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건 조직 수복과정의 장력 및 형태학적 변화에 관한 실험적 연구

Title
건 조직 수복과정의 장력 및 형태학적 변화에 관한 실험적 연구
Other Titles
Experimental study of the tensile strength and morphology on tendon repairs
Issue Date
1982
Publisher
연세대학교 대학원
Description
의학과/박사
Abstract
[한글] 문명의 발달과 더불어 산업재해가 빈발하고 현대 문명생활에 따른 각종 기구를 사용함으로 많은 수부의 건 조직 손상을 유발하여 수부외과에서는 건 수복을 위한 다양한 방법이 고안되어 발전되고 있는 실정이다. 건 조직 손상의 술후 처치에 관하여 조기운동은 조 직을 비후시키며 수복부의 간격을 넓혀 오히려 회복에 지장을 초래한다는 보고와 또한 건 치유가 완전히 회복된 후 운동을 허용할 경우 유착 때문에 얻어지는 운동 범위가 불량하여 조기에 운동을 시작하여야 한다는 상반된 보고가 있다. 그러므로 건 조직이 수복위를 유지하며 조기에 운동을 허용하려면 봉합물질의 장력, 건의 봉합물질 포유력, 수복부 건을 싸고 있는 건초의 부피 및 운동을 할 경우 수복위를 유지하는 지구력 등을 고려하여야 한다. 저자는 이러한 점을 참작하여 건 수복에 흔히 사용 되는 네가지 봉합술에 있어서 장력 변화와 형태 조직학적 반응을 관찰하여 형태학적 및 물리학적수복과정 을 비교하고자 하였다. 실험동물은 체중 2kg의 백색 Leghorn닭을 사용하여 일측의 제 3족지 심굴곡건에 4-0 Ethilon**(R) 봉합사로 단순 봉합술, Bunnel 봉합술, Kessler 봉합술 및 단면직상 봉합술을 시행후 수복부를 석고붕대로 고정하였다. 장력의 측정은 수술 직후부터 21일까지 실험시 기에 따라 수복건을 절제하여 force transducer에 연결하고 봉합부가 파열될 때의 장력을 low level preamplifier를 통하여 증폭시킨 후 Polygraph에 기록하였다. 형태 변화는 육안 및 현미경적으로 6주간 변화를 관찰시기에 따라 봉합건을 절제하여 육안적 관찰과 절제건을 고정하여 hematoxylin-eosin염색과 Masson-trichrome염색을 한 후 검경하에 비교 관찰한 바 다음과 같은 결과를 얻었다. 1. 단순봉합술, Kessler 봉합술 및 단면직상 봉합술을 시행한 실험군에서의 건 장력은 수술 후 5일에, 또한 Bunnel 봉합술을 시행한 실험군에서는 10일에 감소되어 최저치를 보인 후 점차 증가하는 과정을 나타내었다. 2. 전체 실험군 중 수복과정을 통하여 단면직상 봉합술을 시행한 군에서 가장 강한 장력을 나타내었다. 3. 수술 직후에는 장력이 Bunnel, Kessler, 단순 봉합술군의 순으로 강하였으나 21일에는 각기 유사한 장력을 나타내었다. 4. 형태적으로는 단순 봉합술과 Kessler 봉합술이 양호한 수복과정을 보였고 Bunnel 봉합술과 단면직상 봉합술이 불량한 수복과정을 보였다. 이상의 실험 결과로 실험 봉합술중 Kesslerr 봉합술이 형태학적 및 물리학적으로 종합하여 비교적 양호한 봉합술로 인정되었다. Experimental Study of the Tensile Strength and Morphology on Tendon Repairs Kuhn Sung Whang, M.D. Department of Medical Science, The Graduate School, Yonsei University (Directed by Professor Byong Mun Park, M.D.) Many injuries of the hand have been occurred in these days because of frequent industrial hazards and frequent handling of tools in modern civilizing life. A voluminous amount of literature has been recently concerned with many problems and questions posed by tendon surgery. Many investigation have been devoted to discussion of suture materials, tendon suturing, grafting, healing, rate of healing, nutrition and related clinical and laboratory endeavors. Whatever the material, the aim of tendon suture is not only restoration of a strong mechanical union but also sliding function of the tendon. Thus the question has always been after what delay active mobilization can be allowed or encouraged. If immobilization allows fibroblasts to invade the tendon extremities find form a scar mass, its prolong leads to adhesion and loss of normal sliding. On the other hand, one can admit that early passive or active mobilization. even if only over a short distance may distend the adherences and transform them into a kind of mesotenon assuring a better sliding function. Before permiting early motion, several factors must be considered such as tensile strength of the suture material, holding power of the suture for the tendon, bulkiness of the repair and stress that must be withstood. Thus it is the purpose of this study to analysis and comparing of tensile strength and morphological changes in the healing process of tendon tissues by different suturing methods. For this study deep flexor tendon on third toe of adult chicken wish an initial weight of about 2kg was used. The animals were divided into 4 sutured groups which including different suturing methods. Suturing methods used were interrupted suture, Bunnel's lace suture, Kessler suture and end-weave anastomosis, which have been applied frequently in tendon surgery. All suture material used were the same size 4-0 Ethilon**(R) which has least tissue reaction but high strength. In the animals, after the sharp dissection of the distal portion of the deep flexor tendon on third toe, the tendon stumps were approximated and sutured by 4 different methods. Then a long leg cast in the position of flexion of the foot and ankle joint was applied. On operation day and fifth, tenth, fourteenth and twenty-first postoperative day, the animals were sacrified and the specimens were gained. The measurement of the tensile strength of the sutured tendon was performed through the use of force transducer with talc recording of polygraph for permitting continuous monitoring of a progressively increasing load until the failure of tendon repair. Specimens stained with hematoxylin-eosin and Masson-trichrome stain were observed during 42 days after operation. The findings are as follows. 1. The tensile strength of sutured tendon groups using interrupted suture, Kessler suture, and end-weave anastomosis were reduced maximally on fifth postoperative day and the tensile strength of Bunnel's lace suture group was reduced maximally on tenth postoperative day. Thereafter the strength was increased progressively on entire experimental groups. 2. The tensile strength of end-weave anastomosis group was the strongest among all experimental groups during experimental period. 3. Just after the repairs of injured tendon, the order of strength was Bunnel. Kessler and interrupted suture but the strength was nearly approximated on 21st day. 4. The morphological healing process of interrupted and Kessler suture were better than that of Bunnel and end-weave suture. From these morphological and physical results, it is suggested that Kessler suture is the better suturing method in tendon repair.
[영문] Many injuries of the hand have been occurred in these days because of frequent industrial hazards and frequent handling of tools in modern civilizing life. A voluminous amount of literature has been recently concerned with many problems and questions posed by tendon surgery. Many investigation have been devoted to discussion of suture materials, tendon suturing, grafting, healing, rate of healing, nutrition and related clinical and laboratory endeavors. Whatever the material, the aim of tendon suture is not only restoration of a strong mechanical union but also sliding function of the tendon. Thus the question has always been after what delay active mobilization can be allowed or encouraged. If immobilization allows fibroblasts to invade the tendon extremities find form a scar mass, its prolong leads to adhesion and loss of normal sliding. On the other hand, one can admit that early passive or active mobilization. even if only over a short distance may distend the adherences and transform them into a kind of mesotenon assuring a better sliding function. Before permiting early motion, several factors must be considered such as tensile strength of the suture material, holding power of the suture for the tendon, bulkiness of the repair and stress that must be withstood. Thus it is the purpose of this study to analysis and comparing of tensile strength and morphological changes in the healing process of tendon tissues by different suturing methods. For this study deep flexor tendon on third toe of adult chicken wish an initial weight of about 2kg was used. The animals were divided into 4 sutured groups which including different suturing methods. Suturing methods used were interrupted suture, Bunnel's lace suture, Kessler suture and end-weave anastomosis, which have been applied frequently in tendon surgery. All suture material used were the same size 4-0 Ethilon**(R) which has least tissue reaction but high strength. In the animals, after the sharp dissection of the distal portion of the deep flexor tendon on third toe, the tendon stumps were approximated and sutured by 4 different methods. Then a long leg cast in the position of flexion of the foot and ankle joint was applied. On operation day and fifth, tenth, fourteenth and twenty-first postoperative day, the animals were sacrified and the specimens were gained. The measurement of the tensile strength of the sutured tendon was performed through the use of force transducer with talc recording of polygraph for permitting continuous monitoring of a progressively increasing load until the failure of tendon repair. Specimens stained with hematoxylin-eosin and Masson-trichrome stain were observed during 42 days after operation. The findings are as follows. 1. The tensile strength of sutured tendon groups using interrupted suture, Kessler suture, and end-weave anastomosis were reduced maximally on fifth postoperative day and the tensile strength of Bunnel's lace suture group was reduced maximally on tenth postoperative day. Thereafter the strength was increased progressively on entire experimental groups. 2. The tensile strength of end-weave anastomosis group was the strongest among all experimental groups during experimental period. 3. Just after the repairs of injured tendon, the order of strength was Bunnel. Kessler and interrupted suture but the strength was nearly approximated on 21st day. 4. The morphological healing process of interrupted and Kessler suture were better than that of Bunnel and end-weave suture. From these morphological and physical results, it is suggested that Kessler suture is the better suturing method in tendon repair.
URI

http://ir.ymlib.yonsei.ac.kr/handle/22282913/117421
Appears in Collections:
2. 학위논문 > 1. College of Medicine (의과대학) > 박사
Yonsei Authors
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