急性跟腱断裂微创缝合方法的设计及生物力学研究

发布时间：2018-07-04 14:04

  本文选题：跟腱断裂 + 微创　； 参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]设计及制作急性跟腱断裂微创缝合器械;制作跟腱断裂动物模型;通过生物力学试验对比研究微创缝合法、Kessler法和Krackow法的失效载荷;旨在为急性跟腱断裂提供更有效的临床解决办法。[方法]设计及制作跟腱断裂微创缝合器械。对人体跟腱和猪趾深屈肌腱进行解剖和测量,以猪趾深屈肌腱代替人体跟腱进行试验。温室下选新鲜猪小腿标本(自膝关节以下离断)34只,10只用于解剖观察及测量。24只标本解剖暴露趾深屈肌腱,模拟跟腱断裂,将猪趾深屈肌腱横行锐性离断,切口与腱纤维走形垂直,并将断端延冠状位、矢状位各劈裂3刀,间隔1mm,深度10mm,形成马尾状,建立跟腱断裂模型,然后随机分为3组(A、B、C),每组8条肌腱,分别采用自制器械微创缝合器法(A组)、Kessler缝合法(B组)和Krackow缝合法(C组),缝合完毕置于-10℃冰箱中备用。拉力测试前常温解冻标本,后将标本置于日本岛津AG—150KN材料拉力试验机的加载盘中,均匀拉伸至缝合失败,记录缝合失效时的最大载荷等,采集的数据经spss15.0系统软件进行处理并得出实验结果。[结果]人体跟腱平均长度(155.2±5.3)mm,距止点5cm处平均宽度(12.2±0.9)mm,厚度(6.1±0.3)mm。猪趾深屈肌腱测量平均长度(128.5±10.3)mm,距止点 5cm 处平均宽度(11.8±0.8)mm,厚度(5.2土0.5)mm。。可替代人体跟腱进行试验。微创缝合法、Kessler法、Krackow法三组失效载荷平均为(193.8±36.7)(159.3±5.7)(211±28.5)N,对三组试验最大载荷进行两两比较的LSD-t检验,微创缝合组和Krackow组之间差异无统计学意义,微创缝合组和Kessler组、Kessler组和Krackow组之间有统计学意义。[结论]猪趾深屈肌腱可替代人体跟腱进行生物力学试验,新型微创缝合法优于Kessler缝合法,三种方法中,Kessler法提供的失效载荷最小,新型微创缝合法和Krakow之间无统计学差异。生物力学试验证实新型微创缝合法较传统固定方法操作简单,可达到传统缝合方法的缝合效果。新型微创缝合牢靠,使用简便、微创,并发症少。
[Abstract]:[objective] to design and make minimally invasive suture apparatus for acute rupture of Achilles tendon, to make animal model of rupture of Achilles tendon, to compare the failure load of minimally invasive suture method with Kessler method and Krackow method by biomechanical test. To provide a more effective clinical solution for acute Achilles tendon rupture. [methods] A minimally invasive suture apparatus for rupture of Achilles tendon was designed and manufactured. The human Achilles tendon and porcine deep flexor digitorum tendon were dissected and measured, and the human Achilles tendon was replaced by the pig deep flexor digitorum tendon. Under the greenhouse, 34 fresh pig calf specimens (dissected from the knee joint) were selected for anatomical observation and measurement. 24 specimens were dissected to expose the deep flexor digitorum tendon, to simulate the rupture of the Achilles tendon, and to transect the tendon of the deep flexor digitorum muscle strikingly. The incision was perpendicular to the shape of tendon fibers, and was divided into three groups in coronal position and sagittal position, with 1 mm interval and 10 mm depth, to form a cauda equina model and to establish a rupture model of Achilles tendon. Then it was randomly divided into 3 groups (Agnor BUC), with 8 tendons in each group. Kessler's suture (group B) and Krackow's suture (group C) were used in group A and group C respectively. After suture, the suture was placed in refrigerator at -10 鈩，

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