“快速线结解锁技术”的探索与临床应用
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摘要
[目的]探讨一种基于魔术技巧的死结的解锁技术,使无法移动的线结重新恢复移动。[方法]通过一种可以改变线结滑动阻力而无需打开线结的解锁技术,分别在10种手术常用缝线中测试,线结包括方结、外科结,打结层数为2和3,先在肱骨标本上进行松弛线环的打结,使线结距离标本1cm左右并且手力无法拉动线结,先模拟使用器械将不同线材的4种线结采用此技术重新勒紧肱骨,从而验证临床可靠性,然后使用推拉力计测试死结解锁后线结滑动时的阻力。[结果]10种缝线与4种线结的任意组合采用此技术均取得了良好的收紧效果,每种线结采用不同缝线的线结滑动阻力顺序并不一致,而相同材料缝线的线径大小与线结滑动阻力呈正比,相同材料相同线径不同线结滑动阻力:3层的外科结>3层方结>2层外科结>2层方结,所有线材的线结滑动阻力均<0.35 kgf,凭手力十分容易收紧线结。[结论]快速线结解锁技术是一种实用、简单、无需额外开支的技术,解决如何使紧固的无法移动的死结重新恢复双向移动的问题。
[Objective] To explore a magic trick-based rapid unlocking technique for surgical knots, which allows for restoring the movement of unmovable suture knot. [Methods] The suture knots with 10 types of common surgical suture were used in this test, including square knots and surgeons knots with 2 or 3 throws. The 4 suture knots with loosening loops were individually made on the humeral specimens in interval of 1 cm to the knots unslideable, and then the loosening loops of 4 suture knots were tightened using the unlocking technique to observe whether or not the loops had completely fastened the humeral specimens for simulation of surgical conditions. Subsequently, the drag force of knot sliding used for different materials and different knots were measured using a digital force gauge. [Results] Excellent loop tightening was achieved for the arbitrary combinations of the 10 types of suture and 4 kinds of suture knot by using this technique. The drag forces of knot sliding were ranked in sequences as follows: 3-throw surgeons knot > 3-throw square knot > 2-throw surgeons knot >2-throw square knot in term of knot types with the same diameter and made of the same material suture, while 0 silk > 2-0 silk > 3-0 silk > 4-0 silk; 0 Vicryl Plus > 2-0 Vicryl Plus > 3-0 Vicryl Plus in the same kind of suture knots. The drag force of knot sliding for all sutures was less than 0.35 kgf, and it was very easy to retighten the loop by hand. [Conclusion] This rapid suture knot unlocking technique is a practical and easy to learn technique, which requires no additional expense to solve the stuck knot during tightening suture.
[Objective] To explore a magic trick-based rapid unlocking technique for surgical knots, which allows for restoring the movement of unmovable suture knot. [Methods] The suture knots with 10 types of common surgical suture were used in this test, including square knots and surgeons knots with 2 or 3 throws. The 4 suture knots with loosening loops were individually made on the humeral specimens in interval of 1 cm to the knots unslideable, and then the loosening loops of 4 suture knots were tightened using the unlocking technique to observe whether or not the loops had completely fastened the humeral specimens for simulation of surgical conditions. Subsequently, the drag force of knot sliding used for different materials and different knots were measured using a digital force gauge. [Results] Excellent loop tightening was achieved for the arbitrary combinations of the 10 types of suture and 4 kinds of suture knot by using this technique. The drag forces of knot sliding were ranked in sequences as follows: 3-throw surgeons knot > 3-throw square knot > 2-throw surgeons knot >2-throw square knot in term of knot types with the same diameter and made of the same material suture, while 0 silk > 2-0 silk > 3-0 silk > 4-0 silk; 0 Vicryl Plus > 2-0 Vicryl Plus > 3-0 Vicryl Plus in the same kind of suture knots. The drag force of knot sliding for all sutures was less than 0.35 kgf, and it was very easy to retighten the loop by hand. [Conclusion] This rapid suture knot unlocking technique is a practical and easy to learn technique, which requires no additional expense to solve the stuck knot during tightening suture.
引文
[1]Halsted WS.Ligature and suture materia[J].J Am Med Assoc,1913,LX(15):1119-1126.
[2]Taylor FW.Surgical knots[J].Ann Surg,1938,107(3):458-468.
[3]Kelly JD,Vaishnav S,Saunders BM,et al.Optimization of the racking hitch knot:how many half hitches and which suture material provide the createst security[J].Clin Orthop,2014,472(6):1930-1935.
[4]Silver E,Wu R,Grady J,et al.Knot security-how is it affected by suture technique material size and number of throws[J].J Oral Maxillofac Surg,74:1304-1312,2016.
[5]Zhao C,Hsu CC,Moriya T,et al.Beyond the square knot:a novel knotting technique for surgical use[J].J Bone Joint Surg Am,2013,95:1020-1027.
[6]Boutsiadis A,Karampalis C,Tzavelas A,et al.Anterior cruciate ligament remnant-preserving reconstruction using a"lasso-loop"knot configuration[J].Arthroscopy Tech,2015,4(6):741-746.
[7]Delimar D,Korzinek K,Hancevic J.Initial throw locking internal knotting technique[J].Surg Endosc,1998,12:1184-1185.
[8]Lee BG,Cho NS,MD,Rhee YG,et al.Suture bridge technique:a new suture bridge technique with improved tissue holding by the modified mason-allen stitch[J].Clin Orthop Surg,2012,4:242-245.
[9]Kothari R,Somashekar U,Sharma D,et al.A simple and safe extracorporeal knotting technique[J].JSLS,1900,16(2):280-282.
[10]张文玺,郑志良,史建娣.自动筋膜压测量仪在早期诊断筋膜室综合征中的应用体会[J].中国矫形外科杂志,2010,18(24):2089-2091.
[11]Sakamoto N,Akutsu H,Takano S,et al.Useful‘sliding-lock-knot’technique for suturing dural patch to prevent cerdbrospinal fluid leakage after extended transsphenoidal surger[J].Surg Neurol Int,2013,4(1):19.
[2]Taylor FW.Surgical knots[J].Ann Surg,1938,107(3):458-468.
[3]Kelly JD,Vaishnav S,Saunders BM,et al.Optimization of the racking hitch knot:how many half hitches and which suture material provide the createst security[J].Clin Orthop,2014,472(6):1930-1935.
[4]Silver E,Wu R,Grady J,et al.Knot security-how is it affected by suture technique material size and number of throws[J].J Oral Maxillofac Surg,74:1304-1312,2016.
[5]Zhao C,Hsu CC,Moriya T,et al.Beyond the square knot:a novel knotting technique for surgical use[J].J Bone Joint Surg Am,2013,95:1020-1027.
[6]Boutsiadis A,Karampalis C,Tzavelas A,et al.Anterior cruciate ligament remnant-preserving reconstruction using a"lasso-loop"knot configuration[J].Arthroscopy Tech,2015,4(6):741-746.
[7]Delimar D,Korzinek K,Hancevic J.Initial throw locking internal knotting technique[J].Surg Endosc,1998,12:1184-1185.
[8]Lee BG,Cho NS,MD,Rhee YG,et al.Suture bridge technique:a new suture bridge technique with improved tissue holding by the modified mason-allen stitch[J].Clin Orthop Surg,2012,4:242-245.
[9]Kothari R,Somashekar U,Sharma D,et al.A simple and safe extracorporeal knotting technique[J].JSLS,1900,16(2):280-282.
[10]张文玺,郑志良,史建娣.自动筋膜压测量仪在早期诊断筋膜室综合征中的应用体会[J].中国矫形外科杂志,2010,18(24):2089-2091.
[11]Sakamoto N,Akutsu H,Takano S,et al.Useful‘sliding-lock-knot’technique for suturing dural patch to prevent cerdbrospinal fluid leakage after extended transsphenoidal surger[J].Surg Neurol Int,2013,4(1):19.