Fleksör tendon onarımlarında sütür tekniklerinin biyomekanik karşılaştırılması
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
T.C. Maltepe Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
GİRİŞ VE AMAÇ: Fleksör tendon yaralanmalarında cerrahi tedavinin başarısı, kullanılan onarım tekniğinin özelliklerinin yanısıra onarım sonrası uygulanan rehabilitasyon programı ile de ilgilidir. Tendon onarımı sonrası erken başlanan hareket tendon iyileşmesini hızlandırır, yapışıklığı önler. Biz bu çalışmada 3 farklı sütür tekniğini biyomekanik açıdan karşılaştırmayı ve erken aktif harekete izin verebilecek tekniği bulmayı amaçladık. GEREÇ VE YÖNTEM: Çalışmamızda 9 koyunun 18 ön kolu’nun FDP tendonları kullanıldı. Dirsek ekleminden ampute edilmiş ön kollara kesimhaneden alındıktan hemen sonra diseksiyon uygulandı. Yaklaşık 15 cm boyutunda tendonlar elde edildi. Tendonun distal yapışma yerinden itibaren proksimale doğru 6 cm ölçülerek işaretlendi ve tendona tam kesi uygulandı. Kesinin proksimaline ve distaline doğru 10 mm ölçülerek core sütür çıkış bölgesi olarak işaretlendi. Double Modifiye Kessler, Kilitli Cruciate ve 4 geçişli Savage core sütür teknikleri ile onarılan tendonlar 3 grup şeklinde test edildi. Motorlu test standında çekme işlemi 20 mm/ dk hızla başlatıldı. Çekme işlemine sütürler kopana kadar ya da tendonlar çeneden sıyrılarak ayrılana kadar devam edildi. Tenorafi sahasında 2 mm gap oluşturan ve core sütürde kopmaya neden olan maksimum gerilme gücü değerlendirildi. BULGULAR: Çalışmamızda tüm gruplar arasında maksimum gerilme gücü en yüksek olanı 4 geçişli Savage oldu. Hem Kilitli Cruciate, hem de 4 geçişli Savage gruplarının maksimum gerilme değerleri Double Modifiye Kessler grubundan anlamlı (p?0,05) olarak daha yüksekti. Double Modifiye Kessler grubunun maksimum gerilme değeri 6.53±1.46 N, Kilitli Cruciate grubunun maksimum gerilme değeri 11.97±2.81 N, 4 geçişli Savage grubunun maksimum gerilme değeri 15.31±1.2 N’dur. Gruplar arasındaki 2 mm gap oluşumuna neden olan güçler karşılaştırıldığında aralarında anlamlı istatistiksel fark bulunmadı (p > 0.05). SONUÇ: Double Modifiye Kessler grubu sadece pasif fleksiyona izin verirken, Kilitli Cruciate grubu hafif dirence karşı fleksyona, 4 geçişli Savage grubu ise orta dirence karşı fleksiyona izin verecek ölçüde bulundu. Bu sonuçlar güçlü kavrama için gerekli olan gücün altında değerler olduğundan aktif fleksiyona izin vermemekte, fakat tendona pasif fleksiyon yaptırabileceğimizi göstermektedir.
OBJECTİVE: In cases of flexor tendon injuries, the success of surgical treatment is not only related to the characteristics of the repair technique used but also to the rehabilitation program applied after the repair. Early initiation of motion after tendon repair accelerates tendon healing and prevents adhesions. In this study, we aimed to compare three different suture techniques biomechanically and to identify the technique that would allow early active motion. MATHERİAL and METHODS: In our study, the flexor digitorum profundus (FDP) tendons from 9 sheep, totaling 18 forearms, were utilized. The forearms were obtained from the abattoir immediately after amputation at the elbow joint, and dissection was performed. Tendons approximately 15 cm in length were obtained. The tendons were marked 6 cm proximally from their distal attachment site and were subjected to a full-thickness cut. A 10 mm margin was marked both proximal and distal to the incision as the core suture exit zone. Tendons repaired using the Double Modified Kessler, Locking Cruciate, and 4-pass Savage core suture techniques were tested in three groups. A tensile test was conducted using a motorized testing machine, initiating at a speed of 20 mm/min. The test continued until the sutures failed or the tendons detached from the clamps. The maximum tensile strength, which created a 2 mm gap at the tenorrhaphy site and caused core suture failure, was evaluated. RESULTS: In our study, the maximum tensile strength was highest in the 4-strand Savage group among all the groups. Both the Locking Cruciate and 4-strand Savage groups showed significantly higher maximum tensile values compared to the Double Modified Kessler group (p<0.05). The maximum tensile strength for the Double Modified Kessler group was 6.53±1.46 N, for the Locking Cruciate group it was 11.97±2.81 N, and for the 4-strand Savage group it was 15.31±1.2 N. When comparing the forces that resulted in a 2 mm gap formation among the groups, there was no statistically significant difference between them (p > 0.05). CONCLUSION: The Double Modified Kessler group allows only passive flexion, while the Locking Cruciate group is designed to permit flexion against mild resistance, and the 4-strand Savage group is designed to allow flexion against moderate resistance. These results indicate that the values are below the strength required for strong gripping, preventing active flexion but demonstrating the ability to induce passive flexion in the tendon.
OBJECTİVE: In cases of flexor tendon injuries, the success of surgical treatment is not only related to the characteristics of the repair technique used but also to the rehabilitation program applied after the repair. Early initiation of motion after tendon repair accelerates tendon healing and prevents adhesions. In this study, we aimed to compare three different suture techniques biomechanically and to identify the technique that would allow early active motion. MATHERİAL and METHODS: In our study, the flexor digitorum profundus (FDP) tendons from 9 sheep, totaling 18 forearms, were utilized. The forearms were obtained from the abattoir immediately after amputation at the elbow joint, and dissection was performed. Tendons approximately 15 cm in length were obtained. The tendons were marked 6 cm proximally from their distal attachment site and were subjected to a full-thickness cut. A 10 mm margin was marked both proximal and distal to the incision as the core suture exit zone. Tendons repaired using the Double Modified Kessler, Locking Cruciate, and 4-pass Savage core suture techniques were tested in three groups. A tensile test was conducted using a motorized testing machine, initiating at a speed of 20 mm/min. The test continued until the sutures failed or the tendons detached from the clamps. The maximum tensile strength, which created a 2 mm gap at the tenorrhaphy site and caused core suture failure, was evaluated. RESULTS: In our study, the maximum tensile strength was highest in the 4-strand Savage group among all the groups. Both the Locking Cruciate and 4-strand Savage groups showed significantly higher maximum tensile values compared to the Double Modified Kessler group (p<0.05). The maximum tensile strength for the Double Modified Kessler group was 6.53±1.46 N, for the Locking Cruciate group it was 11.97±2.81 N, and for the 4-strand Savage group it was 15.31±1.2 N. When comparing the forces that resulted in a 2 mm gap formation among the groups, there was no statistically significant difference between them (p > 0.05). CONCLUSION: The Double Modified Kessler group allows only passive flexion, while the Locking Cruciate group is designed to permit flexion against mild resistance, and the 4-strand Savage group is designed to allow flexion against moderate resistance. These results indicate that the values are below the strength required for strong gripping, preventing active flexion but demonstrating the ability to induce passive flexion in the tendon.
Açıklama
Anahtar Kelimeler
Fleksör tendon, Biyomekanik, Sütür tekniği, Double modifiye Kessler, Kilitli cruciate, 4 geçişli savage, Flexor tendon, Biomechanics, Suture technique, Double modified Kessler, Locking cruciate, 4-strand savage
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Maharramli, İ. (2023). Fleksör tendon onarımlarında sütür tekniklerinin biyomekanik karşılaştırılması. (Yayımlanmamış Tıpta Uzmanlık Tezi). Maltepe Üniversitesi, Tıp Fakültesi, İstanbul.
