Greenberg James A, Goldman Randi H
Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Rev Obstet Gynecol. 2013;6(3-4):107-15.
Surgical knots are simply a necessary evil needed to anchor smooth suture to allow it to function in its role in tissue reapproximation. Surgical knots reduce the tensile strength of all sutures by thinning and stretching the material. The tying of surgical knots introduces the potential of human error and interuser variability. Knot-secured smooth suture must create an uneven distribution of tension across the wound with the higher tension burdens placed at the knots. Given the excessive relative wound tension on the knot and the reasonable concerns of surgeons for suture failure due to knot slippage, there is a natural tendency toward overcoming these concerns by over-tightening knots; however, tighter knots may be worse for wound healing and strength than looser knots. In minimally invasive laparoscopic surgeries, the ability to quickly and properly tie surgical knots presents a new challenge. In cases in which knot tying is difficult, the use of knotless barbed suture can securely reapproximate tissues with less time, cost, and aggravation. This article reviews the technology behind barbed sutures with a focus on understanding how they differ from traditional smooth sutures and how barbed sutures have performed in in vitro and animal model testing, as well as in human clinical trials.
手术结只是一种必要的麻烦，用于固定光滑缝线，使其在组织对合中发挥作用。手术结会通过使材料变薄和拉伸来降低所有缝线的抗张强度。打手术结存在人为失误和使用者之间差异的可能性。用结固定的光滑缝线必须在伤口上造成不均匀的张力分布，较高的张力负担位于结处。鉴于结处相对伤口的张力过大，以及外科医生对因结滑动导致缝线失效的合理担忧，人们自然倾向于通过过度收紧结来克服这些担忧；然而，过紧的结可能比稍松的结对伤口愈合和强度更不利。在微创腹腔镜手术中，快速且正确地打手术结的能力带来了新的挑战。在打结困难的情况下，使用无结倒刺缝线可以用更少的时间、成本和麻烦来可靠地对合组织。本文回顾了倒刺缝线背后的技术，重点在于理解它们与传统光滑缝线的不同之处，以及倒刺缝线在体外和动物模型测试以及人体临床试验中的表现。
