Sharp H T, Dorsey J H, Chovan J D, Holtz P M
Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, USA.
Obstet Gynecol. 1996 Sep;88(3):408-11. doi: 10.1016/0029-7844(96)00216-5.
To evaluate and compare the strength of six different knot geometries used in laparoscopic slip knots.
The strength of six extracorporeal slip knots used in laparoscopic surgery was measured using a tensiometer. Two multiple-throw laparoscopic square knots (the intracorporeal two-turn flat square knot and the extracorporeal sliding square knot) were used as controls. Each knot type was tied five times, and each type was tied in random order by the same primary and assisting surgeons using a laparoscopic pelvic surgery training model. One-way analysis of variance was performed to detect significant differences in knot strengths, and the variability in knot strength for each knot type was determined by Tukey's multiple comparison test.
A statistically significant effect for knot geometry was identified. The mean knot strengths +/- standard deviation (SD), measured in newtons, from strongest to weakest, were: 4S knot (28.01 +/- 11.45), fisherman's knot (22.45 +/- 6.89), modified Roeder knot (19.86 +/- 9.30), Roeder knot (15.77 +/- 7.02), Weston knot (7.28 +/- 7.96), and Duncan knot (6.55 +/- 0.95). The mean knot strengths for the multiple-throw control square knots were as follows: intracorporeal two-turn flat square knot (41.21 +/- 2.69) and extracorporeal sliding square knot (27.81 +/- 16.27). The intracorporeal two-turn flat square knot (control) was significantly stronger (P < .05) than all slip knots except the 4S and fisherman's knot.
The 4S and fisherman's knots are the strongest laparoscopic slip knots and are the only slip knots similar in strength to multiple-throw square knots.
评估并比较用于腹腔镜滑结的六种不同结型的强度。
使用张力计测量六种用于腹腔镜手术的体外滑结的强度。将两个多折返腹腔镜方结（体内两圈扁平方结和体外滑动方结）用作对照。每种结型均打结五次，每种结型由同一位主刀和助手外科医生使用腹腔镜盆腔手术训练模型以随机顺序打结。进行单因素方差分析以检测结强度的显著差异，并通过Tukey多重比较检验确定每种结型的结强度变异性。
确定了结型对强度有统计学显著影响。以牛顿为单位测量的平均结强度±标准差（SD），从最强到最弱依次为：4S结（28.01±11.45）、渔夫结（22.45±6.89）、改良罗德结（19.86±9.30）、罗德结（15.77±7.02）、韦斯顿结（7.28±7.96）和邓肯结（6.55±0.95）。多折返对照方结的平均结强度如下：体内两圈扁平方结（41.21±2.69）和体外滑动方结（27.81±16.27）。体内两圈扁平方结（对照）比除4S结和渔夫结之外的所有滑结都显著更强（P<.05）。
4S结和渔夫结是最强劲的腹腔镜滑结，并且是仅有的强度与多折返方结相似的滑结。
