AHMET PİŞKİN, Aydın YÜCETÜRK, YILMAZ TOMAK, METE ÖZER, Birol GÜLMAN, Azat ATAMAN, Mustafa KANGAL, Yılmaz ŞAHİN, Eren DESTELİ, Taner ALIÇ

Tendon tamirinde güçlendirilmiş modifiye kessler, modifiye kessler ve savage yöntemlerinin karşılaştırılması: Biyomekanik çalışma

Amaç: Bu çalışmada, basit ve uygulaması kolay, ayrıca erken aktif hareket protokollerinin tamir sahasında oluşturduğu güce dayanabilecek bir dikiş tekniğinin geliştirilmesi amaçlandı. Çalışma planı: Çalışmada, yaşları 12-16 ay arası değişen koyunların tırnaklarına uzanan 30 adet derin fleksör digitorum kasının tendonu kullanıldı. Tendonlar in situ tamir edilmek üzere üç gruba ayrıldı. Bir grupta modifiye Kessler tamiri, bir grupta altı dönüşlü (six strand) Savage tekniği, son grupta ise güçlendirilmiş modifiye Kessler tekniği uygulandı. Tüm gruplarda tamir tekniği epitendinöz dikişle birlikte kullanıldı. Biyomekanik testlerde tamir sahasında 3 mm ayrılma oluşumu sırasında uygulanan güç ve kopma olana kadar uygulanan maksimum güç kaydedildi. Sonuçlar: Modifiye Kessler tamiri kullanılan grupta 3 mm ayrılma ve kopma değerleri sırasıyla ortalama 29.9±2.9 N ve 37.0±4.0 N bulundu. Bu değerler altı dönüşlü Savage tekniği ile sırasıyla 39.1±6.7 N ve 51.3±6.1 N; güçlendirilmiş modifiye Kessler tekniği ile 59.9±8.3 N ve 69.0±8.7 N idi. Güçlendirilmiş modifiye Kessler tekniği kullanılan grupta 3 mm ayrılma ve kopma değerleri diğer iki gruptan anlamlı derecede yüksek; modifiye Kessler tamiri kullanılan grupta her iki değer de anlamlı derecede düşük bulundu (p

Anahtar Kelimeler:

Gerilme kuvveti, Hayvanlar, Dikiş teknikleri, Tendon yaralanmaları, Koyun, Biyomekanik

Tendon repair with the strengthened modified kessler, modified kessler, and savage suture techniques: a biomechanical comparision

Objectives: The aim of the study was to develop a suture technique that would be simple and easy to perform, but also strong enough to resist the strength formed during early active exercise protocols. Methods: Thirty flexor digitorum profundus muscle tendons were obtained from lambs aged 12 to 16 months. The tendons were assigned to three in situ repair groups, including the modified Kessler technique, six-strand Savage technique, and a strengthened modified Kessler technique, all combined with an epitendinous suture. Each group was subjected to biomechanical tests and the maximum strength of the tendons to rupture and the power exerted to yield a 3-mm separation were recorded. Results: The mean strengths of the tendons repaired with the modified Kessler technique for 3-mm separation and rupture were 29.9±2.9 N and 37.0±4.0 N, respectively. The corresponding forces were 39.1±6.7 N and 51.3±6.1 N with the six-strand Savage technique, and 59.9±8.3 N and 69.0±8.7 N with the strengthened modified Kessler technique, respectively. Forces to produce a 3-mm separation and rupture were significantly higher with the strengthened modified Kessler repair, whereas the lowest forces were seen with the modified Kessler technique (p<0.001). Conclusion: Tendon repair with the strengthened modified Kessler technique provides the highest resistance to both 3-mm separation and rupture. These biomechanical properties may allow safe and active motion without any gap formation in the repair area.

Keywords:

Tensile Strength, Animals, Suture Techniques, Tendon Injuries, Sheep, Biomechanics,

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