【摘要】 背景:自体肌腱移植中,末端缝合的最终拉力强度是手术成功的重要组成部分,若想增加固定强度,应从改进缝合材料强度和增加缝线数目着手,但缝合针数过多,裸露线头太多,影响腱骨愈合。目的:通过生物力学测试,探讨前交叉韧带重建中韧带末端采用双锁边缝合固定的最少的必要缝合针数,以减少缝线裸露。方法:1体外生物力学实验:将12条带髌骨的髌韧带标本分为2组,对其末端分别采用Krackow双锁边缝合法缝合3针、5针,缝合材料为强生肌腱缝线,对样本分别进行拉伸力学检测以比较强度,探讨最佳的缝合针数和方法。2临床应用:根据体外实验结果,将改良的Krackow双锁边缝合法临床应用于125例关节镜下前交叉韧带重建中,其中采用3针固定62例,采用5针固定63例。结果与结论:双锁边缝合法缝合3针,缝合点固定强度达到100 N以上,5针固定强度达到110 N,两者的固定强度差别不大,但均超过缝线材料的破坏强度;且将第1针贯穿韧带缝合,不降低固定强度。125例平均随访6.4个月,无论3针固定还是5针固定均取得良好效果,患者满意率达99%,未见早期或晚期缝线断裂松脱。提示:双锁边缝合法缝合3针能达到满意的固定强度,固定可靠且能减少缝线裸露;第1针贯穿韧带,可减少缝线裸露但不降低固定强度。更多还原

【Abstract】 BACKGROUND: During autologous tendon grafting, the ultimate tensile strength used for suturing the end of the ligament is important for successful surgery. Improving suturing strength and increasing the number of stitches is a good choice for increasing the fixed intensity. But excess amount of stitches can produce too many thread residues, thereby affecting tendon healing. OBJECTIVE: To investigate the essential number of suturing pins for the anterior cruciate ligament revascularization in ligament end suture fixation to reduce suturing thread exposure. METHODS:(1) In vitro biomechanics test: 12 patellar ligament specimens were divided into two groups: the specimens were sutured with 5 or 3 stitches using Krackow suture method. The suturing thread was J&J tendon suture thread. The strength of tensile was compared between the two groups by Tensile mechanical test was conducted to compare the strength of tensile between the two groups and to explore the optimal number of stitches and suturing method.(2) Clinical application: According to the results of in vitro experiments, modified Krackow suture method was used clinically for arthroscopic anterior cruciate ligament reconstruction in 125 cases, including 62 cases receiving 3-stitch suture, and 63 cases undergoing 5-stitch suture. RESULTS AND CONCLUSION: The fixed strength of tensile at suture sites was over 100 N for 3-stitch double-lock suture and 110 N for 5-stitch double-lock suture. There was no significant difference in the fixed strength between the two groups, but their strength values were both over the breaking strength of suturing materials. Moreover, the fixed strength could not be reduced by suturing throughout the ligament at the first stitch. All the 125 cases were followed for 6.4 months averagely, and both 3-stitch and 5-stitch suture methods achieved good outcomes. The satisfaction rate was up to 99%, and no suture breakage or loosing occurred at early and late stages. These findings suggest that, using 3-stitch double-lock suture method, a satisfactory fixed strength can be achieved with reduced thread exposure. The suturing thread can run through the ligament at the first stitch, which can reduce thread exposure but not reduce the fixed strength.更多还原