屈肌腱中心缝合与周边缝合顺序的生物力学研究

发布时间：2018-05-15 07:27

本文选题：肌腱 + 缝合　；参考：《吉林大学》2015年硕士论文

【摘要】：研究背景和目的肌腱缝合方法一般分为中心缝合和周边缝合两种，现认为中心缝合联合周边缝合是行之有效的肌腱修复方式，而两种方式的先后缝合顺序所提供的强度是否有差异，国内外报道甚少。现采用体外模拟实验进行中心缝合和周边缝合顺序强度差异的生物力学研究，明确在同等条件及缝合方法时可提供更大抗张强度的缝合方式顺序，减少术后肌腱断裂的发生，有利于术后的早期主动功能锻炼，为临床屈肌腱修复提供理论依据。材料和方法将48只新鲜成年猪前蹄第2趾趾深屈肌腱造成切割伤，每个样本均采用中心缝合与周边缝合2种缝合方式，中心缝合选用改良Kessler法和Cruciate法，周边缝合选用Running法和Cross-stitch法，交叉组合成4组，每组按先中心缝合和先周边缝合分为2小组，每小组6个样本。记录缝合时间，术后即刻应用力学测定仪测定修复肌腱的2mm间隙力，最大负荷，，根据位移-负荷曲线计算刚度，并行统计学分析。结果改良Kessler+Running组、改良Kessler+Cross-stitch组和Cruciate+Cross-stitch组中先周边缝合组的2mm间隙力明显高于先中心缝合组（P＜0.05）。周边缝合选用Cross-stitch法时先周边缝合组最大负荷高于先中心缝合组，而在周边缝合选用Running法时最大负荷无显著性差异。无论选择何种周边缝合时2mm间隙力及最大负荷皆为Cruciate法大于改良Kessler法。先中心缝合组与先周边缝合组刚度相近。先周边缝合耗时较先中心缝合增加5%～15%。结论 1.在相同条件及缝合方法修复屈肌腱时选择先周边缝合可比先中心缝合提供更大的抗张强度，为修复肌腱的早期功能锻炼提供更安全的强度保障。2.肌腱缝合后强度与通过吻合口缝线股数正相关，在肌腱修复的方法中，尽量采用四股以上的中心缝合方法。
[Abstract]:Background and purpose of the study Tendon suture is generally divided into central suture and peripheral suture. It is considered that central suture combined with peripheral suture is an effective method of tendon repair. There are very few reports at home and abroad. In this paper, the biomechanical study on the strength difference between central suture and peripheral suture sequence was carried out by using in vitro simulation experiment. It is clear that the suture mode sequence with greater tensile strength can be provided under the same condition and suture method, and the occurrence of tendon rupture after operation can be reduced. It is beneficial to early active exercise after operation and provides theoretical basis for clinical flexor tendon repair. Materials and methods 48 fresh adult pigs were incised from the second toe deep flexor tendon of the second toe. Each sample was sutured by central suture and peripheral suture. The central suture was performed by modified Kessler and Cruciate, and the peripheral suture by Running and Cross-stitch. Each group was divided into 2 groups according to central suture and peripheral suture. The time of suture was recorded and the 2mm gap force and maximum load were measured by mechanical analyzer immediately after operation. The stiffness was calculated according to the displacement-load curve and the statistical analysis was carried out. Result In modified Kessler Running group, modified Kessler Cross-stitch group and Cruciate Cross-stitch group, the interspace force of 2mm in the first peripheral suture group was significantly higher than that in the central suture group (P < 0.05). The maximum load of peripheral suture group was higher than that of central suture group when peripheral suture was used Cross-stitch method, but the maximum load of peripheral suture group with Running method had no significant difference. No matter what peripheral suture was selected, the gap force and maximum load of 2mm were greater by Cruciate than by modified Kessler. The stiffness of the central suture group was similar to that of the peripheral suture group. Peripheral suture takes 5 times longer than central suture. Conclusion 1. When repairing flexor tendon under the same condition and suture method, the peripheral suture was better than central suture to provide greater tensile strength, which provided a safer strength guarantee for early functional exercise of tendon repair. The strength of tendon suture was positively correlated with the number of sutures through the anastomosis. In the method of tendon repair, more than four strands of central suture were used as far as possible.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.2

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