组织工程与重建外科杂志

组织工程与重建外科杂志 ›› 2014, Vol. 10 ›› Issue (4): 211-214.doi: 10.3969/j.issn.1673-0364.2014.04.011

• 论著 • 上一篇    下一篇

M-Tang法肌腱缝合技术的生物力学研究及其在Ⅱ区屈肌腱修复中的应用

宋楠，冒海蕾，杨茜，徐启明，蒋永康，周晟博，倪锋，王斌   

  1. 上海交通大学医学院附属第九人民医院整复外科；上海复旦大学附属中山医院麻醉与重症医学科
  • 发布日期:2020-07-23

Biomechanical Analysis of a Modification of Tang Method and Its Application on Flexor Tendon Repair in Zone Ⅱ

SONG Nan,MAO Hailei,YANG Xi,XU Qiming,JIANG Yongkang,ZHOU Shengbo,NI Feng,WANG Bin   

  1. Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine; Department of Anesthesiology and Critical Care Medicine, Zhongshan Hospital, Fudan University;
  • Published:2020-07-23
  • Contact: 国家自然科学基金（81271725，81101404）；上海市“重中之重”学科建设经费；复旦大学青年教师科研能力提升项目（20520133394）

摘要： 目的报道一种新的肌腱缝合方法 M-Tang法的生物力学特性及临床应用结果。方法本研究采用36根猪后足屈肌腱作为实验材料,在相当于Ⅱ区水平造成切割伤后,18根用Tang法、18根用M-Tang法进行修复。将修复后的肌腱分别进行直线和90°成角状态下的拉伸,用Instron力学测定仪测定2 mm间隙形成负荷及断裂负荷。M-Tang法用于临床修复Ⅱ区屈肌腱65例共96指,术后均采用保护性主、被动活动相结合的锻炼计划。采用Strickland标准进行功能评价。结果在直线拉伸模式下,M-Tang法的2 mm间隙形成负荷为(46.2±5.2)N,断裂负荷为(61.9±6.0)N,与Tang法相近;在90°成角拉伸模式下,M-Tang法的2 mm间隙形成负荷为(35.9±3.6)N,与Tang法相近,断裂负荷为(57.0±4.5)N,高于Tang法。65例患者术后平均随访26个月,临床运用M-Tang法修复的Ⅱ区屈肌腱无1例发生断裂,根据Strickland TAM标准,其中优78指,良10指,可8指,优良率91.6%。结论 M-Tang法具备Tang法的生物力学强度,操作简便,使用缝线和外露线结少,能满足肌腱早期保护性主动活动的需要,是Ⅱ区屈肌腱修复的优选方法之一。

关键词: Tang法, M-Tang法, 生物力学, 肌键修复

Abstract: Objective To investigate the biomechanical properties and preliminary application of a new suture method, modification of Tang's method, for flexor tendon repair. Methods Thirty-six fresh porcine flexor tendons were divided and repaired with either the modified Tang or the original Tang method. The tendons were subjected to linear or 90 ° angular loading in an Instron tensile testing machine. 2 mm gap formation force and ultimate strength were recorded. M-Tang method was performed in repairing 96 human flexor tendons in zone Ⅱ, and protected passive and active motion protocol were used in eash case after the operation. Strickland TAM classification was applied to evaluate the function postopertively. Results Under linear tension mode, M-Tang was similar to Tang method with its 2 mm gap formation force at (46.2 ±5.2) N, ultimate strength at (61.9 ±6.0) N; Under angular tension mode, M-Tang was similar to Tang with its 2 mm gap formation force at (35.9±3.6) N, but superior to Tang with its ultimate strength at (57.0±4.5) N. No tendon rupture was observed in any of the repaired fingers. Strickland TAM classification showed excellent in 78 cases, good in 10 cases, fair in 8 cases, and the total good rate was 91.6%. Conclusion M-Tang method maintained the biomechanical characters of the original Tang method which can fulfill the requirements for early motion protocol. With fewer suture and knots and easy to operate, M-Tang method was one of the first choice in repairing flexor tendons in zone Ⅱ.

Key words: Tang technique, Modified Tang method, Biomechanics, Tendon repair

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