关节镜下打结技术培训课件.pptVIP

AnincreasingnumberofsurgeonsareperformingarthroscopicsurgeryinthekneetorepairmeniscaltearsandintheshouldertorepairrotatorcufforlabraltearsManyarealsoperformingcapsularshiftstotreatinstability.EssentialtotheseproceduresistheabilitytotiearthroscopicknotstoapproximateintraarticularIntroduction

ThesurgeonmustsequentiallyconstructtheknotoutsidethejointandthenpasstheknotintothejointthroughsmallcannulasTyingarthroscopicknotsistechnicallydemandingandrequiresconsiderablepracticeWiththepopularityofarthroscopicsurgery,thenumberofusedarthroscopicknotsandthenumberofsurgeonsusingtheseknotshasincreased

KnotTyingPrinciples

KnotTyingPrinciples

fourdifferentprocessesofknotfailureknotslippageandlooseningsuturebreakagetissuefailuresutureanchorpulloutfrombonethroughsuturebreakageKnotfailure

KnotTerminologypostlimb(alsocommonlyknownastheaxiallimb)looplimb(alsocommonlyknownasthewrappinglimb,workingend,runningend,orfreeend)Knotsareconstructedbytyingthelooplimbaroundthepostlimb(Fig.1)

FIGURE1.Loopandpostconfiguration

ArthroscopicKnotPushersAnarthroscopicknotpusherisadeviceusedtoadvancetheloopdownthepostlimbintothejointtocreatetheknot.Arthrexknotpushers.A.Single-hole,B.Double-hole,C.6thFinger

FIGURE3.Mitekknotpushers.A.Single-hole,B.Double-hole,C.Slotted

double-holeknotpushersanddoublediameterknot

Double-holeknotpusherFIGURE4.Double-holeknotpusher.

HowtoUsetheDouble-DiameterKnotPusherFIGURE5.A-F.TyingknotswiththeArthrex6thfinger

SuturePropertiesTwotypesofsuturesarecommonlyusedintyingarthroscopicknots:apermanent,braided,polyester,nonabsorbablesutureandanabsorbable,monofilamentsutureExamplesofpermanent,braided,polyester,nonabsorbablesuturesareEthibondandTicronExamplesofabsorbable,monofilamentsuturesarePDSII,polydiax