熊猫索桥技术中两种高强度缝线修复跟腱断裂的生物力学比较研究  

Biomechanical comparison study of two ultra-strong sutures in repair of Achilles tendon via panda rope bridge technique

作　　者：牟嫄 马英轩 杨伟 刁玉磊 乔钊 刘文科 罗彦凤[2] 尹良军[1] MU Yuan;MA Yingxuan;YANG Wei;DIAO Yulei;QIAO Zhao;LIU Wenke;LUO Yanfeng;YIN Liangjun(Department of Orthopedics,the Second Affiliated Hospital of Chongqing Medical University,Chongqing,400010,P.R. China;Bioengineering College of Chongqing University,Chongqing,400044,P.R.China)

机构地区：[1]重庆医科大学附属第二医院骨科,重庆400010 [2]重庆大学生物工程学院,重庆400044

出　　处：《中国修复重建外科杂志》2019年第9期1147-1150,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：重庆市科委技术创新与应用示范基金(cstc2017shmsA130049、cstc2018jscx-msybX0088)~~

摘　　要：目的比较熊猫索桥技术(panda rope bridge technique,PRBT)中两种高强度缝线以不同缝合方式修复跟腱断裂的生物力学差异,以期为临床选择缝线及缝合方式提供参考。方法取市售40条牛跟腱随机分成4组(n=10),在跟腱止点近端4 cm处横形切断并缝合。其中,A、B组使用Ethibond 5号线,近端均为腱腹交界处Krackow缝合,远端分别为跟骨冠状孔固定、跟骨锚钉缝合,断端平面分别经过4、8根线;C、D组均使用Ultrabraid 2号线,近端为腱腹交界处Krackow缝合,远端为带线锚钉固定于跟骨,断端平面分别经过4、8根线。使用电子动静态万能材料仪测试动态拉力20~100、20~200、20~300、20~400 N(0.5 Hz、250个循环)下,每个阶段跟腱断端间隙以及缝合失效发生情况。结果拉力20~100 N和20~200 N,跟腱断端间隙从小到大依次为D、B、C、A组,其中A、B组间及C、D组间差异有统计学意义(P<0.05)。拉力20~300 N和20~400 N,4组跟腱断端间隙>5 mm,为巨大间隙。拉力20~100 N和20~200 N,4组缝合保持率均为100%。拉力20~300 N,A、B、C、D组缝合保持率分别为0、80%、60%和100%。其中,A组缝合保持率与B、D组间比较,差异有统计学意义(P<0.05);其余组间差异无统计学意义(P>0.05)。拉力20~400 N,A、B、C、D组缝合保持率分别为0、50%、0和70%,A、B组间及C、D组间比较差异有统计学意义(P<0.05)。结论采用PRBT以8根高强度缝线经跟腱断端平面方式修复跟腱断裂,可以满足早期快速康复中使用跟腱靴或者跟垫时安全行走的要求。Objective To compare the biomechanical properties of two ultra-strong sutures and suturing methods in panda rope bridge technique (PRBT) application, and provide guidance for clinical selection of suture threads and suture methods. Methods Forty Achilles tendons from bulls were randomly divided into 4 groups (n=10) and transected at the 4 cm proximal to the tendon insertion. Groups A and B used Ethibond sutures (USP 5), the proximal end was fixed at the myotendious junction with Krackow sutures and the distal end was fixed through a calcaneus canal. Groups A and B had 4 and 8 threads through the stump plane, respectively. Groups C and D used Ultrabraid sutures (USP 2), the proximal end was fixed at the myotendious junction with Krackow sutures and the distal end was fixed in the calcaneus with two anchors. Groups C and D had 4 and 8 threads through the stump plane, respectively. The dynamic tensile forces of 20-100, 20-200, 20-300, and 20-400 N were tested respectively by using a dynamic tensile testing machine at 0.5 Hz for 250 cycles. After each stage of testing, the gap between stumps was measured with a caliper and the type of suture failure was recorded. Results After dynamic tensile forces of 20-100 N and 20-200 N, the gaps of the four groups arranged from small to large were groups D, B, C, and A. The differences between groups A and B and groups C and D were significant (P<0.05). But after dynamic tensile forces of 20-300 N and 20-400 N, the gaps were more than 5 mm in all groups. The suture retention rates of the four groups after dynamic tensile forces of 20-100 N and 20-200 N were all 100%. The suture retention rates of groups A, B, C, and D were 0, 80%, 60%, and 100%, respectively after dynamic tensile forces of 20-300 N. The differences of suture retention rates between group A and groups B and D were significant (P<0.05). There was no significant difference between groups B, C, and D (P>0.05). After dynamic tensile forces of 20-400 N, the suture retention rates of groups A, B, C, and D were 0, 50%,

关 键 词：熊猫索桥技术 跟腱断裂 高强度缝线 生物力学 动态拉力 

分 类 号：R687.2[医药卫生—骨科学]