改良式双套圈肌腱缝合法抗拉强度的生物力学特征

Biomechanical characteristics of tensile strength of modified double looped suture

目的:通过测量改良式双套圈肌腱缝合法和改良式Kessler缝合法的抗拉强度,了解一种肌腱新缝合法的生物力学特性。方法:实验于2004-12-08/18在中石油吉林石化公司分析测试所进行。采集新鲜成年男性尸体(家属自愿捐献)示、中指深屈肌腱标本22根,均切成两段,随机取一段切断以改良双套圈法缝合,另一段则切断以改良式Kessler法方法缝合,制成22对肌腱吻合模型。分为3组,在电子拉力实验仪上记录拉力曲线。①10mm/min速率组9对,以10mm/min速率进行慢拉实验。②500mm/min速率组8对,以500mm/min速率快拉。③1000mm/min速率组5对,以1000mm/min速率(频率约20～30次/min),300次20N峰值负荷,行疲劳试验。观察各组改良式Kessler和改良双套圈两种方法拉力曲线出现第一个拉力峰值(G);吻合口完全断裂前出现的最后一个拉力峰值(B)以及吻合口间隙值(D)。结果:22对肌腱吻合模型均进入结果分析。①10mm/min速率组中改良双套圈法G值、D值明显小于改良式Kessler,B值明显大于改良式Kessler[G值:(6.244±7.065),(12.000±2.442)N,P=0.000;B值:(26.989±7.304),(14.044±3.524)N,P=0.000;D值:(0.496±0.133),(7.711±1.082)mm,P=0.000]。②500mm/min速率组中改良双套圈法G值、B值明显大于改良式Kessler,D值明显小于改良式Kessler[G值:(19.738±5.446),(9.150±1.523)N,P=0.000;B值:(19.875±5.888),(9.588±1.825),P=0.001;D值:(0.629±0.195),(5.429±0.846)mm,P=0.000]。③1000mm/min速率组改良双套圈法肌腱的断裂率为0;改良式Kessler肌腱的断裂率为100%(5/5,P=0.008)。结论:改良双套圈法抗拉强度明显大于改良式Kessler,可做为其术后早期主动活动以防止粘连的依据之一。

AIM： To investigate the biomeehanical properties of a new suture of flexor tendon by measuring tensile strengths of modified double loop suture and modified Kessler＇ s. METHODS： The experiment was conducted in the Analytical and Testing Institute of PetroChina Jilin Petrochemical Company from December 8^th to 18^th 2004. Twenty-two fresh flexor profundus tendons of long fingers obtained from 6 adult cadavers （with the permission of the relatives） were divided into 44 tendon samples, which were lacerated and repaired by modified double loop suture and the modified Kessler suture respectively to make into 22 models of tendon anastomosis. The tendons were divided into 3 groups, and the tensile strength curve was determined with a tensile testing machine.①10 mm/minule group with 9 pairs of specimens, which were distracted at a rate of 10 mm/minute （Group 1）. ②500 mm/minute group with 8 pairs of specimens, which were distracted at a rate of 500 mm/minute （Group 2）. ③1000 mm/minute group with 5 pairs of specimens, which were distracted at a rate of 1000 mm/minutes for 300 times 300 times with the peak load of 20N and frequency of about 20-30 times/minute （Group 3）. The force required for gap formation （G）, the maximum failure load （B） and gap distance were recorded. RESULTS： A total of 22 pairs of tendon anastomosis models were involved in the analysis of results, ①The value of G and D by modified double loop suture in group 1 were significantly greater than those by modified Kessler suture [G value： （6.244±7.065）N, （12.000±2.442） N, P=0.000], [B value：（26.989±7,304）N, （14.044±3.524）N, P=0.000] and [D value （0.496±0.133） mm, （7.711±1.082） mm, P=0.000].②In group 2： the value of G and B by modified double loop suture were obviously greater than those of modified Kessler suture, while the D value was remarkably less than that of modified Kessler suture [G value： （19.738±5.446）N, （9.150±1.523） N, （P=0.000）], [B value： （19.875±5.888）, （9.588±1.825）, P=0.001] and [D value （0.629±0.195）,（5.429±0.8465） mm, P=0.000].③In group 3： no gap formation occurred in tendons of modified double loop suture, and all tendons of the modified Kessler suture failed. CONCLUSION： The tensile strength of modified double loop suture is significantly higher than that of the modified Kessler＇s. The modified double loop suture may decrease gap formation and tendon rupture with early mobilization after tendon repairing.