Shear lag sutures: Improved suture repair through the use of adhesives
Shear lag sutures: Improved suture repair through the use of adhesives
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DOI：
10.1016/j.actbio.2015.05.002
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发表时间：
2015-09-01
影响因子：
9.7
通讯作者：
Thomopoulos, Stavros
中科院分区：
文献类型：
--
作者：
Linderman, Stephen W.;Kormpakis, Ioannis;Thomopoulos, Stavros
自五千多年前首次使用以来，缝合材料和手术打结技术已经有了显着改进。然而，该方法仍然受到缝线将载荷传递到缝线锚点处组织的能力的限制。在这里，我们预测粘合剂涂层缝线可以改善机械载荷传递，超出现有缝合方法的性能范围，从而加强修复并降低失败风险。使用剪切滞后模型确定合适的粘合剂的机械性能。对最佳粘合剂的设计空间的检查表明，需要强粘合和低刚度，以最大限度地提高粘合剂涂层缝线修复结构的强度。为了对模型进行实验评估，我们评价了涂有高柔性氰基丙烯酸酯（Loctite 4903和4902）、氰基丙烯酸酯（Loctite QuickTite Instant Adhesive Gel）、橡胶水泥、橡胶/垫圈粘合剂（1300 Scotch-Weld氯丁橡胶高性能橡胶和垫圈粘合剂）、白蛋白-戊二醛粘合剂（BioGlue）或聚（多巴胺）的单股缝线。作为临床相关的概念验证，然后使用氰基丙烯酸酯涂层缝线在尸体组织中进行临床相关的屈指肌腱修复。与不使用粘合剂的标准修复相比，使用粘合剂涂层缝线进行的修复具有显著更高的强度。值得注意的是，氰基丙烯酸酯提供了具有高刚度和脆性行为的强粘合，因此不是用于增强缝合修复的理想粘合剂。然而，即使使用非理想粘合剂，在临床相关环境中修复性能的改善也证明了所提出的方法改善需要缝线固定的治疗结局的潜力。进一步的研究是必要的，以开发一个强有力的粘附，顺应性的粘合剂内的最佳设计空间所描述的模型。(C)2015 Acta Materialia Inc.由爱思唯尔有限公司出版。保留所有权利。
Suture materials and surgical knot tying techniques have improved dramatically since their first use over five millennia ago. However, the approach remains limited by the ability of the suture to transfer load to tissue at suture anchor points. Here, we predict that adhesive-coated sutures can improve mechanical load transfer beyond the range of performance of existing suture methods, thereby strengthening repairs and decreasing the risk of failure. The mechanical properties of suitable adhesives were identified using a shear lag model. Examination of the design space for an optimal adhesive demonstrated requirements for strong adhesion and low stiffness to maximize the strength of the adhesive-coated suture repair construct. To experimentally assess the model, we evaluated single strands of sutures coated with highly flexible cyanoacrylates (Loctite 4903 and 4902), cyanoacrylate (Loctite QuickTite Instant Adhesive Gel), rubber cement, rubber/gasket adhesive (1300 Scotch-Weld Neoprene High Performance Rubber & Gasket Adhesive), an albumin-glutaraldehyde adhesive (BioGlue), or poly(dopamine). As a clinically relevant proof-of-concept, cyanoacrylate-coated sutures were then used to perform a clinically relevant flexor digitorum tendon repair in cadaver tissue. The repair performed with adhesive-coated suture had significantly higher strength compared to the standard repair without adhesive. Notably, cyanoacrylate provides strong adhesion with high stiffness and brittle behavior, and is therefore not an ideal adhesive for enhancing suture repair. Nevertheless, the improvement in repair properties in a clinically relevant setting, even using a non-ideal adhesive, demonstrates the potential for the proposed approach to improve outcomes for treatments requiring suture fixation. Further study is necessary to develop a strongly adherent, compliant adhesive within the optimal design space described by the model. (C) 2015 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.