Yang Chunxi, Xie Cheng, Liu Hui, Hua Zikai, An Bingchen
Department of Bone and Joint Surgery, Department of Orthopedic, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Rehabilitation Medicine, Huadong Hospital, Fudan University, Shanghai, China.
Front Surg. 2022 Dec 19;9:1065666. doi: 10.3389/fsurg.2022.1065666. eCollection 2022.
Suture passer needle, as one of commonly used instrument in the arthroscopic rotator cuff repair, often breaks at the notch of the needle, which originally was designed to facilitate suture with thread. Our study aimed to evaluate the suture failure rate and stitch success rate between intact suture needle and broken needle and explore the mechanism of the needle breakage and achieving better future designs.
From 2017 to 2021, consecutive 437 shoulders (11 cases were bilateral) underwent arthroscopic repair for full-thickness rotator cuff tear at the authors' institution. The breakage of needles was recorded. Finite elements analysis and mechanical test were utilized to compare stress distribution, puncture performance, and loaded puncture performance between the broken needle and the intact needle.
We identified 19 consecutive patients for whom the needle tip of the TruePass™ suture passer was broken in the 437 shoulder surgeries. Based on the finite element analysis of Abaqus, around the tip and the notch of the intact needle was a large stress concentration. The average puncture force required by intact needle tip and the broken tip is 61.78N and 78.23N respectively. While the intact tip with notch is easier to break than the broken tip.
The notch of the needle is a weak point in mechanics. The broken needle without the notch still has good tendon piercing and thread passing ability. The notch of needle may be not necessary, and the tip of the needle should be modified.
缝线穿针器作为关节镜下肩袖修补术中常用器械之一，常在针的缺口处断裂，该缺口最初设计用于便于缝线穿过。本研究旨在评估完整缝线针与断裂针之间的缝线失败率和缝合成功率，并探讨针断裂的机制，以期实现更好的未来设计。
2017年至2021年，作者所在机构连续对437例肩部（11例为双侧）进行了全层肩袖撕裂的关节镜修复手术。记录针的断裂情况。利用有限元分析和力学测试比较断裂针与完整针之间的应力分布、穿刺性能和加载穿刺性能。
在437例肩部手术中，我们确定了19例连续患者，其TruePass™缝线穿针器的针尖在手术中发生断裂。基于Abaqus有限元分析，完整针的尖端和缺口周围存在较大应力集中。完整针尖和断裂针尖所需的平均穿刺力分别为61.78N和78.23N。而带有缺口的完整针尖比断裂针尖更容易断裂。
针的缺口是力学上的薄弱点。没有缺口的断裂针仍具有良好的肌腱穿刺和缝线穿过能力。针的缺口可能并非必要，针的尖端应进行改进。
