三种缝合方式对猪蹄趾屈肌腱断裂修复强度的比较研究

Biomechanical comparision of three different flexor tendon repair methods using pig’s feet

目的对猪蹄趾屈肌腱建模,比较研究传统的两股核心缝线缝合方式(改良Kessler+连续缝合)与四股核心缝线缝合方式(双重改良Kessler+连续缝合)、六股核心缝线缝合方式(三重改良Kessler+连续缝合)修复屈肌腱断裂术后强度的差异。方法对15只猪蹄(30趾)模拟屈肌腱断裂建模后,分别采用改良Kessler+连续缝合、双重改良Kessler+连续缝合以及三重改良Kessler+连续缝合的方式修复其屈肌腱,术后测定比较修复后的最大抗拉力、缝合时间、费用及光滑性。结果两股核心缝线缝合方式修复的猪蹄趾屈肌腱最大抗拉力为(31.69±3.66)N;四股核心缝线缝合方式修复的猪蹄趾屈肌腱最大抗拉力为(47.55±2.68)N;六股核心缝线缝合方式修复的猪蹄趾屈肌腱最大抗拉力为(64.38±3.70)N(P<0.05),差异有统计学意义。两股核心缝线缝合方式修复时间平均(637.8±27.98)s;四股核心缝线缝合方式修复时间平均(903.2±21.49)s;六股核心缝线缝合方式修复时间平均(1434.0±77.40)s(P<0.05),差异有统计学意义。两股核心缝线缝合方式平均费用(327.17±8.33)元;四股核心缝线缝合方式平均费用(400.89±5.97)元;六股核心缝线缝合方式平均费用(598.33±21.50)元(P<0.05),差异有统计学意义。三种方式修复术后屈肌腱光滑程度均较满意。结论六股、四股核心缝线缝合方式缝合的猪蹄趾屈肌腱抗拉力强度明显优于传统两股核心缝线缝合方式。为满足屈肌腱断裂修复术后早期功能训练的需要,六股、四股核心缝线方式更为推荐,理论上预后更好。

Objective To find the best method of flexor tendon repair,we compared the postoperative breaking strength between the traditional two-strand method and the four-strand method and the six-strand method using pig's feet.Methods Thirty pig flexor tendons were repaired with three different repair methods.The strength of the repaired tendons,the suture time,the repair cost and the tendon smoothness were measured and were analyzed statistically.Results The breaking strength of flexor tendons repaired by two-strand method were(31.69±3.66)newton,the breaking strength of flexor tendon repaired by two-strand method were(47.55±2.68)newton,and the breaking strength of flexor tendons repaired by six-strand method were(64.38±3.70)newton.There were significant differences between hree methods.The suture time of flexor tendons repaired by two-strand method were(637.8±27.98)seconds,the suture time of flexor tendons repaired by four-strand method were(903.2±21.49)seconds,and the suture time of flexor tendons repaired by six-strand method were(1434.0±77.40)seconds.There were significant differences between three methods.The cost of flexor tendons repaired by two-strand method was(327.17±8.33)yuan,the cost of flexor tendons repaired by four-strand method was(400.89±5.97)yuan,the cost of flexor tendons repaired by six-strand method was(598.33±21.50)yuan.There were significant differences between three methods.The three methods have no apparent differences in smoothness.Conclusion The breaking strength of flexor tendons of pig feet repaired by the six-strand method and the four-strand method is significantly stronger than that by the traditional two-strand method.The six-strand method and the four-strand method are more recommended for repairing the flexor tendon injury,cases of which have enough strong breaking strenghth and we can then choose active rehabilitation program to get better function.