屈肌腱缝合法之生物力学分析

A BIOMECHANICAL STUDY OF SUTURE TECHANIQUE FOR FLEXOR TENDON REPAIR

屈肌腱缝合之困难在于缝合之抗拉力太弱则容易拉断，为了避免拉断而过度限制病人活动又将导致粘连。因此寻求强有力之缝合法是屈肌腱缝合成功的因素之一。屈肌腱的手术缝合方法众多，本研究中测试四种基本之单边断端缝合法及由基本缝合法衍生出来的八种双端缝合法。虽各种方法之间略有差异，但以断端间跨越缝线数目之多寡对拉力之影响最为显著。二条跨越缝线之平均拉为１．７５ｋｇ，四条跨越缝线为３．０９ｋｇ，六条跨越缝线为４．５４ｋｇ。选用缝合法时需考虑跨越缝线之数目及缝合操作之可行性。

Early motion of the affected finger is essential to healing of repaired flexor tendon,but it may result rupture if the tensile strength of the tendon is not great enough to sustain pulling force.On the other hand, over protection by inhibiting finger motion, the repaired tendon tends to adhere to the surrounding tissue.A good strong suture should be tight and secure against rupture and concomittently allow early motion of the finger. In this study we compared 4 basic suture techniques on one tendon end and eight both ends tendon suture technique as derived from basic methods.Although there are some differences between groups the most significant factor is the number of strands between the repaired tendon ends. The mean tensile strength were 1.75,3.09 and 4.54 Kgs in each group of two, four and six strands. The selection of suture technique depends on number of strands and clinical feasibily.