手术缝针课件

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–madeofhighqualitystainlesssteelStability稳定度–stableinthegraspofaneedleholderSharpness锐利度–sharpenoughtopenetratetissuewithminimaltraumaDuctility柔韧性–rigidenoughtoresistbending,yetductileenoughtoresistbreakingduringsurgerySterileandresistantcorrosion无菌性和抗腐蚀性Smoothness光滑SUTURE-TO-NEEDLEATTACHEMENT针线比接近

硅涂层Un-siliconizedSiliconizedNumberofPenetrations110ForcePenetration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8:1,10:1锐利度8TRUTaperPointGeometry8:122°32°32°12:112:115g25g48gPenetration

ForceSource:NTTechMemo#94-01.针线比NeedlegeometryimprovesneedlediametertosuturediameterratioReducesriskofleakageattheneedletractNeedleTechnology缝针技术历史AHistoryofInnovationTriangularTop/

Bottom

FlatSquareI-BeamTaperTaperCut12:1

TaperEthigardTru

TaperTriangularSpatulatedTGPlusPrecisionUltraGlide,DermaGlideMaterialsGeometrySurface19701980199019952000ASTM420FASTM420EthalloyNoSiliconeSiliconeVisiBlackPointBodyRounded

Corner

I-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RoundSquareFrenchAtraumaticNeedles无损伤针类型ChanneledEndNeedle隧道式DrilledEndNeedle钻孔式(影响针线比)BiteWidthandDepth

咬合宽度与深度PathofPenetrationSwageBodyPointBiteDepthBiteWidth(Chord)Depth深度SameBiteWidth/DifferentDepth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主要用于皮肤缝合。特殊的有用于关节镜下缝合膝半月板和眼科晶状体置换的穿房针。直针原先用于眼科前房手术。针尖弧度先为800，然后马上变为450复合弯针复合弯针首要的原则是：层次越深，医生选用弧度越大的缝针。

1/4弧:眼科和显微外科3/8弧:大的表浅的伤口（浅表区域）1/2弧:在狭窄的范围较易操作5/8弧:泌尿外科和深部体腔复合弧针直形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几何设计RoundTop/BottomFlatSquareRoundedCornersI-BeamRibsSpatulaDiamondSpatulaM.E.T.TaperedI-Beam针体几何设计TheI-BeamNeedleThe300seriessteelI-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ConventionalCuttingReverseCutting“Premium”cutting“Precison”cuttingDiamondPointDermaGlide

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PointGeometryTwoOpposingCuttingEdges

WithaThirdonInsideCurve(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,Extremely

Smooth,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ForDelicatePlasticorCosmaetic

SurgeryConventionalCuttingTipandPrecisionGeometryforIncreasedSharpness(Skin)ReversePrecisionGeometryfor

IncreasedSharpness(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,andeliminatesthedangerofcuttingintothesurroundingtissue－适用于致密坚韧的组织，避免了割伤周围组织的危险反角针针尖和圆体的结合Tipextendapproximately1/32”backfromthepoint.Sometimesreferredtoasatrocarpoint.OldTAPERCUT*NewTAPERCUT*TAPERCUT*:(CALCIFIEDCORONARYNeedle钙化血管针)Uniquepointdesign独特的针尖设计Improvedpenetration改良的穿透力Squarebody-strength&stability方体－强度及稳定性圆针

强生VISI-BLACK*－黑针ColouredBLACKforimprovedvisibility黑色增加了视觉效果钝针

“BLUNTPOINT”－钝头Uniquetipprofile－独特的针尖Preventsskinpenetration－防止刺伤皮肤Safetyinsurgery－手术中更安全用于易碎的组织如肝，脾，肾。出于安全的原因，医生用于妇产科和其他科室。钝针Spatulated

传统铲针SidecuttingSPATULA

改良铲针ADVANCEDSPATULA

OPHTHALMICNEEDLES

眼科针上、下面扁平侧面的切缘设计用于眼科手术这样缝针可以分开巩膜和角膜各个薄层。传统铲针

SPATULATED－铲针Sharppointswithsidecuttingedges针尖锋利，两侧切缘340&440micronwirediameter340&440微米直径Strabismus&Retinalsurgery斜视和视网膜手术Side-cuttingSpatulatedThin,FlatProfileSpeciallyDesignedforOpthalmicSurgery(ScleralorCornealTissue)改良铲针角膜巩膜缝针。最锋利的角巩膜*Trademark改良铲针Anteriorsegmentsurgery眼球前部手术Spatula&ReverseCutting铲针，反角针220,150micronwirediameter220,150,微米直径340micronwireforStrabismussurgery340微米用于眼肌缝合Improvedpenetration穿刺力增强PointGeometrySharpEdgesforBetterPenetration.ReadilyFacilitatesKnotRotationinOphthalmicSurgeryGrasp1/3fromswage

持针位置:离针眼1/3处Nevergrasppoint

不可夹持针尖Matchneedletotissue

缝针的选择应与组织特点相适应Insertseparatelyintoeachsideofwound从伤口两边单独进针四,外科缝针的使用持针器的使用MatchsizeofneedleGoodconditionGraspattipofjawsHoldonlyattheflattenedbodyoftheneedleHold1/3fromswage四,外科缝针的使用W