四股双平面双Kessler缝合法在指屈肌腱修复中的生物力学分析  

Biomechanical analysis of 4-strand double plane double Kessler suture in the repair of flexor tendon of finger

作　　者：郭亮 陈亮 吴学军 陈楚 李宇宁 陈思敏 马超 GUO Liang;CHEN Liang;WU Xuejun(Department of Hospital Hand and Foot Microsurgery,Fuzhou Second General,Fuzhou,Fujian,350007,China)

机构地区：[1]福州市第二总医院手足显微外科,福建福州350007 [2]福建医科大学,福建福州350122 [3]华侨大学附属厦门长庚医院,福建厦门361000

出　　处：《实用手外科杂志》2025年第1期72-76,共5页Journal of Practical Hand Surgery

基　　金：福州市科技局福州市卫生健康委员会中青年科研项目(项目编号:2021-S-wq7);福建省创伤骨科急救与康复临床医学研究中心项目(项目编号:2020Y2014)。

摘　　要：目的研究四股双平面不同角度的双Kessler缝合法在指屈肌腱修复中的生物力学性能。方法收集临床新鲜无再植条件肢体(指体)的废弃指屈肌腱,选取无损伤肌腱共30根,每根长6.0 cm,测量并计算肌腱两端及中点处的横截面积,取三者均值。随机分为两组,每组15根,横向锐性切断。应用4股双Kessler缝合法,第一组采用双Kessler缝合平面垂直交叉(VDK组)、第二组采用双Kessler缝合平面呈非垂直交叉(NVDK组)。肌腱缝合后于拉力机上检测2.0 mm间隙负荷、最大负荷并记录失效模式,进行统计学分析。结果两组肌腱的横截面积VDK组为(8.67±2.10)mm^(2),NVDK组为(7.40±1.57)mm^(2),两组间横截面积差异无统计学意义(P>0.05),具有可比性。VDK组2.0 mm间隙负荷35.15(34.50,35.38)N,最大负荷(53.82±16.19)N;NVDK组2.0 mm间隙负荷(30.01±0.22)N,最大负荷45.19(23.51,51.21)N;VDK组的2.0 mm间隙负荷和最大负荷均大于NVDK组,差异有统计学意义(P<0.05)。失效模式:VDK组中21例缝线断裂(70%),8例肌腱撕脱(26.7%),1例线结松开(3.3%);NVDK组11例缝线断裂(36.7%),18例肌腱撕脱(60%),1例线结松开(3.3%),两组失效模式占比差异有统计学意义(P<0.05)。结论缝合平面垂直交叉的四股双Kessler缝合法的抗张强度更优,结果稳定可靠,可满足指屈肌腱早期功能训练的需求。Objective To study the biomechanical comparison of four double Kessler suture methods in flexor tendon repair.Methods A total of 30 undamaged flexor tendons were collected from clinically fresh limbs without replantation condition(finger body).Each tendon was 6cm long.Measure and calculate the cross-sectional area at both ends and midpoint of the tendon,and take the average of the three.They were randomly divided into 2 groups with 15 roots in each group and were cut with transverse sharpness.The 4-strand double Kessler suture method was applied.The first group used double Kessler suture plane with vertical cross(VDK group),and the second group used double Kessler suture plane with non-vertical cross(NVDK group).The 2mm gap load and maximum load of the tendon were measured on the tension machine after suture,and the failure mode was recorded for statistical analysis.Results The cross-sectional area of tendons in the VDK group was(8.67±2.10)mm^(2);NVDK group:(7.40±1.57)mm^(2),there was no statistical difference in cross-sectional area between the two groups(P>0.05),which was comparable.The 2.0 mm clearance load of the VDK group was 35.15(34.50,35.38)N,and the maximum load was 53.82±16.19N.The 2.0 mm gap load of NVDK group was 30.01±0.22N,and the maximum load was 45.19(23.51,51.21)N.The 2.0 mm gap load and maximum load in VDK group were higher than those in NVDK group,and the difference was statistically significant(P<0.05).Failure mode:In the VDK group,suture rupture occurred in 21 cases(70%),tendon avulsion occurred in 8 cases(26.7%),and knot release occurred in 1 case(3.3%).In NVDK group,suture rupture occurred in 11 cases(36.7%),tendon avulsion occurred in 18 cases(60%),and knot release occurred in 1 case(3.3%).There was significant difference in the proportion of failure mode between the two groups(P<0.05).Conclusion The 4-strand double Kessler suture with vertical cross suture plane has better tensile strength,stable and reliable results,and can meet the needs of early functional training of flexor tendon

关 键 词：指屈肌腱 双平面 双Kessler 4股缝合 生物力学 

分 类 号：R68[医药卫生—骨科学]