膝十字韧带移植重建术中韧带末端缝合固定的生物力学研究及临床应用

Biomechanical study of the suture strength of cruciate ligament and it's clinical application

目的研究膝十字韧带移植重建术中韧带末端缝合固定的方法及固定强度。方法将24条带髌骨的髌韧带标本分为3组,对其末端分别采用Krackow双锁边缝合法缝合2针、3针,缝合材料为Ethilon缝线及直径0.4mm钢丝,对样本分别进行拉伸力学检测以比较强度,探讨最佳的缝合针数和方法并应用于临床。结果Krackow双锁边缝合法缝合2针,缝合点固定强度超过钢丝材料的破坏强度;用缝线缝合2针的强度达到80N以上,超过缝线材料的破坏强度;将第一针贯穿韧带缝合,不降低固定强度。根据实验结果,将改良的Krackow双锁边缝合法临床应用17例,加速了术后早期康复,取得良好效果。结论Krackow双锁边缝合法缝合2针或3针的固定强度差别不大,差异无显著性意义,第一针贯穿韧带,可减少缝线裸露但不降低固定强度,均超过缝合材料破坏强度。若想增加固定强度,应从改进缝合材料强度和增加缝线数目着手,此缝合法临床应用可加速康复,固定可靠。

Objective To test the strength of different suture fixation of tendon or ligament end and evaluate appropriate stitches number in cruciate ligament reconstruction. Methods Twenty-four specimens of patellar tendon with free ends, which was, divided into 3 groups according 2 or 3 stitches and 6 subgroups using different suture materials, either with No1 Ethilon or 0.4 mm diameter stainless steel wire, fixed with Krackow locking stitch, the tensile test were undertaken respectively, so as to find out the least stitches and efficient suture pattern. Results Two Krackow locking stitches had more strength than that of 0.4 mm diameter stainless steel wire itself, the fixation strength of 2 stitches which used No1 Ethilon was more than 80 N, superior to the failure strength of material itself, it still maintained the same strength if the first stitch was across the tendon tissue transversely. On the basis of testing results, this modified stitches pattern was used in 17 cases, all could be well withstand an accelerated postoperative ROM rehabilitation program in clinical practice. Conclusion There is no significant difference between 2 and 3 Krackow locking stitches in suture strength statistically, the fixation strength is superior to the suture material, it can lessen the suture exposure when the first stitch is across the tendon tissue while maintains a comparable strength to other suture. If attempt to make a higher strength of suture, one should focus on selecting a stronger materials or adding the suture materials in number, therefore, a rapid early ROM rehabilitation is possible and reliable in practice.