几种屈肌腱缝合方法的即刻生物力学比较

Instant Biomechanical Study of Flexor Tendon Suture Techniques Common in Clinic

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、津下法,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。

Objective Compare the instant biomechanical characteristics of different tendon suture techniques employed in clinic. Methods Sixty claws of adult AA white-pinna fowl were randomly divided into six groups. After sharp transsection of the flexor digitorum profundus tendons （FDP） in zone Ⅱ ,Modified Kessler , Modified K＋Running, Cruciate＇s ,Tsuge＇s,Modified Tsuge＇s and TangOs methods were employed to repair the tendons respectively. Cut off the repaired tendons immediately and measured the extreme load ,strain ,calculated the ultimate tensile strength, stiffness ,elastic modulus and breaking energy consumption, recorded the running time and breaking style. Results TangOs method was the strongest repair with the significantly greatest ultimate tensile strength on maximum extreme load. Its stiffness and elastic modulus as well as the breaking energy absorption were significantly greater than that of the other five methods （P〈0. 05）. While modified Kessler has the poorest parameters and biomechanical properties （P〈0. 05）. Tsuge＇s and modified Kessler have the shortest operation time. Conclusion Modified Kessler with running technique can provide better mechanical properties with smooth repair site. Tang＇s method can provide the great： est strength. It is safe tO do active or passive exercises early after applying Tang＇s method.