中国实用外科杂志

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (04): 469-472.DOI: 10.19538/j.cjps.issn1005-2208.2025.04.16

• 论著 • 上一篇    下一篇

打结时拉线方向对结安全性影响研究

郭洪峰，侯晓宇，代薇薇，廖德志，文    灿   

  1. 陆军军医大学第一附属医院外科手术学基础教研室，重庆 400038
  • 出版日期:2025-04-01 发布日期:2025-04-30

  • Online:2025-04-01 Published:2025-04-30

摘要： 目的    分析打结时拉线方向对结安全性的影响程度。方法    研究于2022年9月在陆军军医大学外科手术学基础教研室完成。使用3-0不可吸收性丝线，由同一人分别采取双手朝恒定方向拉线和交替方向拉线的方式进行打结。选择叠数为2~7共6种类型的结，每种结各打100个。用拉力测试机测量结的抗拉强度，比较两种拉线方式所打出的不同叠数结的抗拉强度和滑脱率。结果    当叠数分别为2~7时，双手朝恒定方向拉线所打出的结的抗拉强度均低于双手交替方向拉线所打出的结，且前者的5叠结仍未达到最高抗拉强度［（22.0±7.3）N］，而后者的5叠结已达最高抗拉强度［（26.5±3.1）N］。当叠数分别为3~7时，双手朝恒定方向拉线打结的滑脱率均高于双手交替方向拉线所打结，且前者的5叠结未达到最低滑脱率（33%），而后者的5叠结已达最低滑脱率（10%）。当叠数分别为2~5时，双手朝恒定方向拉线所打出的滑脱结的抗拉强度均低于双手交替方向拉线所打出的滑脱结；前者5叠结的抗拉强度仅为（12.2±3.7）N，而后者5叠结的抗拉强度可达（18.9±4.5）N。结论    双手朝恒定方向拉线会导致结的安全性降低，虽然可以通过增加叠数来弥补，但考虑到缝线为异物，故在打结时应尽量以较少的叠数实现较高的安全性。

关键词: 外科基本技术, 打结, 结安全性

Abstract: To determine the effects of pulling direction on knot security during knot tying. Methods    A research on knot tying was conducted at Department of Basic Operative Surgery, Army Medical University in September 2022. Knots were tied by the same person with the hands pulling in constant direction or in alternate directions, respectively. All knots were tied using silk suture in 3-0 gauge. For each kind of knots with 2-7 throws, 100 knots were tied. A tensiometer was used to measure the tensile strength of the knots. Compare the tensile strength and untying rate of knots with different throws produced by two different cable pulling methods. Results    For knots with 2-7 throws, the tensile strength of the ones tied by pulling in constant direction was lower than that of the ones tied by pulling in alternate directions, respectively. Besides, the knots with 5 throws tied by pulling in constant direction did not achieve the maximum tensile strength (22.0±7.3)N, while those tied by pulling in alternate directions achieved the maximum tensile strength (26.5±3.1)N. For knots with 3-7 throws, the untying rate of the ones tied by pulling in constant direction was higher than that of the ones tied by pulling in alternate directions, respectively. Besides, the knots with 5 throws tied by pulling in constant direction did not achieve the minimum untying rate (33%), while those tied by pulling in alternate directions achieved the minimum untying rate (10%). For the unraveled knots with 2-5 throws, the tensile strength of the ones tied by pulling in constant direction was lower than that of the ones tied by pulling in alternate directions, respectively. The unraveled knots with 5 throws tied by pulling in constant direction was just (12.2±3.7)N, while those tied by pulling in alternate directions could reach (18.9±4.5)N. Conclusion    Pulling in constant direction results in inferior knot security. Although it could be compensated by increasing the throw count, considering that suture was foreign body, it is advisable to achieve superior security with fewer throw count.

Key words: basic surgical techniques, knot tying, knot security