Loutzenheiser T D, Harryman D T, Ziegler D W, Yung S W
Medical College of Vermont, Burlington, USA.
Arthroscopy. 1998 Jan-Feb;14(1):57-65. doi: 10.1016/s0749-8063(98)70121-5.
Surgeons need to know how the material properties of a suture affect the security of a surgical knot. The purpose of this study was to compare the security of some clinically important arthroscopic knots when tied using a braided multifilament suture and to draw comparisons with results of similar knots tied with monofilament suture. Permanent braided polyester suture was used to test 10 knot configurations. Eight of the knots included (1) two types of initial cinching knots followed by (2) one of four combinations of half-hitches. We also tested the taut-line hitch locked with half-hitches and the original Revo knot. Each knot was subjected to cyclic loading followed by an ultimate load to failure. Clinical failure was defined as the maximum force that resulted in 3 mm of loop displacement. Force versus displacement data were obtained, and the maximal loop holding capacities were compared statistically. The Duncan loop with switched-post half-hitches and the Revo knot (Linvatec, Largo, FL) showed the highest knot-holding capacities (mean, 87N and 92N, respectively) when compared with all other configurations (P < .0001) for braided suture. A similar knot-holding capacity was described for monofilament suture using the Duncan loop locked with switched-post, reversed-direction half-hitches (mean, 81 N). All knots without post switching slipped completely at significantly lower loads than knots with post switching (monofilament, P < .001; braided, P < .0001). When compared with results of knots tied with monofilament suture, the braided switched-post configurations had smaller cyclic displacements (braided, 0.7 mm; monofilament, 1.7 mm). Although the Revo knot showed good strength for braided suture, it was significantly weaker than other configurations when tied with monofilament suture. Therefore, it is important to test the knot strength for a given suture material before applying it clinically.
外科医生需要了解缝线的材料特性如何影响手术结的安全性。本研究的目的是比较使用编织多股缝线打结时一些临床上重要的关节镜结的安全性，并与使用单股缝线打结的类似结的结果进行比较。使用永久性编织聚酯缝线测试了10种结的构型。其中8种结包括(1)两种类型的初始收紧结，随后是(2)四种半结组合之一。我们还测试了用半结锁定的张力结和原始的Revo结。每个结先承受循环加载，然后承受直至破坏的极限载荷。临床失败定义为导致环移位3毫米的最大力。获取力与位移数据，并对最大环保持能力进行统计学比较。与编织缝线的所有其他构型相比，采用交换桩半结的邓肯环和Revo结（Linvatec，拉戈，佛罗里达州）显示出最高的结保持能力（平均值分别为87N和92N）（P <.0001）。对于使用交换桩、反向半结锁定的邓肯环的单股缝线，描述了类似的结保持能力（平均值，81 N）。所有未交换桩的结在明显低于交换桩结的载荷下完全滑脱（单股，P <.001；编织，P <.0001）。与单股缝线打结的结果相比，编织交换桩构型的循环位移更小（编织，0.7毫米；单股，1.7毫米）。尽管Revo结对编织缝线显示出良好的强度，但与单股缝线打结时，它明显比其他构型弱。因此，在临床应用前测试给定缝线材料的结强度很重要。
