屈肌腱愈合早期在曲线模型中生物力学变化的实验研究  

Biomechanical study of flexor tendon repair in an in vivo curvature model

作　　者：陈建海[1] 姜保国[1] 傅中国[1] 张殿英[1] 王天兵[1] 

机构地区：[1]北京大学人民医院创伤骨科,100044

出　　处：《中华外科杂志》2005年第4期243-246,共4页Chinese Journal of Surgery

摘　　要：目的比较握持缝合法(改良Kessler法)和锁扣缝合法(Tsuge法)修复屈肌腱在术后不同时间曲线模型下的生物力学变化规律和特点。方法分别以改良Kessler法和Tsuge法缝合三黄鸡的第3趾屈趾深肌腱各42条,分别于术后即刻, 1, 4, 7, 10, 14, 21d取材,进行生物力学测试。测试内容包括拉伸断裂负荷和功耗。结果拉伸断裂负荷改良Kessler法在术后10d出现明显降低(13N),术后21d恢复到即刻水平;Tsuge法术后10d以后持续性降低(21N);Tsuge法术后即刻组和术后7d组较改良Kessler法能承受更高的拉伸断裂负荷。拉伸断裂功耗改良Kessler法术后10d(65mJ), 14d(40mJ)组较术后即刻(170mJ), 1(222mJ), 4(188mJ), 7d(196mJ)组明显降低,术后21d恢复到即刻水平;Tsuge法术后14 d( 72 mJ), 21 d组( 59 mJ)较术后即刻( 283 mJ),1(219mJ), 4(216mJ), 7(279mJ), 10d(191mJ)组明显降低;Tsuge法术后即刻组(283mJ)较改良Kessler法(170mJ)具有更高的拉伸断裂功耗。结论两种缝合方法都是在术后10d以后生物力学性能显著下降,改良Kessler法在术后21d恢复到即刻水平,而Tsuge法则不能在术后21d恢复到即刻水平。两种缝合方法的力学性能在术后10d以后无差异。Objective To compare the biomechanical characteristics of 2 different repair methods:Modified Kessler and Tsuge. Methods Eighty-four profoundus flexor tendons of 3~rd toe of Sanhuang chicken were severed and repaired by either Modified Kessler or Tsuge method randomly. Six repaired tendons for each repair method were harvested at 0,1,4,7,10,14,21 days after operation and tested in an Instron 1185 biomechanical testing machine. An elongation force-elongation distance curve was obtained, and biomechanical meters (including rupture force and rupture work) were calculated from this curve. Results Rupture force: rupture force significantly decreased at 10~th and 14~th day in both repair groups, and returned to immediate level at 21~st day in Modified Kessler group but not in Tsuge group; Tsuge method was significantly higher than Modified Kessler group at time-points immediately and 7 days after operation. Rupture work: this work significantly decreased at 10~th (65.17 mJ) and 14~th (40.0 mJ) day and resumed to immediate level at 21~st day in Modified Kessler group; While in Tsuge group, it decreased significantly at 14~th and 21~st day. Tsuge method was significantly higher than Modified Kessler group only at time 0. Conclusion The biomechanical properties decrease significantly after 10~th day at both repair method groups. It resumes to immediate level at 21~st day in Modified Kessler group. There is no significant difference after 10~th day between both repair methods.

关 键 词：术后 Kessler法 屈肌腱 改良 生物力学 缝合方法 愈合 水平 恢复 变化 

分 类 号：R687.2[医药卫生—骨科学]