Surgical Needles Surgical Needles 手术缝针手术缝针1 •The Ideal Needle.－－理想的缝针理想的缝针•General Information --缝针总论缝针总论•Needle Design－－缝针的设计缝针的设计• Uses－－缝针的缝针的使用使用AgendaAgenda－－介绍流程介绍流程2 The Ideal NeedleThe Ideal Needle－－理想的缝针理想的缝针•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-NEEDLE ATTACHEMENT 针线比接近针线比接近 3 缝针总论缝针总论 一一,缝针的材料缝针的材料•大多数缝针是用以下材料制作大多数缝针是用以下材料制作 -- 420 Stainless Steel (硬度最小硬度最小,韧度最大韧度最大)•455 Stainless Steel•300 Stainless Steel (硬度最大硬度最大,韧度最小韧度最小)•硅涂层硅涂层(更光滑更光滑)4 硅涂层硅涂层Un-siliconizedSiliconizedNumber of Penetrations110Force5 •Penetration 穿透力•Strength 硬度•Ductility 柔韧性•Tempering 回火•Curvature 弧度•Length 针长•Flattening 扁平度•Wire diameter 钢丝直径二二, ,缝针特性缝针特性专业术语专业术语6 二二,缝针特性缝针特性ConvenienceAppropriate for specific proceduresLength & CurvatureLess breakageEasy to reshapeResist breaking during useDuctile needlesLess suture line bleedLess tissue traumaLow needle to suture material ratioClose needle to suture diametersReduces tissue tear on continuous stitchesWithstand repeated passes through tissueDurable pointBetter needle controlLess needle breakageEase of penetration w/o bleedingStrong NeedlesEasy Tissue passageLess tissue damageSuperior penetrationSharp NeedlesBENEFITSADVANTAGEFEATURE7 强度强度钢材钢材钢材钢材钢丝直径钢丝直径钢丝直径钢丝直径回火工艺回火工艺回火工艺回火工艺合金合金合金合金针体形状针体形状针体形状针体形状VS方体8 稳稳定度定度针体扁平以增进稳定度持针器夹持是否稳定也持针器夹持是否稳定也会影响缝针的表现。
会影响缝针的表现我们所有我们所有22 mil（（千分之千分之一英寸）一英寸） 以上的缝针针以上的缝针针体都是扁平体都是扁平9 锐锐锐锐利度利度与与与与Taper RatioTaper Ratio( (针尖长与钢丝直径之比针尖长与钢丝直径之比针尖长与钢丝直径之比针尖长与钢丝直径之比) ) ) )有有关关关关 12:1 , 12:1 , 其他其他厂厂厂厂商商8:1,10:18:1,10:1锐锐利度利度810 Taper Ratio12 to 1 Taper RatioTaper Length12D11 TRU Taper Point Geometry8:1 22°32°32°12:1 12:1 15g25g48gPenetrationPenetrationForceForceSource: NT Tech Memo # 94-01.Source: NT Tech Memo # 94-01.12 专利钢材专利钢材专利钢材专利钢材( (供应各缝线厂供应各缝线厂供应各缝线厂供应各缝线厂): ):好的柔好的柔韧韧性性 , , 針不易針不易弯弯弯弯曲曲. .柔柔韧韧性性13 针线比针线比•Needle geometry improves needle diameter to suture diameter ratio•Reduces risk of leakage at the needle tract 14 Needle TechnologyNeedle Technology缝针技术历史缝针技术历史A History of InnovationA History of InnovationTriangular Top/Bottom FlatSquareI-BeamTaper Taper Cut12:1 TaperEthigardTru TaperTriangularSpatulatedTG Plus PrecisionUltraGlide,DermaGlideMaterialsGeometrySurface19701980199019952000ASTM 420FASTM 420FASTM 420FASTM 420ASTM 420ASTM 420EthalloyEthalloyEthalloyNo SiliconeNo SiliconeNo SiliconeSiliconeSiliconeSiliconeVisiBlackVisiBlackVisiBlackPointPointPointBodyBodyBodyRoundedCorner I-BeamMR AlloyMR AlloyMR AlloyASTM 455ASTM 455ASTM 45515 Needle AnatomyNeedle Anatomy－－缝针的结构缝针的结构铉长铉长针尖针尖针尖针尖针体针体针体针体针长针长针长针长针体直径针体直径针体直径针体直径半径半径半径半径缝线箝合处缝线箝合处缝线箝合处缝线箝合处三三, ,缝针设计缝针设计•三个基本的组成部件：针尖、针体和针眼三个基本的组成部件：针尖、针体和针眼 16 针眼设计针眼设计•把缝线和缝针相连的两种方式•Eyed 针眼穿针式•Atraumatic 无损伤式•Eyed Needles 针眼类型•Round•Square•French17 •Atraumatic Needles 无损伤针类型•Channeled End Needle 隧道式•Drilled End Needle 钻孔式(影响针线比)18 Also Preclose Channel with EpoxyChannelChannelDrillDrill19 Bite Width and DepthBite Width and Depth咬合宽度与深度咬合宽度与深度Path of PenetrationSwageBodyPointBite DepthBite Width (Chord)20 DepthDepth深度深度Same Bite Width / Different Depth21 Bite WidthBite Width咬合宽度咬合宽度Same Depth / Different Bite Width22 直针雪橇针1/4 弧3/8 弧1/2 弧5/8 弧复合弯针针体针体的形的形状状23 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缝针的形状和典型应用28 针体的横截面设计针体的横截面设计•方体方体•圆体圆体•M.E.T.•… …针体几何设计针体几何设计29 针体几何设计针体几何设计RoundTop/Bottom FlatSquareRounded CornersI-BeamRibsSpatulaDiamond SpatulaM.E.T.30 Tapered I-Beam针体几何设计针体几何设计31 The I-Beam Needle•The 300 series steel I-Beam configuration provides for the best compromise between both strength and ductility32 The Square Body NeedleThe Square Body Needle方体方体•Square body needles allow for excellent strength, however in doing so, they sacrifice the ductility required for use in cardiovascular surgery33 Body GeometryStableStableStableStableUnstableUnstable针体几何设计针体几何设计34 Point GeometryTaper PointFor Soft, Easily Penetrated Tissues(Blood Vessels, Muscle, Myocardium,…)针体几何设计针体几何设计35 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36 Point Geometry Point Geometry 针尖几何针尖几何Skin, Sternum.Skin, Sternum.皮肤胸皮肤胸骨骨Fascia, Ligament, ENT, Skin.筋膜，韧带，眼科，皮筋膜，韧带，眼科，皮肤肤Calcified Tissue, Periosteum, Fascia, Ligament, Tendon.钙化钙化组织，腹膜，筋膜，韧带，肌腱组织，腹膜，筋膜，韧带，肌腱GI, Muscle, Nerve, Fascia, Fat, Dura.胃肠，胃肠，肌肉，神经，筋膜，脂肪，肌肉，神经，筋膜，脂肪，硬脑膜硬脑膜圆体角针圆体角针正角针正角针37 Fascia, Intestine, Kidney, Fascia, Intestine, Kidney, Liver, Spleen, Cervix.Liver, Spleen, Cervix.筋膜，肠，筋膜，肠，筋膜，肠，筋膜，肠，肾，肝，脾，宫颈肾，肝，脾，宫颈肾，肝，脾，宫颈肾，肝，脾，宫颈Eye, MicrosurgeryEye, Microsurgery眼，显微外眼，显微外眼，显微外眼，显微外科科科科. .EyeEye眼眼眼眼Skin (Plastic, Cosmetic)Skin (Plastic, Cosmetic)皮肤（整形，美容）皮肤（整形，美容）皮肤（整形，美容）皮肤（整形，美容）. .钝针钝针CS铲针铲针铲针铲针精细角针精细角针38 针尖与切缘针尖与切缘39 CUTTING NEEDLESCUTTING NEEDLES角针角针•Conventional Cutting•Reverse Cutting•“Premium” cutting•“Precison” cutting•Diamond Point•DermaGlide 40 角针角针•TROCAR POINTTROCAR POINT－－穿刺头穿刺头•Strong cutting head Strong cutting head exceeds diameter of exceeds diameter of bodybody－－针头的切缘直径大针头的切缘直径大于针体于针体•Powerful penetrationPowerful penetration－－很强的针尖切割能力很强的针尖切割能力•组织损伤组织损伤41 •CONVENTIONAL CUTTINGCONVENTIONAL CUTTING传统角针传统角针•2 apposing cutting edges + third cutting 2 apposing cutting edges + third cutting edge on inside curvature of needleedge on inside curvature of needle两个并列两个并列的切缘加第三个朝内的切缘的切缘加第三个朝内的切缘•Ideal for skin, ligament and tendonsIdeal for skin, ligament and tendons用于皮用于皮肤，肌腱，韧带肤，肌腱，韧带•PC is designed specifically for plasticsPC is designed specifically for plastics精精细反角针特别用于整形外科细反角针特别用于整形外科42 Point GeometryTwo Opposing Cutting EdgesWith a Third on Inside Curve(Skin, Sternum…)43 REVERSE CUTTINGREVERSE CUTTING－－反角针反角针•2 apposing cutting edges and third cutting 2 apposing cutting edges and third cutting edge on outer curvature of needleedge on outer curvature of needle－－两个并两个并列切缘加一个朝外的切缘列切缘加一个朝外的切缘^向外切割向外切割^这种设计的优点：这种设计的优点：比类似角针强度更好比类似角针强度更好大大减少组织切割大大减少组织切割缝合面组织更宽缝合面组织更宽44 Point GeometryFor Tough, Difficult to Penetrate TissuesCutting Edge on Outer Curve, ExtremelySmooth, Extremely Sharp (Skin, Eye, …)45 Reverse Cutting (Deep)Reverse Cutting (Deep)Conventional Cutting (Shallow)Conventional Cutting (Shallow)46 CUTTING NEEDLES 角针• PC (PC ( Precision Cosmetic Precision Cosmetic Needle )Needle )精细角针精细角针•专利钢材专利钢材•Finer wire diameterFiner wire diameter－－更细的更细的针体针体•For Plastic and Cosmetic For Plastic and Cosmetic surgerysurgery－－整形及美容缝合整形及美容缝合•Conventional or Reverse Conventional or Reverse CuttingCutting－－正角针和反角针正角针和反角针47 For Delicate Plastic or CosmaeticSurgery Conventional Cutting Tip and Precision Geometry for Increased Sharpness (Skin)48 Reverse Precision Geometry forIncreased Sharpness (Skin)49 Other Cutting GeometriesK-PointTrocar Point50 TAPER NEEDLES圆针•Pierce & spread tissue without Pierce & spread tissue without cutting.cutting.不是以切割的方式穿透组织不是以切割的方式穿透组织•Needle point tapers to a sharp tipNeedle point tapers to a sharp tip针尖虽尖但为圆形针尖虽尖但为圆形•Designed for easy penetration Designed for easy penetration through tissue eg. Peritoneum, abdom. through tissue eg. Peritoneum, abdom. viscera, internal anastomosisviscera, internal anastomosis专为容易穿过组织设计。
腹膜，内脏，吻专为容易穿过组织设计腹膜，内脏，吻合51 .当希望组织中的针眼最小，组织切割当希望组织中的针眼最小，组织切割最少时首选最少时首选肠吻合，筋膜缝合，妇产科，疝气和肠吻合，筋膜缝合，妇产科，疝气和心血管手术心血管手术52 TAPER CUT NEEDLES圆体角针• • Three cutting edges extend Three cutting edges extend 1/321/32” back from the point, back from the point, followed by a taper bodyfollowed by a taper body针尖针尖为三角形切缘而针体为圆针为三角形切缘而针体为圆针• Used for dense tough Used for dense tough tissue, and eliminates the tissue, and eliminates the danger of cutting in to the danger of cutting in to the surrounding tissuesurrounding tissue－－适用于致适用于致密坚韧的组织，避免了割伤周围密坚韧的组织，避免了割伤周围组织的危险组织的危险53 反角针针尖和圆体的结合反角针针尖和圆体的结合Tip extend approximately 1/32” back Tip extend approximately 1/32” back from the point.from the point.Sometimes referred to as a trocar Sometimes referred to as a trocar point.point.Old TAPERCUT*New TAPERCUT*54 TAPERCUT*:TAPERCUT*:55 (CALCIFIED CORONARY Needle(CALCIFIED CORONARY Needle钙化血管针钙化血管针) )Unique point design Unique point design 独特的针尖设计独特的针尖设计Improved penetrationImproved penetration改良的穿透力改良的穿透力Square body - strength & stabilitySquare body - strength & stability方体－强度及稳定性方体－强度及稳定性56 圆针• 强生强生VISI-BLACK*VISI-BLACK*－－黑针黑针•Coloured BLACK for improved Coloured BLACK for improved visibilityvisibility黑色增加了视觉效果黑色增加了视觉效果57 钝针钝针• “BLUNT POINTBLUNT POINT”－－钝头钝头• Unique tip profile Unique tip profile－－独特的独特的针尖针尖• Prevents skin penetration Prevents skin penetration－－防止刺伤皮肤防止刺伤皮肤• Safety in surgery Safety in surgery－－手术中更手术中更安全安全58 •Spatulated传统铲针Side cutting SPATULA改良铲针ADVANCED SPATULA OPHTHALMIC NEEDLES OPHTHALMIC NEEDLES 眼科针眼科针60 SPATULATEDSPATULATED－－铲针铲针•Sharp points with side cutting edgesSharp points with side cutting edges针针尖锋利，两侧切缘尖锋利，两侧切缘•340 & 440 micron wire diameter340&440340 & 440 micron wire diameter340&440微微米直径米直径•Strabismus & Retinal surgeryStrabismus & Retinal surgery斜视和视网斜视和视网膜手术膜手术62 Side-cutting SpatulatedThin, Flat ProfileSpecially Designed for Opthalmic Surgery(Scleral or Corneal Tissue)63 •改良铲针改良铲针•Anterior segment surgeryAnterior segment surgery眼球前眼球前部手术部手术•Spatula & Reverse CuttingSpatula & Reverse Cutting铲针，铲针，反角针反角针•220, 150 micron wire 220, 150 micron wire diameter220,150,diameter220,150,微米直径微米直径•340 micron wire for Strabismus 340 micron wire for Strabismus surgery340surgery340微米用于眼肌缝合微米用于眼肌缝合•Improved penetrationImproved penetration穿刺力增强穿刺力增强65 Point GeometrySharp Edges for Better Penetration. Readily Facilitates Knot Rotation in Ophthalmic Surgery66 •Grasp 1/3 from swage 持针位置:离针眼1/3处•Never grasp point 不可夹持针尖•Match needle to tissue 缝针的选择应与组织特点相适应•Insert separately into each side of wound 从伤口两边单独进针四四,外科缝针的使用外科缝针的使用67 持针器的使用持针器的使用•Match size of needle•Good condition•Grasp at tip of jaws•Hold only at the flattened body of the needle•Hold 1/3 from swage68 四四,外科缝针的使用外科缝针的使用Wound69 Care of the NeedleCare of the Needle对缝针的保护对缝针的保护• The needle holder must be an appropriate size for the needle. The needle holder must be an appropriate size for the needle. 使用的持针钳的尺寸一定要和缝针的大小相匹配使用的持针钳的尺寸一定要和缝针的大小相匹配• Needles should be grasped in an area about Needles should be grasped in an area about ¼ to to ½ the distance from the distance from the swage to the point. Not on or near the swaged area. the swage to the point. Not on or near the swaged area. 持针的位置应在针体的后持针的位置应在针体的后1/41/4到到1/2.1/2.不要夹在针线连接处不要夹在针线连接处• The needle should be placed securely in the tip of the needle holder jaws. The needle should be placed securely in the tip of the needle holder jaws. 缝针必须在持针钳中稳定得被夹持缝针必须在持针钳中稳定得被夹持• If the needle is held too tightly in a sharp or hard jawed or defective If the needle is held too tightly in a sharp or hard jawed or defective needle holder, the needle may be damaged or notched and therefore weakened.needle holder, the needle may be damaged or notched and therefore weakened.• 如果缝针在持针钳中夹持的过紧，则有可能在缝针上造成夹印而使缝针的强度减弱如果缝针在持针钳中夹持的过紧，则有可能在缝针上造成夹印而使缝针的强度减弱• When the needle holder with needle is passed to the surgeon, the needle When the needle holder with needle is passed to the surgeon, the needle should be pointing in the direction in which he or she will start to use should be pointing in the direction in which he or she will start to use it without needing to readjust.it without needing to readjust.当夹好针的针持被递给外科医生时，医生应该不用当夹好针的针持被递给外科医生时，医生应该不用再次调整缝针在针持中的位置而直接可以使用再次调整缝针在针持中的位置而直接可以使用 70 谢谢 谢谢71 。