V-Y延长指背腱膜终腱止点重建术治疗陈旧性锤状指的生物力学实验研究  

Biomechanical study on V-Y extending terminal tendon of extensor tendon for distal attachment inhuman cadaver hands

作　　者：王高飞 张珠峰 魏壮[1] Wang Gaofei;Zhang Zhufeng;Wei Zhuang(Department of Hand Surgery,China-Japan Union Hospital of Ji Lin University,Changchun 130012,Jilin Province,China;Department of Burn and Plastic Surgery,The Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guiyang Province,China)

机构地区：[1]吉林大学中日联谊医院新民院区手外科,长春130012 [2]贵州医科大学附属医院整形烧伤外科,贵阳550004

出　　处：《中国临床解剖学杂志》2021年第3期330-335,共6页Chinese Journal of Clinical Anatomy

摘　　要：目的探讨V-Y延长指背腱膜终腱(terminal tendon,TT)止点重建术治疗陈旧性锤状指(腱-骨型或部分骨性)的生物力学优势。方法冰冻成人手指标本12例,随机分为实验组与对照组,每组6指。对照组TT止点处切除腱膜1.0 mm,以"牵出纽扣"法重建止点;实验组TT止点处切除腱膜1.0mm,近端TT"V"字切开、"Y"字缝合,远端"牵出纽扣"法重建止点,两组分别进行力学测试并对结果进行统计学分析。结果最大载荷时实验组V-Y缝合处缝线断裂占33.3%(2/6)、肌腱切割占66.7%(4/6),止点重建处缝线拉长;对照组均为止点重建处缝线断裂,最大载荷实验组低于对照组(P<0.05);最大位移两组无统计学差异(P>0.05)。腱-骨间隙达到1.0 mm时100%标本止点重建处缝线拉长,实验组V-Y缝合处腱-腱贴合紧密;位移实验组长于对照组(P<0.05);载荷、刚度两组比较均无统计学差异(P>0.05)。结论测量成人手指标本腱-骨间隙1.0 mm时载荷、位移、刚度,相较最大载荷、最大位移更具临床指导意义;V-Y缝合重建止点能有效延长TT,使腱-骨紧密贴合同时不影响TT生物力学特性。Objective To discuss the biomechanics of V-Y extending terminal tendon(TT)for distal attachment to treat chronic mallet fingers(tendon-bone or partial bony).Methods Twelve fingers were randomly divided into the following two groups based upon the repair technique.A control group:1 mm TT was removed at the insertion,the distal TT was attached by pull-out;an experimental group:1 mm TT was removed at the insertion,the proximal portion of the TT was cut with a"V"incision which was then repaired in a"Y"fashion,and the distal TT was attached by pull-out.Biomechanics experimental outputs were calculated and statistically analyzed.Results As the rupture(load failure)occurred,the experimental group:2 specimens(accounting for 33.3%)failed by suture breakages and 4 cases(accounting for 66.7%)failed by suture pulled out from the tendon at V-Y suture and all sutures were prolonged at attachment.Suture breakages happened in all specimens of the control group.There was significant difference between the two groups(P<0.05)in the load failure while no significant difference(P>0.05)in the maximum displacement.All sutures were prolonged at the attachment when the tendon-bone gap reached 1 mm in both groups and the tendon-tendon was closely sticked at V-Y suture.There was significantly different between the two groups(P<0.05)in the displacement while no significant difference(P>0.05)in the load and stiffness.Conclusions The load,displacement and stiffness of 1 mm tendon-bone gap were more clinically meaningful than the repair failure force and maximum displacement.Reattachment with V-Y suture effectively extended TT and repaired tendon-bone gap,while unaffected the biomechanical properties of TT.

关 键 词：陈旧性锤状指 V-Y延长 止点重建 生物力学 

分 类 号：R318.01[医药卫生—生物医学工程] R686.1[医药卫生—基础医学]