| Hallex Valgus is a common disease in foot surgery. Though treatment options for Hallex Valgus are diverse, therapeutic effect is imcompatible. Musculus adductor pollicis and musculus abductor hallucis shift anastomosis is one of the better methods, which rectify the deformity of Hallex Valgus as well as pronation, so it is especially adaptable to the adolescent patient. Many failures are attributed to the breakage of stoma which be anastomosed by some methods in our clinical practice. Therefore, to identify which method can provide enough intension, we use four methods including gap stitch ,Kessler's stitch , Bunnell's stitch and terminal wove stitch to shift and anastomose the foot musculus adductor pollicis and musculus abductor halluis from fresh adult corpse, and research biomechanics property on the stretching mechanics, stress relaxation, creep and viscoelastic properties respectively.Though a lot of biomechanics and biological experiment studies on the four methods which have been mentioned have been reported by many scholars both here and abroad, most of experiments were on animals and flexor tendon. There has been no systematic research on the stretching mechanics, stress relaxation, creep and viscoelastic properties of the Musculus adductor pollicis and musculus abductor hallucis before and after operation.To provide objective theoretical evidence to clinical practice and be satisfied with clinical demand, the author attempts to understand how to appraise gap stitch , terminal wove stitch ,Kessler's stitch and Bunnell's stitch objectively and whether it is in accord with biomechanics principle. Consequently, the author use the foot musculus adductor pollicis and musculus abductor halluis of the adult male's fresh corpse of the normal Chinese which had been succumbed to acute traumata as normal specimens , which be shifted and anastomosed by gap stitch ,Kessler's stitch , Bunnell's stitch and terminal wove stitch , and systematically research on the stretching mechanics, stress relaxation, creep and viscoelastic properties respectively.The forty specimens comes from twenty health adult male's fresh corpse which had been succumbed to acute head traumata, both left and right foot were used in this experiment. We dissected and exposed the foot musculus adductor pollicis and musculus abductor halluis within two hours after death. Firstly, we used normal specimens to proceed stress relaxation and creep experiment, stretching experiment will be done twenty-four hours later. Then , we anastomosed the ruptured specimens by gap stitch ,Kessler's stitch , Bunnell's stitch and terminal wove stitch and proceed stress relaxation and creep experiment respectively. Finally, all specimens were restored for twenty-four hours and precede stretching experiment.The experimental apparatus is auto-control electronic omnipotent test engine ABG-10TA, which has been made in Japan and can auto-control the acceleration of strain and the stabilization of stress and strain.In stress relaxation experiment, the specimens were pretreated by loading and unloading repeatedly for twenty times. We fix each specimens on the experimental apparatus and set the computer programmer, the acceleration of strain is set at 20%/min, and record results by x–T coordinate graph which x and T represents stress and time respectively. All of 100 figures be collected from the beginning to 7200s and results can be printed automatically when the setting time exhaust, the time interval of the date collection of the first 10 figures, the next 40 figures and the final 50 figures are 0.6s, 10s and 136s respectively.The result of the stress relaxation experiment show that the quantity of stress relaxation of the musculus adductor pollicis (0.616MPa) in 7200s in normal group is 0.069MPa smaller than the musculus abductor hallucis (0.685MPa), and has significant difference(p<0.05) between them; in normal group it is hardly equal with the terminal wove stitch group(0. 654MPa) and insignificant difference (p>0.05); it has insignificant difference(p>0.05) between Kessler's stitch group(0.641MPa) and Bunnell's stitch group(0.641MPa); in gap stitch group it is 0.618MPa; in Bunnell's stitch group, Kessler's stitch group and gap stitch group they are greater than the normal group.The difference of the quantity of stress relaxation of the musculus abductor hallucis in 7200s between the terminal wove stitch group (0.742MPa)and the normal group is insignificant (p>0.05); in Bunnell's stitch group, Kessler's stitch group and gap stitch group they are 0.726MPa, 0.734MPa, 0.742MPa respectively and insignificant difference(p>0.05).In the creep experiment, we used the same experimental apparatus and methods as we used in stress relaxation experiment to pretreat and fix each specimens, record results and collect figures, but set the acceleration of creep at 0.5GPa/min and record results by x–T coordinate graph which x and T represents strain and time respectively. Creep data and curve can be printed automatically when the setting time exhaust.The result of the creep experiment show that the quantity of creep of the musculus adductor pollicis in the beginning in normal group, terminal wove stitch group, Kessler's stitch group, Bunnell's stitch group and gap stitch group are 0.456%, 0.994%, 0.768% , 0.789%, 0.644% respectively; in 7200s they are1.862%,1.775%,1.663%,1.715%,1.77% respectively; the quantity of creep of the musculus abductor hallucis in the beginning they are 0.442%, 1.01%, 0.684% , 0.665%, 0.67% respectively; in 7200s they are 1.35%, 1.622%, 1.363% , 1.4%, 1.45% respectively.The difference of the quantity of creep in the beginning in normal group between the musculus adductor pollicis and the musculus abductor hallucis is insignificant (p>0.05). The quantity of creep of the musculus adductor pollicis in the beginning is greater than the musculus abductor hallucis and has significant difference(p<0.05) between them; the quantity of creep of the musculus adductor pollicis in the beginning in normal group is smaller than others and has significant difference(p<0.05); in Bunnell's stitch group it is hardly equal with Kessler's stitch group and insignificant difference (p>0.05); in the terminal wove stitch group it is greater than the Bunnell's stitch group and Kessler's stitch group and has significant difference(p<0.05).The quantity of creep of the musculus adductor pollicis in 7200s in normal group is greater than others and has significant difference (p<0.05); in the terminal wove stitch group it is greater than the Bunnell's stitch group and Kessler's stitch group and has significant difference (p<0.05); in gap stitch group it is smaller than the terminal wove stitch group and has significant difference (p<0.05, respectively).The quantity of creep of the musculus abductor hallucisin 7200s in normal group is smaller than others and has significant difference (p<0.05); the difference between the Bunnell's stitch group and Kessler's stitch group is insignificant (p>0.05); in gap stitch group it is smaller than the terminal wove stitch group and has significant difference (p<0.05, respectively).In the tensile experiment, we used the same experimental apparatus and methods as we used in stress relaxation experiment to pretreat and fix each specimens, record results and collect figures. The tensile stress which be set at 5mm/min be exerted on the specimens until the specimens were broken, then the computer will put out some date including the ultimate stretch load, stress and strain automatically.The result of the experiment of the musculus adductor pollicis shift anastomosis show that the ultimate stretch load in the normal group, terminal wove stitch group,gap stitch group , Kessler's stitch group and Bunnell's stitch group were 0.59KN, 0.353KN, 0.0884KN, 0.225KN, 0.22KN respectively; the stress were 8.12MPa, 4.5MPa,1.323MPa, 3.37MPa, 3.297MPa respectively; the strain were 3.27%, 4.098%, 6.71%, 5.16%, 5.10% respectively.The result of the experiment of musculus abductor hallucis shift anastomosis show that the ultimate stretch load in the normal group, terminal wove stitch group,gap stitch group , Kessler's stitch group, Bunnell's stitch group were 0.551KN,0.342KN, 0.084KN, 0.212KN, 0.216KN respectively; the stress were 8.32MPa,5.16MPa,1.177MPa, 2.932MPa, 2.981MPa respectively; the strain were 2.509%, 3.089%, 6.12%, 4.284%, 4.14% respectively.The ultimate stretch load of musculus adductor pollicis is greater than musculus abductor hallucis in normal group, because it corresponds with their cross sectional area, there is insignificant difference between them (p>0.05). The strain of musculus adductor pollicis is greater than musculus abductor hallucis in normal group (p<0.05).The ultimate stretch load and stress of musculus adductor pollicis in normal group are greater than the terminal wove stitch group, there is insignificant difference between them (p>0.05), respectively); in the terminal wove stitch group they are greater than gap stitch group , Kessler's stitch groupand Bunnell's stitch group, there are significant difference between them(p<0.05, respectively). Compared with the stress of terminal wove stitch group, the proportion of Bunnell's stitch group, Kessler's stitch group and gap stitch group are 73%, 74.8%, 29.4% respectively. The favorable coincidence of the results operated with urbaniak.ect and us.The strain in normal group is smaller than the terminal wove stitch group, Bunnell's stitch group, Kessler's stitch group and gap stitch group; in gap stitch group it is greater than the terminal wove stitch group, Bunnell's stitch group and Kessler's stitch group, there are significant difference between them (p<0.05, respectively); in Bunnell's stitch group it is hardly equal with Kessler's stitch group and has insignificant difference (p>0.05).The ultimate stretch load and stress of musculus abductor hallucis in normal group are greater than the terminal wove stitch group, there is significant difference between them (p<0.05, respectively); in the terminal wove stitch group they are greater than gap stitch group , Kessler's stitch groupand Bunnell's stitch group, there are significant difference between them(p<0.05, respectively). Compared with the stress of terminal wove stitch group, the proportion of Bunnell's stitch group, Kessler's stitch group and gap stitch group are 56.8%, 57.7%, 22.8% respectively.The strain in normal group is smaller than the terminal wove stitch group, Bunnell's stitch group, Kessler's stitch group and gap stitch group; in gap stitch group it is greater than Bunnell's stitch group and Kessler's stitch group, has significant difference between them (p<0.05, respectively); in Bunnell's stitch group it is hardly equal with Kessler's stitch group and has insignificant difference (p>0.05).Empirical study on the biomechanics property of musculus adductor pollicis and musculus abductor halluis and four anatomizes provide biomechanics theoretical evidences to musculus adductor pollicis and musculus abductor halluis shift anastomosis using in clinical practice of the treatment of Hallex Valgus. Form our study and the anatomic feature of musculus adductor pollicis and musculus abductor halluis, we can conclude that the terminal wove stitch have superiority in biomechanics properties such as intension and strain to other anastomosis, and is consistent with the biomechanics requirement for the treatment of Hallex Valgus. |
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