Volkan ÖZTUNA, Ali YILMAZ, CENGİZ YILMAZ, Metin M. ESKANDARİ, İRFAN AYAN, Abtullah MİLCAN, Fehmi KUYURTAR

Tendon onarımında N-butil-2-siyanoakrilat (Histoakril) kullanımı: Koyun fleksör tendonuyla biyomekanik çalışma

Amaç: Bu çalışmada, tendon periferik onarımında devamlı epitendinöz dikiş ve biyoçözünür bir yapıştırıcı olan N-butil-2-siyanoakrilat (Histoakril) (NBSA) kullanı- larak yapılan onarımların biyomekanik özellikleri karşı- laştırıldı. Çalışma planı: Çalışmada 24 adet koyun şeksör tendonu kullanıldı. Orta seviyeden kesim işleminden sonra 12 tendona (grup 1) no 2 prolen ile modifiye Kessler kor dikiş ve 3/0 prolen ile devamlı epitendinöz dikiş yapıldı. Diğer 12 tendonda ise (grup 2), modifiye Kessler kor dikişten önce kesi hattına NBSA sürüldü. Her iki gruptan altışar tendona hidrolik test cihazında yüklenme-deformasyon (20 mm/dak hızda gerilme) ve siklik yüklenmedeformasyon (1-15 N arası 20 siklus/dakika frekansta yüklenme) testleri uygulandı. İki testte de onarım sahası nda 1 mm boşluk oluşumu onarımın bozulması olarak yorumlandı. Sonuçlar: Grup 1’de onarımın bozulması için gerekli yük ortalama 27.3 N (dağılım 25-32 N), ikinci grupta ise 50.4 N (da- ğılım 32-63 N) bulundu (p=0.022). Grup 1’de onarımın bozulması na kadar yapılan siklus sayısı ortalama 140 (dağılım 45-250), grup 2 de ise 350 (dağılım 150-600) idi (p=0.032). Çıkarımlar: Bu çalışmada, tendonlarda NBSA ile yapılan periferik onarımın, devamlı epitendinöz dikiş ile yapılan onarıma göre biyomekanik açıdan daha avantajlı olduğu görüldü.

Anahtar Kelimeler:

Siyanoakrilat, Enbukrilat, El yaralanmaları, Dikiş teknikleri, Gerilme kuvveti, Tendon yaralanmaları, Biyomekanik, Malzeme testi

The use of N-butyl-2-cyanoacrylate (Histoacryl) in primary tendon repair: A biomechanical study with sheep flexor tendons

Objectives: In this study, the biomechanical properties of peripheral tendon repair with the use of epitendinous suture technique and N-butyl-2-cyanoacrylate (Histoacryl) (NBSA), a biodegradable glue, were compared. Methods: Twenty-four flexor tendons were harvested from sheep hind limbs. Following transection of the tendons, 12 tendons (group 1) were repaired with modified Kessler core sutures using no 2 prolene and epitendinous running sutures with 3/0 prolene. In the other 12 tendons (group 2), NBSA was applied between the cut surfaces before placing modified Kessler core sutures. Placed on an hydrolic test machine, half of the tendons from each group were subjected to load to failure with a tensile force of 20 mm/min and the other half to cyclic loading with a tensile loading between 1-15 N at a rate of 20 cycles/min. Observation of a gap of 1 mm between the tendon ends in each test was regarded as repair failure. Results: The mean load to failure was 27.3 N (range 25 to 32 N) for group 1 and 50.4 N (range 32 to 63 N) for group 2 (p=0.022). The mean number of cycles at failure was 140 (range 45 to 250) in group 1 and 350 (range 150 to 600) in group 2 (p=0.032). Conclusion: Our results showed that peripheral tendon repair with the use of NBSA has biomechanical advantages over repair with the epitendinous running suture technique.

Keywords:

Cyanoacrylates, Enbucrilate, Hand Injuries, Suture Techniques, Tensile Strength, Tendon Injuries, Biomechanics, Materials Testing,

PDF

___

1. Elliot D, Moiemen NS, Flemming AF, Harris SB, Foster AJ. The rupture rate of acute flexor tendon repairs mobilized by the controlled active motion regimen. J Hand Surg [Br] 1994;19:607-12.
2. Cullen KW, Tolhurst P, Lang D, Page RE. Flexor tendon repair in zone 2 followed by controlled active mobilisation. J Hand Surg [Br] 1989;14:392-5.
3. Silfverskiold KL, May EJ. Flexor tendon repair in zone II with a new suture technique and an early mobilization program combining passive and active flexion. J Hand Surg [Am] 1994; 19:53-60.
4. Lee H. Double loop locking suture: a technique of tendon repair for early active mobilization. Part II: Clinical experience. J Hand Surg [Am] 1990;15:953-8.
5. Strickland JW. Flexor tendons. Acute injuries. In: Green DP, Hotchkiss RN, Pederson WC, editors. Green’s operative hand surgery. Vol. 2, 4th ed. New York: Churchill Livingstone; 1999. p. 1851-97.
6. Kubota H, Manske PR, Aoki M, Pruitt DL, Larson BJ. Effect of motion and tension on injured flexor tendons in chickens. J Hand Surg [Am] 1996;21:456-63.
7. Dona E, Gianoutsos MP, Walsh WR. Optimizing biomechanical performance of the 4-strand cruciate flexor tendon repair. J Hand Surg [Am] 2004;29:571-80.
8. Merrell GA, Wolfe SW, Kacena WJ, Gao Y, Cholewicki J, Kacena MA. The effect of increased peripheral suture purchase on the strength of flexor tendon repairs. J Hand Surg [Am] 2003;28:464-8.
9. Tang JB, Wang B, Chen F, Pan CZ, Xie RG. Biomechanical evaluation of flexor tendon repair techniques. Clin Orthop Relat Res 2001;(386):252-9.
10. Dona E, Turner AW, Gianoutsos MP, Walsh WR. Biomechanical properties of four circumferential flexor tendon suture techniques. J Hand Surg [Am] 2003;28:824-31.
11. Tran HN, Cannon DL, Lieber RL, Abrams RA. In vitro cyclic tensile testing of combined peripheral and core flexor tenorrhaphy suture techniques. J Hand Surg [Am] 2002;27: 518-24.
12. Mishra V, Kuiper JH, Kelly CP. Influence of core suture material and peripheral repair technique on the strength of Kessler flexor tendon repair. J Hand Surg [Br] 2003;28:357-62.
13.Wang B, Tang JB. Embedded cross-stitch suture: an alternative to current cross-stitch peripheral suture. J Hand Surg [Br] 2003;28:471-4.
14. Bonutti PM, Weiker GG, Andrish JT. Isobutyl cyanoacrylate as a soft tissue adhesive. An in vitro study in the rabbit Achilles tendon. Clin Orthop Relat Res 1988;(229):241-8.
15. Shermak MA, Wong L, Inoue N, Chao EY, Manson PN. Butyl-2-cyanoacrylate fixation of mandibular osteotomies. Plast Reconstr Surg 1998;102:319-24.
16.Vihtonen K, Vainionpaa S, Mero M, Patiala H, Rokkanen P, Kilpikari J, Tormala P. Fixation of experimental osteotomies of the distal femur in rabbits with bone cement and cyanoacrylate. Arch Orthop Trauma Surg 1986;105:133-6.
17. Trail IA, Powell ES, Noble J, Crank S. The role of an adhesive (Histoacryl) in tendon repair. J Hand Surg [Br] 1992; 17:544-9.
18. Pruitt DL, Manske PR, Fink B. Cyclic stress analysis of flexor tendon repair. J Hand Surg [Am] 1991;16:701-7.
19. Gelberman RH, Amifl D, Gonsalves M, Woo S, Akeson WH. The influence of protected passive mobilization on the healing of flexor tendons: a biochemical and microangiographic study. Hand 1981;13:120-8.
20. Gelberman RH, Botte MJ, Spiegelman JJ, Akeson WH. The excursion and deformation of repaired flexor tendons treated with protected early motion. J Hand Surg [Am] 1986; 11:106-10.
21. Gelberman RH, Nunley JA 2nd, Osterman AL, Breen TF, Dimick MP, Woo SL. Influences of the protected passive mobilization interval on flexor tendon healing. A prospective randomized clinical study. Clin Orthop Relat Res 1991;(264):189-96.
22. De Klerk AJ, Jonck LM. Tendon response to trauma and its possible clinical application. An experimental study in primates. S Afr Med J 1991;80:444-9.
23. Amarante MT, Constantinescu MA, O'Connor D, Yaremchuk MJ. Cyanoacrylate fixation of the craniofacial skeleton: an experimental study. Plast Reconstr Surg 1995; 95:639-46.
24. Ahn DK, Sims CD, Randolph MA, O'Connor D, Butler PE, Amarante MT, Yaremchuk MJ. Craniofacial skeletal fixation using biodegradable plates and cyanoacrylate glue. Plast Reconstr Surg 1997;99:1508-15.
25. Gosain AK, Song L, Corrao MA, Pintar FA. Biomechanical evaluation of titanium, biodegradable plate and screw, and cyanoacrylate glue fixation systems in craniofacial surgery. Plast Reconstr Surg 1998;101:582-91.
26. Evans CE, Lees GC, Trail IA. Cytotoxicity of cyanoacrylate adhesives to cultured tendon cells. J Hand Surg [Br] 1999;24:658-61.