Retaining intradiscal pressure after annulotomy by different annular suture techniques, and their biomechanical evaluations

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• 作者：Yueh-Feng Chiang^a ; ^b ; Chang-Jung Chiang^c ; Chih-Hong Yang^b ; ^d ; Zheng-Cheng Zhong^e ; Chen-Sheng Chen^e ; Cheng-Kung Cheng^b ; ^{ckcheng@ym.edu.tw} ; Yang-Hwei Tsuang^c ; ^{tsuangyh@s.tmu.edu.tw}
• 关键词：annulotomy ; intradiscal pressure ; annular repair ; modified purse-string suture (MPSS) ; finite element analysis ; quantitative discomanometry
• 刊名：Clinical Biomechanics
• 出版年：2012
• 期刊代码：56_02680033
• 类别：med
• 出版时间：March, 2012
• 卷：27
• 期：3
• 页码：241-248
• 文件大小：2208 K

摘要

Background

The adverse effects of annulotomy during lumbar discectomy have been increasingly recognized, and methods are developing to repair the annular defect. Biomechanically, the repair should retain the intra-nuclear pressure, which is doubtful using the current suture techniques. Therefore, a new suture technique was designed and tested to close a simpler type of annular incision.

Methods

A new suture technique, the modified purse-string suture, was introduced into a re-validated nonlinear finite element human disk model after creating a standard transverse slit incision, as well as two other suture techniques: either two simple sutures, or a horizontal crossed suture, and compared their contact pressure on the cleft contact surface. Then, porcine lumbar endplate-disk-endplate complexes with transverse slit incisions were repaired using the three techniques. Quantitative discomanometry was then applied to compare their leakage pressure, as a parameter of disk integrity.

Findings

In finite element model, the new technique created the greatest contact pressure along the suture range (the outer annulus), and generated a minimum contact pressure at the critical point, which was 68%and 55%higher than the other two suture techniques. In quantitative discomanometry, the new suture technique also had an average leakage pressure of 85%and 49%higher than the other two suture techniques.

Interpretation

The modified purse-string suture can generate higher contact pressure than the other two techniques at finite element analysis and in realistic animal models, which aids in retaining intra-discal pressure, and should be encouraged in clinical practice.