内置十字交叉法肌腱缝合技术的生物力学研究及其在Ⅶ区伸肌腱修复中的应用

Biomechanical Analysis of Embedded Cross-stitch Suture and Its Application on Extensor Tendon Repair in Zone Ⅶ

目的报道一种新的肌腱缝合方法——内置十字交叉法的生物力学特性,及其修复Ⅶ区伸肌腱损伤的初步临床应用结果。方法本研究采用33根猪后足的肌腱作为实验材料,随机等分成3组,分别用十字交叉法、内置十字交叉法及Halsted法进行修复。用Instron材料力学测定仪测定修复后肌腱的2-mm间隙形成负荷、断裂负荷、刚度和断裂功耗。用内置十字交叉法临床修复Ⅶ区伸肌腱断裂21例,共56指,术后均采用保护性主被动活动相结合的锻炼计划。采用Strickland标准进行功能评价。结果等速直线拉伸模式下,内置十字交叉法的2-mm间隙形成负荷为(49.2±5.6)N,断裂负荷为(68.3±6.3)N,刚度为(6.9±0.7)N/mm,断裂功耗为(0.79±0.07)J,均优于十字交叉法和Halsted法(P<0.05)。术后平均随访26个月,内置十字交叉法修复的Ⅶ区伸肌腱(56指)无一例发生断裂,根据Strickland TAM标准,优50指,良4指,可2指,优良率96.4%。结论内置十字交叉法具备良好的生物力学强度,外露缝线少,能满足伸肌腱早期保护性主被动活动的需要,是伸肌腱修复的理想选择。

Objective To investigate the biomechanical properties of embedded cross-stitch suture and its preliminary application for extensor tendon repair in zone Ⅶ. Methods Thirty-three fresh porcine extensor tendons were randomly divided into 3 groups and repaired with cross-stitch, embedded cross-stitch or Halsted suture method respectively. The tendons were subjected to an Instron tensile testing machine to test 2-mm gap formation force, ultimate strength, stiffness and energy to failure. Embedded cross-stitch was performed for repairing extensor tendons in zone V~ of 56 fingers. Protected passive and active motion protocol was used in each case after operation. Strickland TAM classification was applied to evaluate the function postoperatively. Results Under linear tension mode, embedded cross-stitch was superior to cross-stitch and Halsted method with its 2-mm gap formation force at （49.2±5.6） N, ultimate strength at （68.3±6.3） N, Stiffness at （6.9±0.7） N/mm, and energy to failure at （0.79±0.07） J （P〈0.05）. Patients were followed up for 26 months, no tendon rupture was observed in any of the repaired fingers. Strickland TAM classification showed excellent in 50 fingers, good in 4 fingers, fair in 2 fingers, and the total good rate was 96.4%. Conclusion Embedded cross-stitch suture employs strong biomechanical characters with fewer suture exposure, which can fulfill the requirements for early motion protocol. Therefore, it is suggested for extensor tendon repair.