骨科打结技术

Second, tightening the knot by pulling the free limbs apart results in a very similar feel as that of flattening a half-hitch or surgeon’s knot, allowing more accurate tensioning of the suture.
In this article, we describe a sliding knot that is self-stabilizing (non-slipping) and easy to make and tighten in both open and arthroscopic surgery. Its use with a doubled high-strength suture also makes it applicable in a variety of contexts involving large displacement forces. With these features, this novel fixation technique has proven very useful in our practice for several years.
ForceFiber or NiceLoop [Tornier]). - Double the suture over itself to obtain two free limbs on one end and a loop
on the other (Fig. 1A). - Pass the suture around the tissues to be fixed, using a suture shuttle
Fig. 1E Fig. 1F
Figure 1: Knot technique.A. A doubled-over suture is passed around the tissue.B. A single half-hitch is thrown.C. The two free limbs are passed through the loop.D. The knot is dressed.E. The knot is slid down by pulling the two free limbs apart.(The two limbs can also be pulled back towards the surgeon at once or alternately.A knot pusher can also be used to help the knot down while the limbs are being pulled.)F. The tightened knot is ready to be secured with three alternating half-hitches or surgeon’s knots.
or a removable needle mounted on the loop end (if needed). - After removing the shuttle or needle, throw a simple half-hitch using the
loop on one hand and the two free limbs on the other (treated as a simple, undoubled suture) (Fig. 1B). - Open the loop and pass both free limbs through it (Fig. 1C), then dress the knot by making the loop smaller (Fig. 1D). - When ready to secure the involved tissues, tighten down the sliding knot either by pulling the two free limbs apart (Fig. 1E)–as done during open surgery–or by pulling the free limbs (acting as the post) back towards you–which is most useful during arthroscopic surgery. * As with other sliding knots, while the post is being pulled back, the knot can be helped down either manually or with an arthroscopic knot pusher to reduce the traction forces seen by the tissues around which the sutures are sliding. Another way to reduce such traction forces is pulling the post’s two free limbs separately in alternation (but still in the same axis). - Finally, perform three alternating half-hitches or surgeon’s knots using the two separated free limbs (Fig. 5). This precludes the possibility that the free limbs slide back out of the loop, thus securing the knot definitively. * Excellent as its loop security and holding capacity may be, we consider them provisional, until the knot is secured definitively with the three alternating half-hitches8,16.
Figure 2: Tuberosity fixation during hemiarthroplasty for proximal humerus fracture(left shoulder, anterosuperior “saber” incision).Note that two cerclages have already been placed to fix the greater tuberosity to the prosthesis (after bringing the arm into external rotation for anatomic tuberosity reduction).This figure illustrates the two final cerclages around both tuberosities, their doubled sutures having been shuttled around with a regular needle-loaded suture.A. With the lower blue cerclage a Nice Knot is prepared and left loose; on the upper green cerclage a Nice Knot is tightened provisionally.B. The tuberosity reduction is adjusted as required, then the lower blue cerclage Nice Knot is tightened.C. The upper green cerclage can now be tightened definitively, then both knots are secured and cut.D. Final appearance with all four cerclages and two vertical tension bands in place.
Introduction:
Secure fixation is crucial for tissue healing, whether it is bone or soft tissue. A knot is considered of good quality if it is easy to learn and tie, has a low profile, has good loop and knot security, and allows accurate control of the tension applied7,15,17,21. Traditionally, flat non-sliding knots, such as square knots, have been used in open surgery, as they have been perceived to be more secure than sliding knots. With the development of arthroscopic and endoscopic surgery, the technical challenges of tying intracorporeal flat knots have contributed to the development of many effective sliding knots2,3,10-14,18-20,22.
WHITE PAPER
The Doubled-Suture Nice Knot
A sliding, self-stabilizing knot for reliable fixation in a variety of situations