Hodge J
Surg Gynecol Obstet. 1986 Jan;162(1):56-9.
Surgical techniques can be refined and dexterity improved by using angulated needle holders and instruments. This allows the surgeon to place his or her hand in the position of function while suturing either retrograde or antegrade, thus permitting flexion, extension, abduction, adduction, pronation and supination with circumduction to occur without restriction. Under normal circumstances abduction, pronation and extension are limited by anatomic factors, such as the greater mulitangular abutting the longer styloid process of the radius and the stronger ulnar collateral ligament restricting abduction. The chief indication for using angulated needle holders is in retrograde suturing, such as placing posterior row sutures in anastomosing blood vessels, intestine and the ureter. These instruments are not substitutes for straight needle holders but are chiefly an adjunct that permit the surgeon to perform movements with his hand at the wrist joint that are not allowed with the use of straight needle holders which require greater torque in performing operative procedures. They allow better exposure by improving visibility to the area being sutured since the surgeon is not looking down the barrel of the needle holder and has a clear unobstructed view. The instruments permit clamping and suturing of tissues and vessels in small deep wounds that do not readily admit nonangulated hemostats and needle holders, such as those in urologic and gynecologic operations. Instrument tying is easily accomplished because of the short shaft of the instrument, especially in plastic or surface surgical procedures. Furthermore, with angulation, one is able to grasp the needle holder between the thumb and volar aspect of the second and third digits, thus allowing easy retrograde movements that one experiences in grasping a thumb forceps. From the standpoint of medical egonometrics, hand fatigue is reduced since the needle holder does not have to be locked by closing the rings and engaging the serations each time the needle is handed to the surgeon for placement of sutures.
使用成角持针器和器械可使手术技术得到改进，灵活性得以提高。这能让外科医生在逆行或顺行缝合时将手置于功能位置，从而使屈、伸、外展、内收、旋前和旋后以及环转运动不受限制地进行。在正常情况下，外展、旋前和伸展受解剖因素限制，比如大多角骨与桡骨较长的茎突相抵，以及较强的尺侧副韧带限制外展。使用成角持针器的主要适应证是逆行缝合，比如在吻合血管、肠道和输尿管时放置后层缝线。这些器械并非直持针器的替代品，主要是一种辅助工具，能让外科医生在腕关节处进行使用直持针器时无法进行的手部动作，因为直持针器在进行手术操作时需要更大的扭矩。由于外科医生无需顺着持针器的针筒向下看，能获得清晰无遮挡的视野，所以它们通过改善对缝合区域的可视性实现了更好的暴露。这些器械可用于在小而深的伤口中钳夹和缝合组织及血管，这类伤口不易容纳非成角的止血钳和持针器，比如泌尿外科和妇科手术中的伤口。由于器械的轴较短，器械打结很容易完成，尤其是在整形或体表外科手术中。此外，通过成角，人们能够将持针器夹在拇指与示指和中指的掌侧之间，从而实现像抓握拇指镊子时那样轻松的逆行动作。从医学人体工程学的角度来看，由于每次将针递给外科医生进行缝合时无需通过闭合环并啮合锯齿来锁定持针器，手部疲劳得以减轻。
