不同肌腱缝合方法的生物力学比较研究

发布时间：2018-07-26 12:49

【摘要】：目的评价改良Kessler缝合联合"8"字缝合修复肌腱的生物力学性能,为其用于临床修复急性跟腱断裂提供依据。方法取40条猪后肢趾长屈肌腱,随机分为4组(n=10),A组:制备急性横行切割伤,采用Krackow缝合方法缝合;B、C、D组:制备急性马尾样损伤后,分别采用Krackow缝合、Kessler缝合、改良Kessler缝合联合"8"字缝合方法缝合。将各组缝合后的肌腱固定于万能材料试验机,测量上、下端夹子之间肌腱实际长度,肌腱两端及中点3个截面的长轴和短轴长度,计算肌腱横截面积;然后以15 mm/min速度行拉伸测试,直至缝合失效(缝线脱出或者缝线断裂等),绘制负载-位移曲线,计算最大载荷、最大应力、最大应变、失效位移及刚度。结果各组肌腱实际长度及横截面积比较,差异无统计学意义(F=0.245,P=0.863;F=0.094,P=0.963)。加载负荷后,B组2例、C组1例、D组1例标本发生滑脱,未纳入统计学分析;A、B组肌腱均因缝线断裂而失效,C组由于缝线自肌腱组织内撕脱而失效,D组由于肌腱上3条缝线一起自缝合部位撕脱而失效。A、B组肌腱最大载荷、最大应力、最大应变、失效位移以及刚度比较,差异均无统计学意义(P0.05)。D组最大载荷、最大应力以及刚度均明显大于B、C组,差异有统计学意义(P0.05);最大应变、失效位移与B、C组比较,差异无统计学意义(P0.05)。B组最大载荷、最大应力、失效位移以及刚度均大于C组,差异有统计学意义(P0.05),两组最大应变差异无统计学意义(P0.05)。结论改良Kessler缝合联合"8"字缝合方法可提供优于Krackow缝合和Kessler缝合的生物力学性能。
[Abstract]:Objective to evaluate the biomechanical properties of modified Kessler suture combined with "8" suture for the repair of acute Achilles tendon rupture. Methods Forty flexor digitorum longus tendons were randomly divided into 4 groups: group A: acute transverse incision injury was prepared, Krackow suture method was used to suture the cauda equina suture group D, and Krackow suture was used to suture Kessler suture, respectively. Modified Kessler suture combined with "8" suture. The sutured tendons of each group were fixed on the universal material testing machine. The actual length of the tendon between the lower clippings and the length of the long and short sections of the two ends and the midpoint of the tendon were measured and the cross-sectional area of the tendon was calculated. Then the tensile test is carried out at a speed of 15 mm/min, until the suture fails (suture protrusion or seams break), the load-displacement curve is drawn, and the maximum load, maximum stress, maximum strain, failure displacement and stiffness are calculated. Results there was no significant difference in the actual length and cross-sectional area of tendon in each group (F = 0.245). After loading, group B (2 cases), group C (1 case) and group D (1 case) had spondylolisthesis. No statistical analysis was taken into account. All tendons of group A and B failed because of rupture of suture, and group C failed due to the avulsion of suture from tendon tissue. Group D failed due to the avulsion of three sutures from the suture site of the tendon. The maximum load and maximum stress of tendon in group A were maximum. There was no significant difference in maximum strain, failure displacement and stiffness between group D and group B (P0.05). The maximum stress and stiffness of group D were significantly higher than that of group C (P0.05), the maximum strain and displacement of failure were significantly higher than that of group B (P 0.05), and the maximum strain and displacement of failure were significantly higher than that of group B (P 0.05). The maximum load, maximum stress, failure displacement and stiffness of group B were higher than that of group C (P0.05). There was no significant difference in maximum strain between two groups (P0.05). Conclusion modified Kessler suture combined with "8" suture can provide better biomechanical properties than Krackow suture and Kessler suture.
【作者单位】：四川大学华西医院骨科;
【分类号】：R687.2

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