Meyer Dominik C, Bachmann Elias, Lädermann Alexandre, Lajtai Georg, Jentzsch Thorsten
Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland.
Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
Orthop Traumatol Surg Res. 2018 Dec;104(8):1277-1282. doi: 10.1016/j.otsr.2018.08.010. Epub 2018 Oct 13.
Surgical knots are particularly challenged by high-strength suture material. It was hypothesized that sutures in a double-stranded looped configuration present mechanical advantages.
This in vitro biomechanical study repeatedly tested 12 different knots with a static distraction material testing machine with a constant tensile speed. The cow hitch, its altered version, and conventional half hitches were also tested on bovine tendon. Suture material was braided polyblend non-bioresorbable polyester. Primary outcome was knot security (stiffness) at clinical failure (≥3mm displacement). Secondary outcomes were knot size and loop security.
Double-stranded looped knots were up to three times stronger than one and a half- and single-stranded knots. The cow hitch was stiffest (mean 185 [95% CI 172-197]Newton per millimeter [N/mm]) (p<0.001), followed by the Nice knot (169 [154-183]N/mm). It was stiffer than half hitches (65 [53-78]N/mm). These findings remained in tendons (82 [77-86] and 40 [32-49]N/mm, p<0.001). The cow hitch (7.6mm) and Nice knot (6.1mm) were smaller than half hitches (9.5mm). Loop security did not differ between the cow hitch and Nice knot, but was higher in the cow hitch than half hitch (158 [120-196]N and 85 [57-113]N, p<0.001).
Double-stranded knot configurations with a loop on one side are mechanically stronger and stiffer, less bulky, and preserve applied tension during tying better than conventional knots. The best performing and technically most simple knots best suited to exploit enormous mechanical capabilities of modern high-strength suture material are the cow hitch and Nice knot.
Not applicable due to the biomechanical nature of the study.
高强度缝合材料给手术打结带来了特殊挑战。据推测，双链环状结构的缝线具有机械优势。
本体外生物力学研究使用静态拉伸材料试验机，以恒定拉伸速度对12种不同的结进行反复测试。还在牛肌腱上测试了双套结、其变体以及传统的半结。缝合材料为编织聚混纺非生物可吸收聚酯。主要结局指标为临床失败（≥3mm移位）时的结安全性（刚度）。次要结局指标为结的大小和环的安全性。
双链环状结的强度比单股半结和单链结高出两倍。双套结最牢固（平均185[95%可信区间172 - 197]牛顿每毫米[N/mm]）（p<0.001），其次是尼斯结（169[154 - 183]N/mm）。它比半结更牢固（65[53 - 78]N/mm）。这些结果在肌腱中同样成立（82[77 - 86]和40[32 - 49]N/mm，p<0.001）。双套结（7.6mm）和尼斯结（6.1mm）比半结（9.5mm）小。双套结和尼斯结的环安全性没有差异，但双套结的环安全性高于半结（158[120 - 196]N和85[57 - 113]N，p<0.001）。
一侧带有环的双链结结构在机械性能上更强、更牢固，体积更小，并且在打结过程中比传统结更能保持施加的张力。双套结和尼斯结是性能最佳且技术上最简单的结，最适合发挥现代高强度缝合材料的巨大机械性能。
由于本研究的生物力学性质，不适用。
