and the summated outcomes were represented as OR.RESULTS: The systematic search of medical literature yielded 10 RCTs on 1354 patients. Prevalence of wound infection (OR = 0.97; 95%CI: 0.56, 1.69; Z = 0.11; P = 0.92) and operative morbidity (P = 0.45) was comparable in both groups. Nonetheless, the use of AS lead to lower risk of wound break-down (OR = 0.12; 95%CI: 0.04, 0.39; Z = 3.52; P < 0.0004).CONCLUSION: This meta-analysis of 10 RCTs demonstrates that the use of AS is similar to NAS for skin closure for surgical site infection and other operative morbidities. AS do not increase the risk of skin wound dehiscence, rather lead to a reduced risk of wound dehiscence compared to NAS.     

Comparison of the cheese-wiring effects among three sutures used in rotator cuff repair

Purpose:

The goal of this study was to compare the cheese-wiring effects of three sutures with different coefficients of friction.

Materials and Methods:

Sixteen human cadaveric shoulders were dissected to expose the distal supraspinatus and infraspinatus muscle tendons. Three sutures were stitched through the tendons: #2 Orthocord^™ suture (reference #223114, DePuy Mitek, Inc., Raynham, MA), #2 ETHIBOND* EXCEL Suture, and #2 FiberWire^® suture (FiberWire^®, Arthrex, Naples, FL). The sutures were pulled by cyclic axial forces from 10 to 70 N at 1 Hz for 1000 cycles through a MTS machine. The cut-through distance on the tendon was measured with a digital caliper.

Results:

The cut-through distance in the supraspinatus tendons (mean ± standard deviation, n = 12) were 2.9 ± 0.6 mm for #2 Orthocord^™ suture, 3.2 ± 1.2 mm for #2 ETHIBOND* suture, and 4.2 ± 1.7 mm for #2 FiberWire^® suture. The differences were statistically significant analyzing with analysis of variance (P = 0.047) and two-tailed Student''s t-test, which showed significance between Orthocord^™ and FiberWire^® sutures (P = 0.026), but not significant between Orthocord^™ and ETHIBOND* sutures (P = 0.607) or between ETHIBOND* and FiberWire^® sutures (P = 0.103).

Conclusion:

The cheese-wiring effect is less in the Orthocord^™ suture than in the FiberWire^® suture in human cadaveric supraspinatus tendons.

Clinical Relevance:

Identification of sutures that cause high levels of tendon cheese-wiring after rotator cuff repair can lead to better suture selection.