Optimized choice of tissue-engineered tendon suture materials based on biomechanics characteristics

doi:10.3969/j.issn.2095-4344.2015.12.027

Abstract

Abstract:

BACKGROUND: The therapeutic effectiveness on tendon injury is closely related to the material of tendon suture.
OBJECTIVE: To review the progress of tendon suture materials and tendon biomechnics in recent years.
METHODS: A computer-based search of CNKI (January 1999 to December 2014), and PubMed (January 1950 to December 2014) was performed for relevant articles using the keywords of “tendon, suture materials, biomechanics” in Chinese and English, respectively.
RESULTS AND CONCLUSION: Ideal tendon repair refers to the restoration of the continuity of its anatomical structure, tensile strength and sliding function in physiology, which is influenced by many factors. Suture technique and choice of suture materials are two steps that cannot be ignored. With the development of surgical tendon suture technique, in order to improve the quality of tendon healing, ideal tendon suture is first to have sufficient strength to avoid an early tensile fracture; secondly, the elasticity cannot be too large that can cause a gap between suturing ends and affect tendon healing, and time for protecting the tendon strength is as long as possible. Therefore, the optimal choice of tendon suture materials should be based on suture methods and biomechanical characteristics of suture lines, thereby to promote tendon healing.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

全文链接：

Key words: Suture Techniques, Biomechanics

CLC Number:

R318

Wang Ji-hong, Wen Shu-zheng, Lin Xiao-hui, Yin Chao, Fan Dong-sheng, Hao Zeng-tao, Jing Shang-fei, Han Chao-qian, Wang Yong-fei . Optimized choice of tissue-engineered tendon suture materials based on biomechanics characteristics[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(12): 1948-1952.

Figures/Tables 1

2.1 肌腱缝合材料的研究进展随着人类文明进步和医学的高度发展，人们对所使用缝合线的要求日益提高。肌腱本身的组织代谢不具备较高的活性，而且缺少供应血液的神经组织和淋巴回流，所以其自身修复能力有限，一旦受到损伤就很难进行自我修复[2]。肌腱的组织学特性决定了组成肌腱的大部分胶原纤维与肌腱修复后链接肌腱的缝线方向基本是一致的，因此，缝线必须具备较高的摩擦力和较小的切割作用，否则缝合的缝线会从肌腱中抽出[3]。通常来说，理想的缝合材料应满足以下条件：通用性，即能适用于任何外科手术；无过敏性及无致癌性；易于操作；组织反应轻微，不利于细菌生长；柔顺性好，打结时不致松开，缝线本身不致磨损或裂开；不致在组织内收缩；缝合目的达到后，能被吸收而仅引起轻微反应[4]。然而，由于这种理想的通用性缝线目前还不存在，所以外科医生必须选用尽可能接近理想且具备以下特性的缝线：抗张强度均匀，以利使用较细型号的缝线；缝线的直径均匀而恒定；无菌性；柔韧性强，使操作方便、结扎安全；不含刺激性物质或杂质，以利组织相容；缝合结果可信任，对肌腱的切割作用小不容易从肌腱断端抽出、对肌腱的保护时间长，可以促进伤口的愈合，还能为外科手术提供方便等[5]。 2.1.1 缝合线的分类根据不同的分类标准，缝合线可以被分成多种类别。过去，按照材料属性可以分为天然材料、合成材料和金属材料；按照加工工艺来分，可以分成单丝型、编织型和捻合型等；按照缝线的编织方法可分为单股纤维缝线和多股纤维缝线(表1)[6]；目前，中国缝合线的主要分类标准为它的生物降解性，按照这一标准，可以分为可吸收和非吸收两种，可吸收缝线暂时性地维系对合伤口边缘，直到伤口愈合到足以承受正常的张力为止，可分为天然材质的可吸收缝线和化学合成的可吸收缝线，这些缝线还可以用能改善缝线使用性能的化学试剂浸渍或涂层，或用特殊的染料着色以增加其在组织内的可视性，不可吸收缝线不能被机体的酶类消化也不能被水解，是由金属的、人工合成的或有机纤维通过纽织和编织等方法制成的单股或多股纤维细丝所组成[7]。目前临床上缝合肌腱使用较多的缝合线包括不可吸收的聚酯多股编织缝合线(泰龙、素捷普和聚丙烯单股缝合线普里灵等)和可吸收的普迪思等[8]。"

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