重建指屈肌腱鞘滑车方法的力学实验研究

Biomechanical study of flexor tendon pulley reconstruction

目的通过对移植肌腱重建A2滑车的不同缝合方法和宽度进行力学对比分析,为临床重建滑车提供理论依据。方法(1)选用60条新鲜人体指浅屈肌腱,随机分为10组,每组6条指浅屈肌腱。分别用缠绕肌腱一圈(宽0.5 cm)和缠绕两圈(宽1.0 cm)的方法重建直径为1.5 cm的A2滑车。两种宽度均选用Kessler、Tsugd、Bunnell、Kleinert、Koch-mason 5种方法缝合肌腱。肌腱缝合后在Css-44020型电子万能实验机上匀速直线拉伸,记录最大抗拉强度,并对该数据进行方差分析。(2)比较两种重建A2滑车的方法对屈肌腱滑动摩擦力的影响。结果所有重建滑车的断裂方式为缝线豁出,无缝线断裂。(1)5种缝合方法中,用指浅屈肌腱缠绕一圈重建A2滑车中,Tsugel法的平均最大抗拉强度为41.65N,大于其他4种方法,两者差异有统计学意义(P<0.05)。(2)用指浅屈肌腱缠绕两圈重建A2滑车法中,Tsugel法的平均最大抗拉强度为221.47N,大于其他4种方法,两者差异有统计意义(P<0.05)。(3)用指浅屈肌腱缠绕两圈重建A2滑车法比缠绕一圈的方法对指屈肌腱的摩擦力小,两者差异有统计学意义(P<0.05)。结论(1)5种缝合方法中,Tsugel法重建A2滑车的最大抗拉强度最大。(2)用指浅屈肌腱重建A2滑车缠绕两圈法的最大抗拉强度较缠绕一圈的最大抗拉强度大。(3)用指浅屈肌腱缠绕两圈重建A2滑车法对指屈肌腱的滑动摩擦力小于缠绕一圈重建滑车法,并在一定程度上克服了对指屈肌腱的绞勒作用。

Objective To analyze the biomechanical properties of A2 pulley reconstruction using different suture methods and different widths of tendon graft and provide theoretical basis for clinical reconstruction. Methods Sixty pieces of flexor digitorum superficialis tendon were divided into 2 groups and 5 subgroups, with 6 pieces each. The A2 pulleys were reconstructed by making a single loop （0.5 cm wide） or double loops （1.0 cm wide） with 1.5 cra diameter. 5 kinds of different suture techniques were used to reconstruct the A2 pulley： Kessler, Tsugel, Bunnoll, Kleinert and Koch-mason. An Instron C, ss-44020 testing machine was used to test failure load of the five suture methods. At the same time, gliding friction was recorded and comparison was made between pulley reconstruction with 0.5 cm width and with 1.0 cm width using ANOVA two-way analysis of variance. Results Pulley reconstruction failure was caused by suture cutting through the tendon. There was no suture rupture. Tsugel method had the greatest failure load among five groups. The average failure load was 41.65 N when the pulley was reconstructed by a single loop （0.5 cm） of flexor digitorum superficialis tendon. The average failure load was 221.47 N when the pulley was reconstructed by double loops （ 1.0 cm） of flexor digitorum superficialis tendon. Reconstruction of A2 pulley by two loops of tendon graft caused smaller gliding friction than single loop reconstruction. Conclusion Tsugel method has the greatest failure load among 5 suture methods. Double loop tendon graft for A2 pulley reconstruction results in bigger tensile strength and smaller gliding friction. The wider construct also causes less constriction to the flexor tendon.