Name: polytetrafluoroethylene (ptfe) as a suture material in tendon surgery
Uploaded: 2022-10-06T13:00:00
Description: Watch this Scientific Journal Video about Polytetrafluoroethylene PTFE as a Suture Material in Tendon Surgery at JoVE.com

该研究由Sana医院Hof提供资金。此外，作者要感谢Hafenrichter女士（Serag Wiessner，Naila）对实验的不懈帮助。

本文不包含任何作者对人类参与者或动物进行的任何研究。人体材料的使用完全符合埃尔朗根大学解剖学研究所关于使用尸体和可识别身体部位的大学政策。
1.收获屈肌腱
<ol><li>收获深部指屈肌<ol><li>将新鲜的尸体上肢放在解剖台上，腹掌侧面向外科医生。使用标准手固定装置将指骨保持在伸展中。</li>
		<li>注意死者的年龄和性别。</li>
		<li>使用15号手术刀，在?...

<ol>
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An experimental and clinical study.</a> Acta Orthopaedica Scandinavia. 40 (5), 587-601 (1969).</li><li>Waitayawinyu, T., Martineau, P. A., Luria, S., Hanel, D. P., Trumble, T. 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B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=History+and+nomenclature+of+multistrand+repairs+in+digital+flexor+tendons.">History and nomenclature of multistrand repairs in digital flexor tendons.</a> Journal of Hand Surgery. 41 (2), 291-293 (2016).</li><li>Lawrence, T. M., Davis, T. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+biomechanical+analysis+of+suture+materials+and+their+influence+on+a+four-strand+flexor+tendon+repair.">A biomechanical analysis of suture materials and their influence on a four-strand flexor tendon repair.</a> Journal of Hand Surgery. 30 (4), 836-841 (2005).</li><li>Lawrence, T. M., Davis, T. 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B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=New+developments+are+improving+flexor+tendon+repair.">New developments are improving flexor tendon repair.</a> Plastic and Reconstructive Surgery. 141 (6), 1427-1437 (2018).</li><li>Dang, M. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Some+biomechanical+considerations+of+polytetrafluoroethylene+sutures.">Some biomechanical considerations of polytetrafluoroethylene sutures.</a> Archives of Surgery. 125 (5), 647-650 (1990).</li><li>Abellan, D., Nart, J., Pascual, A., Cohen, R. E., Sanz-Moliner, J. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Physical+and+mechanical+evaluation+of+five+suture+materials+on+three+knot+configurations:+an+in+vitro+study.">Physical and mechanical evaluation of five suture materials on three knot configurations: an in vitro study.</a> Polymers. 8 (4), 147 (2016).</li><li>Silva, J. M., Zhao, C., An, K. N., Zobitz, M. E., Amadio, P. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gliding+resistance+and+strength+of+composite+sutures+in+human+flexor+digitorum+profundus+tendon+repair:+an+in+vitro+biomechanical+study.">Gliding resistance and strength of composite sutures in human flexor digitorum profundus tendon repair: an in vitro biomechanical study.</a> Journal of Hand Surgery. 34 (1), 87-92 (2009).</li><li>Chauhan, A., Palmer, B. A., Merrell, G. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Flexor+tendon+repairs:+techniques,+eponyms,+and+evidence.">Flexor tendon repairs: techniques, eponyms, and evidence.</a> Journal of Hand Surgery. 39 (9), 1846-1853 (2014).</li><li>Tolerton, S. K., Lawson, R. D., Tonkin, M. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Management+of+flexor+tendon+injuries+-+Part+2:+current+practice+in+Australia+and+guidelines+for+training+young+surgeons.">Management of flexor tendon injuries - Part 2: current practice in Australia and guidelines for training young surgeons.</a> Hand Surgery. 19 (2), 305-310 (2014).</li><li>Tang, J. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Strong+digital+flexor+tendon+repair,+extension-flexion+test,+and+early+active+flexion:+experience+in+300+tendons.">Strong digital flexor tendon repair, extension-flexion test, and early active flexion: experience in 300 tendons.</a> Hand Clinics. 33 (3), 455-463 (2017).</li><li>Gray, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Grays Anatomy. , (2013).</li><li>McGregor, A. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Fundamental Techniques of Plastic Surgery. 10th editon. , (2000).</li><li>Tsuge, K., Yoshikazu, I., Matsuishi, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Repair+of+flexor+tendons+by+intratendinous+tendon+suture.">Repair of flexor tendons by intratendinous tendon suture.</a> Journal of Hand Surgery. 2 (6), 436-440 (1977).</li><li>Croog, A., Goldstein, R., Nasser, P., Lee, S. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparative+biomechanic+performances+of+locked+cruciate+four-strand+flexor+tendon+repairs+in+an+ex+vivo+porcine+model.">Comparative biomechanic performances of locked cruciate four-strand flexor tendon repairs in an ex vivo porcine model.</a> Journal of Hand Surgery. 32 (2), 225-232 (2007).</li><li>Tang, J. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Indications,+methods,+postoperative+motion+and+outcome+evaluation+of+primary+flexor+tendon+repairs+in+Zone+2.">Indications, methods, postoperative motion and outcome evaluation of primary flexor tendon repairs in Zone 2.</a> Journal of Hand Surgery. 32 (2), 118-129 (2007).</li><li>Head, W. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Adhesion+barriers+in+cardiac+surgery:+A+systematic+review+of+efficacy.">Adhesion barriers in cardiac surgery: A systematic review of efficacy.</a> Journal of Cardiac Surgery. 37 (1), 176-185 (2022).</li><li>Pressman, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Teflon+or+Ivalon:+a+scoping+review+of+implants+used+in+microvascular+decompression+for+trigeminal+neuralgia.">Teflon or Ivalon: a scoping review of implants used in microvascular decompression for trigeminal neuralgia.</a> Neurosurgery Reviews. 43 (1), 79-86 (2020).</li><li>Pillukat, T., van Schoonhoven, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Nahttechniken+und+Nahtmaterial+in+der+Beugesehnenchirurgie.">Nahttechniken und Nahtmaterial in der Beugesehnenchirurgie.</a> Trauma und Berufskrankheit. 18 (3), 264-269 (2016).</li><li>Dudenhoffer, D. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=In+vivo+biocompatibility+of+a+novel+expanded+polytetrafluoroethylene+suture+for+annuloplasty.">In vivo biocompatibility of a novel expanded polytetrafluoroethylene suture for annuloplasty.</a> The Thoracic and Cardiovascular Surgeon. 68 (7), 575-583 (2018).</li><li>Dy, C. J., Daluiski, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Update+on+zone+II+flexor+tendon+injuries.">Update on zone II flexor tendon injuries.</a> Journal of the American Academy of Orthopaedic Surgeons. 22 (12), 791-799 (2014).</li><li>Killian, M. L., Cavinatto, L., Galatz, L. 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在一系列实验中，PTFE链被评估为屈肌腱修复的缝合材料。该协议再现了除两个方面外的所有方面都类似于 体内 情况的条件。首先， 体内 施加的负荷是重复的，因此循环重复的负荷类型可能更合适。其次，在术后前6周，随着肌腱愈合的进展，从生物力学向生物学的重大转变，这是一个在 离体 条件下无法充分解决的过程。
该方案中使用的PTFE材料显示出?...

半个多世纪以来，手屈肌腱损伤的治疗一直是一个有争议的问题。直到 1960 年代，中指骨和近端手掌之间的解剖区域被命名为“无人区”，以表示在该区域进行原发性肌腱重建的尝试是徒劳的，结果非常差1.然而，在 1960 年代，通过引入新的康复概念重新审视了初级肌腱修复问题2.在1970年代，随着神经科学的进步，可以开发早期康复的新概念，包括动态夹板3，但此后只能实现微小的改善。最近，引入了整体稳定性显著提高的新材料4，5，因此缝合线材料失效以外的技术问题成为焦点，包括奶酪布线和拉拔6。
直到最近，聚丙烯（PPL）和聚酯还广泛用于屈肌腱修复。直径为 0.150-0.199 mm 的 4-0 USP（美国药典）聚丙烯链的线性拉伸强度小于 20 牛顿 （N）6，7，而手的屈肌腱可以在体内产生高达 75 N8 的线性力。创伤和手术后，由于水肿和粘连，组织的抵抗力增加更多9。经典的肌腱修复技术包括双股配置，必须通过额外的上腱运行缝合线3，10进行加固。具有更高线强度的新型共混聚合物材料带来了技术发展4;具有长链超高分子量聚乙烯（UHMWPE）芯的单条共混物链与与PPL直径相同的聚酯编织护套相结合，可以承受高达60 N的线性力。然而，挤出技术可以制造具有可比机械性能的单丝聚合物链6。
修复技术在过去十年中也得到了发展。两股肌腱修复技术已经让位于更复杂的四股或六股配置11，12。通过使用环形缝合线13，可以减少结的数量。通过将新材料与新技术相结合，可以实现超过100 N的初始线强度4。 
在任何情况下都应提倡个体化康复方案，同时考虑到患者的特殊属性和肌腱修复技术。例如，无法长时间遵循复杂指示的儿童和成人应延迟动员。较弱的修复应仅通过被动运动动员14，15。否则，早期的主动运动方案应该是黄金标准。 
该方法的总体目标是评估用于屈肌腱修复的新型缝合材料。为了赞扬该方案的基本原理，该技术是文献4，10，12，16中先前验证的方案的演变，作为在类似于临床常规的条件下评估缝合材料的手段。使用现代伺服液压材料测试系统，可以设置类似于体内应力的300 mm / min的牵引速度，与使用25-180 mm / min4，10的早期协议相反，考虑到软件和测量设备的局限性。该方法适用于屈肌腱修复的离体研究，在更广泛的意义上适用于缝合材料应用的评价。在材料科学中，此类实验通常用于评估聚合物和其他类别的材料17。
研究阶段：研究分两个阶段进行;每个步骤都分为两个或三个后续步骤。在第一阶段，比较聚丙烯（PPL）链和聚四氟乙烯（PTFE）链。3-0 USP和5-0 USP链均用于模拟真实的临床状况。首先研究了材料本身的机械性能，尽管是医疗设备，但这些材料已经过广泛的测试。对于这些测量，测量N = 20股的线性拉伸强度。还研究了打结的股线，因为打结会改变线性拉伸强度并产生潜在的断裂点。第一阶段的主要部分是测试两种不同材料在临床条件下的性能。此外，还进行了3-0的核心修复（两股基希迈尔-凯斯勒与Zechner和Pennington的修改）并测试了线性强度。对于调查的额外侧翼，在修复中增加了一条 5-0 的上肢跑步缝合线，以增加强度18，19。 
在随后的阶段，对三种缝合材料进行了比较，包括PPL，UHMWPE和PTFE。对于所有比较，使用USP 4-0股，对应于直径为0.18 mm。有关所用材料的完整列表，请参阅 材料表。在最后一步中，如前所述进行了阿德莱德20 或M-Tang21 核心维修。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Chirobloc</td>
			<td>AMT AROMANDO Medizintechnik GmbH</td>
			<td>CBM</td>
			<td>Hand Fixation</td>
		</tr>
		<tr>
			<td>Cutfix Disposable scalpel</td>
			<td>B. Braun Medical Inc, Germany</td>
			<td>5518040</td>
			<td>Safety one use blade</td>
		</tr>
		<tr>
			<td>Coarse paper/ Aluminium Oxide Rhynalox</td>
			<td>Indasa</td>
			<td>440008</td>
			<td>abrasive with a grit size of ISO P60&#160;</td>
		</tr>
		<tr>
			<td>Fiberloop 4-0</td>
			<td>Arthrex GmbH</td>
			<td>AR-7229-20</td>
			<td>Ultra-high molecular weight polyethylene with a braided jacket of polyester 4-0</td>
		</tr>
		<tr>
			<td>G20 cannula Sterican</td>
			<td>B Braun</td>
			<td>4657519</td>
			<td>100 Pcs package</td>
		</tr>
		<tr>
			<td>Isotonic Saline 0.9% Bottlepack 500 mL&#160;</td>
			<td>Serag Wiessner GmbH</td>
			<td>002476</td>
			<td>Saline 500 mL</td>
		</tr>
		<tr>
			<td>KAP-S Force Transducer</td>
			<td>A.S.T. &#8211; Angewandte System Technik GmbH</td>
			<td>AK8002</td>
			<td>Load cell</td>
		</tr>
		<tr>
			<td>Metzenbaum Scissors (one way, 14 cm)</td>
			<td>Hartmann</td>
			<td>9910846</td>
			<td></td>
		</tr>
		<tr>
			<td>Screw grips, Type 8133, Fmax 1 kN</td>
			<td>ZwickRoell GmbH &#38; Co. KG,</td>
			<td>316264</td>
			<td></td>
		</tr>
		<tr>
			<td>Seralene 3-0</td>
			<td>Serag Wiessner GmbH</td>
			<td>LO203413</td>
			<td>Polypropylene Strand 3-0</td>
		</tr>
		<tr>
			<td>Seralene 4-0</td>
			<td>Serag Wiessner GmbH</td>
			<td>LO151713</td>
			<td>Polypropylene Strand 4--0</td>
		</tr>
		<tr>
			<td>Seralene 5-0</td>
			<td>Serag&#160; Wiessner GmbH</td>
			<td>LO103413</td>
			<td>Polypropylene Strand 5-0</td>
		</tr>
		<tr>
			<td>Seramon 3-0</td>
			<td>Serag Wiessner GmbH</td>
			<td>MEO201714</td>
			<td>Polytetrafluoroethylene 3-0</td>
		</tr>
		<tr>
			<td>Seramon 4-0</td>
			<td>Serag Wiessner GmbH</td>
			<td>MEO151714</td>
			<td>Polytetrafluoroethylene 4-0</td>
		</tr>
		<tr>
			<td>Seramon 5-0</td>
			<td>Serag Wiessner GmbH</td>
			<td>MEO103414</td>
			<td>Polytetrafluoroethylene 5-0</td>
		</tr>
		<tr>
			<td>testXpert III testing software (Components following)</td>
			<td>ZwickRoell GmbH &#38; Co. KG, Ulm, Germany</td>
			<td>See following points for components</td>
			<td>testing software</td>
		</tr>
		<tr>
			<td>Results Editor</td>
			<td>ZwickRoell GmbH &#38; Co. KG, Ulm, Germany</td>
			<td>1035615</td>
			<td></td>
		</tr>
		<tr>
			<td>Layout Editor</td>
			<td>ZwickRoell GmbH &#38; Co. KG, Ulm, Germany</td>
			<td>1035617</td>
			<td></td>
		</tr>
		<tr>
			<td>Report Editor</td>
			<td>ZwickRoell GmbH &#38; Co. KG, Ulm, Germany</td>
			<td>1035620</td>
			<td></td>
		</tr>
		<tr>
			<td>Export Editor</td>
			<td>ZwickRoell GmbH &#38; Co. KG, Ulm, Germany</td>
			<td>1035618</td>
			<td></td>
		</tr>
		<tr>
			<td>Organization Editor</td>
			<td>ZwickRoell GmbH &#38; Co. KG, Ulm, Germany</td>
			<td>1035614</td>
			<td></td>
		</tr>
		<tr>
			<td>Virtual testing machine VTM</td>
			<td>ZwickRoell GmbH &#38; Co. KG, Ulm, Germany</td>
			<td>1035522</td>
			<td></td>
		</tr>
		<tr>
			<td>Language swapping</td>
			<td>ZwickRoell GmbH &#38; Co. KG, Ulm, Germany</td>
			<td>1035622</td>
			<td></td>
		</tr>
		<tr>
			<td>Upload/download</td>
			<td>ZwickRoell GmbH &#38; Co. KG, Ulm, Germany</td>
			<td>1035957</td>
			<td></td>
		</tr>
		<tr>
			<td>Traceability</td>
			<td>ZwickRoell GmbH &#38; Co. KG, Ulm, Germany</td>
			<td>1035624</td>
			<td></td>
		</tr>
		<tr>
			<td>Extended control mode</td>
			<td>ZwickRoell GmbH &#38; Co. KG, Ulm, Germany</td>
			<td>1035959</td>
			<td></td>
		</tr>
		<tr>
			<td>Video Capturing</td>
			<td>ZwickRoell GmbH &#38; Co. KG, Ulm, Germany</td>
			<td>1035575</td>
			<td></td>
		</tr>
		<tr>
			<td>Plus testControl II</td>
			<td>ZwickRoell GmbH &#38; Co. KG, Ulm, Germany</td>
			<td>1033655</td>
			<td></td>
		</tr>
		<tr>
			<td>Temperature control</td>
			<td>ZwickRoell GmbH &#38; Co. KG, Ulm, Germany</td>
			<td>1035623</td>
			<td></td>
		</tr>
		<tr>
			<td>HBM connection</td>
			<td>ZwickRoell GmbH &#38; Co. KG, Ulm, Germany</td>
			<td>1035532</td>
			<td></td>
		</tr>
		<tr>
			<td>National Instruments connection</td>
			<td>ZwickRoell GmbH &#38; Co. KG, Ulm, Germany</td>
			<td>1035524</td>
			<td></td>
		</tr>
		<tr>
			<td>Video Capturing multiCamera I</td>
			<td>ZwickRoell GmbH &#38; Co. KG, Ulm, Germany</td>
			<td>1035574</td>
			<td></td>
		</tr>
		<tr>
			<td>Video Capturing multiCamera II</td>
			<td>ZwickRoell GmbH &#38; Co. KG, Ulm, Germany</td>
			<td>1033653</td>
			<td></td>
		</tr>
		<tr>
			<td>Measuring system related measuring uncertainty to CWA 15261-2</td>
			<td>ZwickRoell GmbH &#38; Co. KG, Ulm, Germany</td>
			<td>1053260</td>
			<td></td>
		</tr>
		<tr>
			<td>Zwick Z050 TN servohydraulic materials testing system&#160;</td>
			<td>ZwickRoell GmbH &#38; Co. KG, Ulm, Germany</td>
			<td>58993</td>
			<td>servohydraulic materials testing system</td>
		</tr>
	</tbody>
</table>

polytetrafluoroethylene (ptfe) as a suture material in tendon surgery

随着缝合材料的发展，初级和次级肌腱修复的范式发生了变化。改进的机械性能允许更积极的康复和更早的恢复。然而，为了使修复能够满足更高的机械要求，必须结合这些材料评估更先进的缝合和打结技术。在该协议中，研究了使用聚四氟乙烯（PTFE）作为缝合材料并结合不同的修复技术。在协议的第一部分中，评估了用于屈肌腱修复的三种不同材料的线张力强度和打结与未打结股的伸长率。这三种不同的材料是聚丙烯（PPL），超高分子量聚乙烯与聚酯编织护套（UHMWPE）和聚四氟乙烯（PTFE）。在下一部分（尸体屈肌腱的离体 实验）中，评估了使用不同缝合技术的PTFE的行为，并与PPL和UHMWPE进行了比较。
该实验包括四个步骤：从新鲜的尸体手上收获屈肌腱，以标准化方式横断肌腱，通过四种不同的技术进行肌腱修复，在标准线性测功机上安装和测量肌腱修复。UHMWPE和PTFE表现出相当的力学性能，在线性牵引强度方面明显优于PPL。事实证明，使用四股和六股技术进行修复比两股技术更强大。由于表面摩擦非常低，PTFE的处理和打结是一个挑战，但四股或六股修复的紧固相对容易实现。外科医生在心血管外科和乳房手术中经常使用PTFE缝合材料。PTFE股适用于肌腱手术，提供强大的肌腱修复，以便可以应用早期的主动运动方案进行康复。

肌腱修复：当单独使用两股基希迈尔-凯斯勒技术时，滑移率很高，修复达到大约 30 N 的线性强度（图 2 和图 5A）5。在体内，深指屈肌的肌腱可以产生高达75 N8的线性牵引力。在创伤后条件下，由于摩擦、肿胀和粘连，该值可能更高9. 
当双股Kirchm...

Watch this Scientific Journal Video about Polytetrafluoroethylene PTFE as a Suture Material in Tendon Surgery at JoVE.com

Polytetrafluoroethylene PTFE as a Suture Material in Tendon Surgery

本协议说明了一种评估离 体肌腱修复的生物物理特性的方法。通过该方法对聚四氟乙烯（PTFE）缝合材料进行了评估，并在不同条件下与其他材料进行了比较。

聚四氟乙烯（PTFE）作为肌腱手术中的缝合材料

With the evolution of suture materials, there has been a change in paradigms in primary and secondary tendon repair. Improved mechanical properties allow ...

通过该协议，我们能够评估屈肌腱修复的机械性能。新的发展，如线性拉伸强度，可以通过这种方式可靠地进行评估。甚至可以检测到细微的差异。首先，将新鲜的尸体上肢放在解剖台上，腹掌侧面向外科医生。使用 15 号手术刀，在掌侧食指处放置一个正中纵向切口，从远端指骨开始，远端朝向掌指关节上方的 A1 滑轮。在不损伤屈肌腱的情况下纵向切断 A1 和 A2 滑轮，然后用手术刀在远端指间关节水平切断深屈肌。使用肌腱牵开器将肌腱置于牵引力下，并在 A1 滑轮水平处取回指深屈肌。然后，使用15号手术刀在rasceta折痕上做一个6厘米的横向切口。在rasceta近端10厘米处做另一个横向切口。接下来，在前臂掌侧的正中处做一个纵向切口，连接两个横向切口。在前臂筋膜水平处形成两个相对的皮瓣，以暴露屈肌腱。屈肌腱在皮肤下很容易识别。再次，使用肌腱牵开器将指趾屈肌腱置于牵引之下，并将肌腱缩回腕近端。用 11 号手术刀切断肌腱连接处的肌腱以获得最大肌腱长度，并将肌腱标本放入 500 毫升 0.9% 盐水溶液中。对第三到第五根手指重复这些步骤。将肌腱标本固定在带有销钉或 18 号套管的膨胀聚苯乙烯板上，并使用带有 11 号刀片的手术刀在中间横断肌腱。接下来，对于阿德莱德“交叉锁4股核心修复”，将针插入横断肌腱的左残端，沿着外科医生一侧的肌腱路径1.5厘米，并在肌腱表面退出。将针头向左插入三毫米，咬一口三毫米，朝外科医生退出。然后，将针向右插入三毫米，靠近第一条路径的出口点，并沿着肌腱向最侧面直到左残端。将针头插入肌腱最外侧的路径中的右残端，然后向残端右侧约 1.5 厘米处退出。然后，再次将针头插入右侧三毫米处。抓住肌腱，从肌腱侧面退出。将针头插回右侧残端，向左输入约3毫米。从右侧树桩出口，然后再次进入左侧树桩 1.5 厘米。用缝合线抓住三毫米肌腱的一部分，并在中线附近退出。将针头重新插入靠近残端三毫米的位置，然后沿着肌腱向右的方向移动，确保在残端退出。将针插入右侧残端，然后沿着肌腱纤维向右移动约 1.5 厘米。在表面退出。重新进入肌腱，向右进一步移动并抓住，瞄准远侧。将针头向左插入三毫米，然后沿着肌腱，从残端退出。现在，用八次投掷打一个手术结，手动交替方向。对于M-Tang 6股核心修复，将环的针插入距离肌腱右残端约1.5厘米处，并抓住约3毫米大小的肌腱的一部分。然后，将针穿过环并将针插入肌腱表面。沿着肌腱的路径，在残肢之间退出。将针头重新插入对面的残肢，沿着肌腱在深平面上移动 1.8 厘米。在肌腱表面退出。接下来，在树桩附近输入三毫米。沿着横向路径到肌腱的远侧并在那里退出。将轴承环的指针向左插入三毫米，远离树桩。沿着肌腱的路径，在残肢之间退出。从对面的残端重新进入，并在肌腱表面向右 1.5 厘米处退出。用剪刀剪断武装针头的两股中的一股。然后，插入针头并抓住肌腱的三毫米部分。手动用八次投掷打手术结，交替方向。取另一条环形缝合线，通过在右侧 1.5 厘米处抓住大约 3 毫米的肌腱部分来进行 Tsuge 缝合。重新插入针头并沿着肌腱的路径向左移动。在树桩之间退出。重新进入左残端，沿着肌腱的路径行驶1.5厘米。在肌腱表面退出。用一把剪刀剪断布扎针的两股中的一股，然后重新插入针头，抓住三毫米的肌腱。最后，手动打一个手术结，八次投掷，交替方向。此处显示了聚丙烯和聚四氟乙烯在使用基希迈尔-凯斯勒技术时的线性拉伸强度。两种材料之间的线性拉伸强度没有差异，尽管聚四氟乙烯由于滑移而稍弱。当使用表层运行缝合线时，滑移对于聚丙烯修复来说不是一个问题，但修复在大约 50 牛顿时崩溃了。相反，由于滑移，聚四氟乙烯的维修在大约 70 牛顿时失败。结合更强的修复，如4股阿德莱德“或6股M-Tang，和更强的缝合材料，如聚四氟乙烯或多股，可以实现75牛顿或更高的线性拉伸强度。与6股技术相比，没有观察到4股技术的显着优势。此处显示了屈肌腱修复结果的摘要。使用聚四氟乙烯进行修复显示出与多股相当的峰值拉伸强度。两种修复都明显强于聚丙烯。修复应在断腱的两个残端对称进行。应冲洗多股缝合线，以使缝合线均匀地滑过肌腱纤维。维修的结会带来一些问题。也许在未来，可以开发一些无结的修复。

Research

JoVE Journal

Medicine

Polytetrafluoroethylene (PTFE) as a Suture Material in Tendon Surgery

A Strategy to Identify de Novo Mutations in Common Disorders such as Autism and Schizophrenia

一项战略，以确定在常见的疾病，如自闭症和精神分裂症的新突变

There are several lines of evidence supporting the role of de novo mutations as a mechanism for common disorders, such as autism and schizophrenia. First, ...

科研

医学

The In ovo CAM-assay as a Xenograft Model for Sarcoma

The In ovo CAM-assay as a Xenograft Model for Sarcoma

该<em&gt;在OVO</em&gt; CAM作为一个肉瘤Xenograftmodel的检测

Sarcoma is a very rare disease that is heterogeneous in nature, all hampering the development of new therapies. Sarcoma patients are ideal candidates for ...

Isolated Hepatic Perfusion as a Treatment for Liver Metastases of Uveal Melanoma

隔离肝脏灌注作为治疗葡萄膜黑色素瘤肝转移

Isolated hepatic perfusion (IHP) is a procedure where the liver is surgically isolated and perfused with a high concentration of the chemotherapeutic ...

Oxygen-Glucose Deprivation and Reoxygenation as an In Vitro Ischemia-Reperfusion Injury Model for Studying Blood-Brain Barrier Dysfunction

Oxygen-Glucose Deprivation and Reoxygenation as an In Vitro Ischemia-Reperfusion Injury Model for Studying Blood-Brain Barrier Dysfunction

缺氧缺糖再给氧作为<em&gt;在体外</em&gt;缺血再灌注损伤模型的研究血脑屏障功能障碍

Ischemia-Reperfusion (IR) injury is known to contribute significantly to the morbidity and mortality associated with ischemic strokes. Ischemic ...

Murine Flexor Tendon Injury and Repair Surgery

鼠屈肌腱损伤修复手术

Tendon connects skeletal muscle and bone, facilitating movement of nearly the entire body. In the hand, flexor tendons (FTs) enable flexion of the fingers ...

Use of Two Intracorporeal Ventricular Assist Devices As a Total Artificial Heart

两体内心室辅助装置作为全人工心脏的应用

Mechanical circulatory support (MCS) has been introduced as a viable alternative to heart transplantation primarily through the use of intracorporeal ...

Evaluation of Stem Cell Therapies in a Bilateral Patellar Tendon Injury Model in Rats

大鼠双侧髌腱损伤模型中干细胞治疗的评价

Regenerative medicine provides novel alternatives to conditions that challenge traditional treatments. The prevalence and morbidity of tendinopathy across ...

Tachycardia-Induced Cardiomyopathy As a Chronic Heart Failure Model in Swine

心动过速诱发的心肌病作为猪慢性心力衰竭模型的研究

A stable and reliable model of chronic heart failure is required for many experiments to understand hemodynamics or to test effects of new treatment ...

Emergency Undocking in Robotic Surgery: A Simulation Curriculum

机器人手术中的紧急脱位: 一个模拟课程

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of ...