Loutzenheiser T D, Harryman D T, Yung S W, France M P, Sidles J A
Department of Orthopaedics, University of Washington, Seattle 98195, USA.
Arthroscopy. 1995 Apr;11(2):199-206. doi: 10.1016/0749-8063(95)90067-5.
Arthroscopic repairs, such as those for shoulder instability, are commonly performed. However, the failure rate after arthroscopic repair appears to be higher than with open surgery. These failures may relate to the challenge of tying secure knots arthroscopically. Many knots tied arthroscopically commonly consist of an initial slip knot to remove slack, and a series of half-hitches. Half-hitches, instead of square throws, are difficult to avoid and result when asymmetrical tension is applied to the strands. For this reason, the security of knots tied arthroscopically may not be equivalent to square knots and a greater rate of failure may occur. The purpose of this study was to determine (1) the security of various arthroscopic knots under cyclic and peak loading conditions, (2) how the surgeon can modify the method or sequence of half-hitch throws to minimize knot slippage or breakage, and (3) whether using an arthroscopic knot pusher affects the security of the same knot tied by hand. The most secure knot configurations were achieved by reversing the half-hitch throws and alternating the posts. These knots performed significantly better than all other knots tested (P < .002). Thus the surgeon can control the holding capacity and minimize suture loop displacement by proper alternation of the tying strands and reversal of the loop when placing the hitches.(ABSTRACT TRUNCATED AT 250 WORDS)
关节镜修复手术，如用于治疗肩部不稳定的手术，是常见的操作。然而，关节镜修复后的失败率似乎高于开放手术。这些失败可能与关节镜下系紧牢固结的挑战有关。许多在关节镜下系的结通常由一个初始滑结来消除松弛，以及一系列平结组成。平结而非方结难以避免，并且当对线绳施加不对称张力时就会出现。因此，关节镜下系的结的安全性可能不如方结，并且可能会出现更高的失败率。本研究的目的是确定：（1）在循环和峰值负荷条件下各种关节镜结的安全性；（2）外科医生如何修改平结打法的方法或顺序以尽量减少结的滑动或断裂；（3）使用关节镜打结器是否会影响手工系相同结的安全性。通过反转平结打法并交替线柱可实现最安全的结构型。这些结的表现明显优于所有其他测试的结（P <.002）。因此，外科医生在打平结时，通过对线绳进行适当的交替并反转线环，可控制结的固定能力并尽量减少缝线环的移位。（摘要截短于250字）
