手术缝针

SurgicalNeedles手术缝针苏震波2008年3月•TheIdealNeedle.－理想的缝针•GeneralInformation--缝针总论•NeedleDesign－缝针的设计•Uses－缝针的使用Agenda－介绍流程TheIdealNeedle－理想的缝针•Strength强度–madeofhighqualitystainlesssteel•Stability稳定度–stableinthegraspofaneedleholder•Sharpness锐利度–sharpenoughtopenetratetissuewithminimaltrauma•Ductility柔韧性–rigidenoughtoresistbending,yetductileenoughtoresistbreakingduringsurgery•Sterileandresistantcorrosion无菌性和抗腐蚀性•Smoothness光滑•SUTURE-TO-NEEDLEATTACHEMENT针线比接近缝针总论一,缝针的材料•大多数缝针是用以下材料制作--420StainlessSteel(硬度最小,韧度最大)–455StainlessSteel–300StainlessSteel(硬度最大,韧度最小)•硅涂层(更光滑)硅涂层Un-siliconizedSiliconizedNumberofPenetrations110Force•Penetration穿透力•Strength硬度•Ductility柔韧性•Tempering回火•Curvature弧度•Length针长•Flattening扁平度•Wirediameter钢丝直径二,缝针特性专业术语二,缝针特性ConvenienceAppropriateforspecificproceduresLength&CurvatureLessbreakageEasytoreshapeResistbreakingduringuseDuctileneedlesLesssuturelinebleedLesstissuetraumaLowneedletosuturematerialratioCloseneedletosuturediametersReducestissuetearoncontinuousstitchesWithstandrepeatedpassesthroughtissueDurablepointBetterneedlecontrolLessneedlebreakageEaseofpenetrationw/obleedingStrongNeedlesEasyTissuepassageLesstissuedamageSuperiorpenetrationSharpNeedlesBENEFITSADVANTAGEFEATURE强度钢材钢丝直径回火工艺合金针体形状VS方体稳定度针体扁平以增进稳定度持针器夹持是否稳定也会影响缝针的表现。我们所有22mil（千分之一英寸）以上的缝针针体都是扁平。锐利度与TaperRatio(针尖长与钢丝直径之比)有关12:1,其他厂商8:1,10:13212:1PENCILPOINT2212:1TRUTAPER锐利度8TaperRatio12to1TaperRatioTaperLength12DTRUTaperPointGeometry8:122°32°32°12:112:115g25g48gPenetrationForceSource:NTTechMemo#94-01.专利钢材(供应各缝线厂):好的柔韧性,針不易弯曲.柔韧性针线比•Needlegeometryimprovesneedlediametertosuturediameterratio–ReducesriskofleakageattheneedletractNeedleTechnology缝针技术历史AHistoryofInnovationTriangularTop/BottomFlatSquareI-BeamTaperTaperCut12:1TaperEthigardTruTaperTriangularSpatulatedTGPlusPrecisionUltraGlide,DermaGlideMaterialsGeometrySurface19701980199019952000ASTM420FASTM420EthalloyNoSiliconeSiliconeVisiBlackPointBodyRoundedCornerI-BeamMRAlloyASTM455NeedleAnatomy－缝针的结构铉长针尖针体针长针体直径半径缝线箝合处三,缝针设计•三个基本的组成部件：针尖、针体和针眼针眼设计•把缝线和缝针相连的两种方式–Eyed针眼穿针式–Atraumatic无损伤式•EyedNeedles针眼类型–Round–Square–French•AtraumaticNeedles无损伤针类型–ChanneledEndNeedle隧道式–DrilledEndNeedle钻孔式(影响针线比)AlsoPrecloseChannelwithEpoxyChannelDrillBiteWidthandDepth咬合宽度与深度PathofPenetrationBiteDepthBiteWidth(Chord)Depth深度SameBiteWidth/DifferentDepthBiteWidth咬合宽度SameDepth/DifferentBiteWidth直针雪橇针1/4弧3/8弧1/2弧5/8弧复合弯针针体的形状直形1/4弧3/8弧1/2弧5/8弧复杂弯曲胃肠道，肌腱，鼻道，血管，神经，口腔，咽，皮肤眼部（主要应用）显微手术腱膜，胆道，眼，筋膜，胃肠道，肌肉，心肌，神经，软骨膜，腹膜，肌腱，泌尿生殖道，血管胆道，眼，胃肠道，肌肉，鼻道。口腔。骨盆，腹膜，咽，呼吸道，皮肤，皮下脂肪,泌尿生殖道肛门直肠（痔切除术），心血管系统，鼻道，骨盆，泌尿生殖道（主要应用）眼（前面）缝针的形状和典型应用针体的横截面设计•方体•圆体•M.E.T.•……针体几何设计针体几何设计RoundTop/BottomFlatSquareRoundedCornersI-BeamRibsSpatulaDiamondSpatulaM.E.T.TaperedI-Beam针体几何设计TheI-BeamNeedle•The300seriessteelI-BeamconfigurationprovidesforthebestcompromisebetweenbothstrengthandductilityTheSquareBodyNeedle方体•Squarebodyneedlesallowforexcellentstrength,howeverindoingso,theysacrificetheductilityrequiredforuseincardiovascularsurgeryBodyGeometryStableStableUnstable针体几何设计PointGeometryTaperPointForSoft,EasilyPenetratedTissues(BloodVessels,Muscle,Myocardium,…)针体几何设计Sharpoint独有的M.E.T是一种融合圆针与方体针优点的特殊设计缝针,是强度与柔韧度的完美结合,具有极佳的使用性能PointGeometry针尖几何Skin,Sternum.皮肤胸骨Fascia,Ligament,ENT,Skin.筋膜，韧带，眼科，皮肤CalcifiedTissue,Periosteum,Fascia,Ligament,Tendon.钙化组织，腹膜，筋膜，韧带，肌腱GI,Muscle,Nerve,Fascia,Fat,Dura.胃肠，肌肉，神经，筋膜，脂肪，硬脑膜圆体角针正角针Fascia,Intestine,Kidney,Liver,Spleen,Cervix.筋膜，肠，肾，肝，脾，宫颈Eye,Microsurgery眼，显微外科.Eye眼Skin(Plastic,Cosmetic)皮肤（整形，美容）.钝针CS铲针铲针精细角针针尖与切缘CUTTINGNEEDLES角针•ConventionalCutting•ReverseCutting•“Premium”cutting•“Precison”cutting•DiamondPoint•DermaGlide角针•TROCARPOINT－穿刺头•Strongcuttingheadexceedsdiameterofbody－针头的切缘直径大于针体•Powerfulpenetration－很强的针尖切割能力•组织损伤•CONVENTIONALCUTTING传统角针•2apposingcuttingedges+thirdcuttingedgeoninsidecurvatureofneedle两个并列的切缘加第三个朝内的切缘•Idealforskin,ligamentandtendons用于皮肤，肌腱，韧带•PCisdesignedspecificallyforplastics精细反角针特别用于整形外科PointGeometryTwoOpposingCuttingEdgesWithaThirdonInsideCurve(Skin,Sternum…)REVERSECUTTING－反角针•2apposingcuttingedgesandthirdcuttingedgeonoutercurvatureofneedle－两个并列切缘加一个朝外的切缘^向外切割^这种设计的优点：比类似角针强度更好大大减少组织切割缝合面组织更宽PointGeometryForTough,DifficulttoPenetrateTissuesCuttingEdgeonOuterCurve,ExtremelySmooth,ExtremelySharp(Skin,Eye,…)ReverseCutting(Deep)ConventionalCutting(Shallow)CUTTINGNEEDLES角针•PC(PrecisionCosmeticNeedle)精细角针•专利钢材•Finerwirediameter－更细的针体•ForPlasticandCosmeticsurgery－整形及美容缝合•ConventionalorReverseCutting－正角针和反角针ForDelicatePlasticorCosmaeticSurgeryConventionalCuttingTipandPrecisionGeometryforIncreasedSharpness(Skin)ReversePrecisionGeometryforIncreasedSharpness(Skin)OtherCuttingGeometriesK-PointTrocarPointTAPERNEEDLES圆针•Pierce&spreadtissuewithoutcutting.不是以切割的方式穿透组织•Needlepointtaperstoasharptip针尖虽尖但为圆形•Designedforeasypenetrationthroughtissueeg.Peritoneum,abdom.viscera,internalanastomosis专为容易穿过组织设计。腹膜，内脏，吻合。.当希望组织中的针眼最小，组织切割最少时首选。肠吻合，筋膜缝合，妇产科，疝气和心血管手术。TAPERCUTNEEDLES圆体角针•Threecuttingedgesextend1/32”backfromthepoint,followedbyataperbody针尖为三角形切缘而针体为圆针•Usedfordensetoughtissue,andeliminatesthedangerofcuttingintothesurroun