Thomas J O'Keefe, Louis A Perkins, Isabella Guajardo, Laura M Adams, Bard C Cosman, William D Ardill, Bruce M Potenza
{"title":"使用半结来解开手术结的安全性和环紧度。","authors":"Thomas J O'Keefe, Louis A Perkins, Isabella Guajardo, Laura M Adams, Bard C Cosman, William D Ardill, Bruce M Potenza","doi":"10.21037/atm-25-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Most surgeons tie half-hitch knots, but many are unfamiliar with the principles underlying their security leading to insecure knots. When presented with evidence regarding tying technique and knot security, we note a proclivity among surgeons towards resistance to change with rationalizations such as concerns regarding tissue strangulation with increasing knot security. We hypothesize that this concern is unfounded. The aim of this study was to identify whether the impact of loop tautness on knot security is mediated through the configuration of the knot.</p><p><strong>Methods: </strong>Six-throw knots were tied with 0 silk. The loop of the knot encompassed two brass rings and a piece of latex hose. Four knot types were tied and tested: non-taut and taut single post knots (SxSxSxSxSxS in Dinsmore notation), and non-taut and taut alternating post knots (SxSxS#S#S#S in Dinsmore notation). The latex hose was then removed from the loop and the brass rings were distracted on a tensiometer to assess knot security. The main outcome for the study was knot security, including maximum force resisted by each knot type to 1 and 2 mm slippage and ultimate failure defined by slippage to unraveling or breakage of the suture. Differences of means were tested with 2-sided <i>t</i>-test.</p><p><strong>Results: </strong>By 1 mm slippage, the tautly tied alternating post knots were more secure than the single post knots, and the non-taut single post knots were less secure than all other configurations. By 2 mm slippage, the tautly tied alternating post knots were more secure than all other configurations and the non-taut alternating post knots were more secure than the tautly tied and non-taut single post knots. By ultimate failure, the tautly tied and non-taut alternating post knots were comparable and both more secure than both single post knots.</p><p><strong>Conclusions: </strong>Surgeons can utilize single and alternating post throws to independently confer knot security and loop tautness and thereby tie the knot needed under a given set of circumstances.</p>","PeriodicalId":8216,"journal":{"name":"Annals of translational medicine","volume":"13 2","pages":"15"},"PeriodicalIF":0.0000,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106118/pdf/","citationCount":"0","resultStr":"{\"title\":\"Using half-hitch knots to uncouple surgical knot security and loop tautness.\",\"authors\":\"Thomas J O'Keefe, Louis A Perkins, Isabella Guajardo, Laura M Adams, Bard C Cosman, William D Ardill, Bruce M Potenza\",\"doi\":\"10.21037/atm-25-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Most surgeons tie half-hitch knots, but many are unfamiliar with the principles underlying their security leading to insecure knots. When presented with evidence regarding tying technique and knot security, we note a proclivity among surgeons towards resistance to change with rationalizations such as concerns regarding tissue strangulation with increasing knot security. We hypothesize that this concern is unfounded. The aim of this study was to identify whether the impact of loop tautness on knot security is mediated through the configuration of the knot.</p><p><strong>Methods: </strong>Six-throw knots were tied with 0 silk. The loop of the knot encompassed two brass rings and a piece of latex hose. Four knot types were tied and tested: non-taut and taut single post knots (SxSxSxSxSxS in Dinsmore notation), and non-taut and taut alternating post knots (SxSxS#S#S#S in Dinsmore notation). The latex hose was then removed from the loop and the brass rings were distracted on a tensiometer to assess knot security. The main outcome for the study was knot security, including maximum force resisted by each knot type to 1 and 2 mm slippage and ultimate failure defined by slippage to unraveling or breakage of the suture. Differences of means were tested with 2-sided <i>t</i>-test.</p><p><strong>Results: </strong>By 1 mm slippage, the tautly tied alternating post knots were more secure than the single post knots, and the non-taut single post knots were less secure than all other configurations. By 2 mm slippage, the tautly tied alternating post knots were more secure than all other configurations and the non-taut alternating post knots were more secure than the tautly tied and non-taut single post knots. By ultimate failure, the tautly tied and non-taut alternating post knots were comparable and both more secure than both single post knots.</p><p><strong>Conclusions: </strong>Surgeons can utilize single and alternating post throws to independently confer knot security and loop tautness and thereby tie the knot needed under a given set of circumstances.</p>\",\"PeriodicalId\":8216,\"journal\":{\"name\":\"Annals of translational medicine\",\"volume\":\"13 2\",\"pages\":\"15\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-04-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106118/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of translational medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.21037/atm-25-2\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/4/29 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of translational medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21037/atm-25-2","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/4/29 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
Using half-hitch knots to uncouple surgical knot security and loop tautness.
Background: Most surgeons tie half-hitch knots, but many are unfamiliar with the principles underlying their security leading to insecure knots. When presented with evidence regarding tying technique and knot security, we note a proclivity among surgeons towards resistance to change with rationalizations such as concerns regarding tissue strangulation with increasing knot security. We hypothesize that this concern is unfounded. The aim of this study was to identify whether the impact of loop tautness on knot security is mediated through the configuration of the knot.
Methods: Six-throw knots were tied with 0 silk. The loop of the knot encompassed two brass rings and a piece of latex hose. Four knot types were tied and tested: non-taut and taut single post knots (SxSxSxSxSxS in Dinsmore notation), and non-taut and taut alternating post knots (SxSxS#S#S#S in Dinsmore notation). The latex hose was then removed from the loop and the brass rings were distracted on a tensiometer to assess knot security. The main outcome for the study was knot security, including maximum force resisted by each knot type to 1 and 2 mm slippage and ultimate failure defined by slippage to unraveling or breakage of the suture. Differences of means were tested with 2-sided t-test.
Results: By 1 mm slippage, the tautly tied alternating post knots were more secure than the single post knots, and the non-taut single post knots were less secure than all other configurations. By 2 mm slippage, the tautly tied alternating post knots were more secure than all other configurations and the non-taut alternating post knots were more secure than the tautly tied and non-taut single post knots. By ultimate failure, the tautly tied and non-taut alternating post knots were comparable and both more secure than both single post knots.
Conclusions: Surgeons can utilize single and alternating post throws to independently confer knot security and loop tautness and thereby tie the knot needed under a given set of circumstances.
期刊介绍：
The Annals of Translational Medicine (Ann Transl Med; ATM; Print ISSN 2305-5839; Online ISSN 2305-5847) is an international, peer-reviewed Open Access journal featuring original and observational investigations in the broad fields of laboratory, clinical, and public health research, aiming to provide practical up-to-date information in significant research from all subspecialties of medicine and to broaden the readers’ vision and horizon from bench to bed and bed to bench. It is published quarterly (April 2013- Dec. 2013), monthly (Jan. 2014 - Feb. 2015), biweekly (March 2015-) and openly distributed worldwide. Annals of Translational Medicine is indexed in PubMed in Sept 2014 and in SCIE in 2018. Specific areas of interest include, but not limited to, multimodality therapy, epidemiology, biomarkers, imaging, biology, pathology, and technical advances related to medicine. Submissions describing preclinical research with potential for application to human disease, and studies describing research obtained from preliminary human experimentation with potential to further the understanding of biological mechanism underlying disease are encouraged. Also warmly welcome are studies describing public health research pertinent to clinic, disease diagnosis and prevention, or healthcare policy. With a focus on interdisciplinary academic cooperation, ATM aims to expedite the translation of scientific discovery into new or improved standards of management and health outcomes practice.
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