对五种不同缝合方法在肌腱愈合中的动态生物力学观察

Dynamic biomechanical observations of healing process of tendon repaired by five different suture techniques

目的观察5种不同缝合方法在肌腱愈合不同阶段的生物力学特点，为临床肌腱修复提供参考。方法在成年雌性海兰褐蛋鸡双足2到4趾Ⅱ区建立趾深屈肌腱横断模型，用单线改良Kessler（MK）法、Kessler＋Running（K＋R）法、双线改良Kessler（DK）法、双套圈（DT）法、改良双套圈（MT）法修复，分别于术后第3天、第3周开始主、被动功能锻炼。于术后即刻、第14、21、35天分批处死动物，获取标本，行生物力学检查。结果解剖学所见：断裂发生率，K＋R法〈MK法（P〈O．05）；优良率，K＋R，DK法〉DT法。生物力学测试结果：第35天MK法的极限强度与MT、DT法无统计学差异，余时间段MK法的各项生物力学结果最小（P〈0．05）；K＋R法各时段的极限载荷和极限拉伸强度最大（P＜0．05）；各缝合方法力学参数均符合：术后第35天〉术后第21天〉术后第14天（P〈0．05）；术后第14天和术后即刻相比，各结果无统计学差异。结论肌腱修复过程中，术后第14天各生物力学参数恢复至术后即刻水平，随后逐步增强。K＋R法缝合在肌腱愈合的各阶段，生物力学性能优于其他几种缝合方法，其断裂发生率低，是一种强度大、有效减少断裂和粘连的肌腱吻合方法。

Objective To observe the biomechanical properties of tendons repaired by five suture techniques in different stage of healing process. Methods After establishing the zone 11 FDP transection model in 2nd, 3rd, 4th toe of both feet in female fowls, the ruptured tendons were repaired with Modified Kessler（MK）, Kessler plus running（K＋R）, double-strand Kessler（DK）, double loop（DT） and modified double loop （MT） methods, respectively. Passive and active mobilizations were applied on the 3rd day and 21st day postoperatively. Animals were executed postoperatively, on the 14th, 21st and 35th days, respectively and both feet were harvested for biomechanical test. Results Anatomical findings included： The breakage incidence of K ＋R group was smaller than that of MK group. The excellent and good results of K ＋R and DK groups were higher compared with that of MK group. Biomechanical results showed： The MK group had the poorest biomechanical results in every stage of tendon healing （P〈0.05） except that the results from MK group on the 35th showed no statistical difference compared with that of MT and DT in extreme load; K＋R group exbited the greatest extreme load and tensile strength （P〈0.05）; Biomechanical test results from all groups showed significant differences on different testing point： 35th day〉21st day〉14th day （P〈0.05）; No significant differences were found in all groups between the immediate postoperative results onlst day and that from 14th day. Conclusion During the recovery of tendon, biomechanical properties returned to the immediate postoperative level on the 14th day and increased along with time. K＋R group shows the superiority to the other methods in biomechanical properties as well as low breaking incidence rate in every stage of tendon healing. Kessler plus running is an effective method with high strength against breakage and great resistance to adhesion formation