三种屈肌腱缝合方法的生物力学研究

摘要

Objective To perform biomechanical analysis of three flexor tendon suture techniques.Methods A total of 24 porcine flexor digitorum profundus tendons were harvested and randomly divided into 3 groups.The tendons were transversely cut and then repaired using 3 different techniques including Modified Kessler suture,Interlock Stitch Ten-don suture and Semi Kessler-Loop lock suture.All of them were combined with running suture.The time required for suturing was recorded and compared among the groups.The 2 mm gap load,the ultimate failure load and the gap at fail-ure were compared.Results Results showed that,in comparison with Modified Kessler suture,Interlock Stitch Tendon suture and Semi Kessler-Loop lock suture could significantly improve the 2 mm gap load and the ultimate failure load of tendon repair.The 2 mm gap load was not significantly different between Interlock Stitch Tendon suture(58.8±8.1)N and Semi Kessler-Loop lock suture(53.7±6.0)N.The ultimate failure load of Interlock Stitch Tendon suture(72.7±6. 0)N was greater than Semi Kessler-Loop lock suture(60.4±6.6)N,while Modified Kessler suture(46.5±4.5)N was the lowest.The gap at failure was the largest in Semi Kessler-Loop lock suture(8.5±1.3)mm.The time spent in per-forming Modified Kessler suture(11.1±1.4)min was shorter than in performing Interlock Stitch Tendon suture(15.4± 1.1)min and Semi Kessler-Loop lock suture (15.8±0.9)min.Conclusion In comparison with Modified Kessler suture and Semi Kessler-Loop lock suture,Interlock Stitch Tendon suture can remarkably improve the biomechanical proper-ties of tendon repair and effectively prevent gap formation,which could be useful in clinical applications.%目的：比较三种不同屈肌腱缝合方法的生物力学性能及操作时间，寻找一种不仅具有良好生物力学性能而且有利于临床推广的屈肌腱缝合方式。方法选取猪后足屈趾深肌腱作为实验对象，共24个，随机分为3组。横行切断肌腱后，分别采用改良 kessler缝合、内锁缝合、半结锁定式缝合三种不同缝合方式并结合连续周边缝合将肌腱断端进行缝合，记录操作时间，并对修复肌腱进行生物力学测试，测定修复肌腱的2 mm裂隙抗张强度、断裂抗张强度和断裂间隙。结果与改良 kessler缝合相比，内锁缝合与半结锁定式缝合均能显著提高修复肌腱的2 mm裂隙抗张强度和断裂抗张强度。内锁缝合的2 mm裂隙抗张强度（58．8±8．1）N与半结锁定式缝合（53．7±6．0）N没有明显差异，而断裂抗张强度（72．7±6．0）N明显大于半结锁定式缝合（60．4±6．6）N。内锁缝合与改良 kessler缝合的断裂间隙无明显差异，两者均小于半结锁定式缝合（8．5±1．3）mm。与改良 kessler缝合（11．1±1．4）min相比，内锁缝合（15．4±1．1）min与半结锁定式缝合（15．8±0．9）min的操作时间均较长，而两者之间无明显差异。结论与改良 kessler缝合和半结锁定式缝合相比，内锁缝合具有更好的生物力学性能并有效阻止间隙形成，更值得临床应用推广。