Quill快翎骨科应用.ppt

钟兴明 君安创业科技（北京）有限公司 13501216985 johnsimene@超凡体验The Use of Barbed Sutures in Orthopedics--Transforming the nature of tissue closure双向倒刺缝合新技术在骨科应用 --从根本上革新组织缝合 钟兴明 13501216985 johnsimene@ 君安创业科技（北京）有限公司Bidirectional Barbed Suture for Bladder Neck Reconstruction, Posterior Reconstruction and Vesicourethral Anastomosis During Robot Assisted Radical Prostatectomy双向倒刺缝合应用于机器人下前列腺根治性 切除后膀胱颈、后壁、膀胱尿道吻合 R. Valeroa,b,∗, O. Schatloffa, S. Chauhana, Y. HwiiKoa,c, A. Sivaramana, R.F. Coelhoa,d, K.J. Palmera,b, H. Davila b y V.R. Patel，Institute of Robot Global, Hospital Celebration Health de Florida，USA作者采用倒刺 缝合修改了 RARP手术技 术，所有病例 手术均获成功Dr.Patel “美国外科机器人之父”Video链接Suture surgery history缝缝合外科历历史Sutures and surgery have been tied together since the first operations were performed. 自世界第一例手术术以来，缝线缝线与外科就系在一起l 1930s Surgical gut and silk; 羊肠线、丝线 l 1940s Nylon, polyester, polypropylene; 尼龙线，聚酯线，聚丙烯线 l 1970s Absorbable sutures PDO,PGA 合成可吸收线Suture surgery history缝缝合外科历历史l1951 when the idea of using barbed sutures was presented for tendon repairs; 倒刺缝合理念诞生 l1956 Dr. J. H. Alcamo was granted the first US patent for a unidirectional barbed suture; 单向倒刺缝合技术专利l 2004 Angiotech Pharmaceuticals, Inc was granted the first US patent for a bidirectional barbed suture; 双向倒刺缝合技术专利l 2007 The first FDA approval Quill bidirectional barbed suturefor Angiotech Pharmaceuticals, Inc. FDA批准上市从根本上革新了组织的缝合 QUILL（锚定线）发明专利证书2010获世界医疗 技术设计大奖国际缝合线发展史上 的里程碑技术突破Why Not Knots?为为什么需要免打结结l A knot-secured, smooth suture inevitably creates an uneven distribution of tension across the wound.打结缝合---提供单点支撑，张力分布不平衡l The weakest spot in any surgical suture line is the knot.外科缝合中最薄弱环节是打结l The second weakest point is the portion immediately adjacent to the knot (35% to 95%).外科缝合中第二薄弱环节是节点间张力的降低Why Not Knots?为为什么需要免打结结l knot slippage.滑结/松结l excessively tight knots.打结过紧，缺血坏死，减少成纤维组织细胞 增殖，过度组织叠加 导致伤口张力下降l The volume of a knot is directly related to the total amount of surrounding inflammatory reaction.结点数量直接导致周围炎性反应的强烈l Laparoscopic/Robotic surgeries.腔镜外科/机器人外科传统缝线(光滑 ）双向倒刺缝线 Bidirectional barbed特点：360度DNA螺旋式 倒刺分布，倒刺间距 0.88~0.98mm，缝线直径 的30%左右为倒刺部分传统传统传统传统 打打结缝结缝结缝结缝 合合 线线线线QUILL SRSQUILL SRS缝线缝线缝线缝线助手可能需要不需要，一个人操作 缝缝合技法逐层缝层缝 合，间间断 缝缝合全层缝层缝 合，连续缝连续缝 合打结结需要不需要，自动闭动闭 合 打结结潜在问题问题 打结结并发发症无 张张力支点单单点多点支撑，张张力分布 均匀技术比较传统传统传统传统 打打结缝线结缝线结缝线结缝线QUILL SRSQUILL SRS缝线缝线缝线缝线 缝缝合效率慢快 缝缝合张张力节节点强，节节点 间间弱强，沿伤伤口缘缘均匀 分布伤伤口疤痕疤痕明显显疤痕细细微，无需拆 线线止血效果可能因松结结， 打结结不牢出现现 渗血或出血 “水密屏障”，止血 效果很好 疗效比较Watertight anastomosesl腹腔镜手术/内窥镜手术/关节镜手术，机器人手术l无需止血式缝合（八字缝合，锁边缝合）l替代荷包缝合l 美容效果l 特别适合于深腔狭窄部位的缝合，例如鼻腔、口 腔等腔道新技术应用潜力快、强、美、安全可靠突出优势l Speed为什么快？用连续、全层缝合代替打结，使软组织对齐操作 更快速更方便l Strong为什么强？360°双向倒刺设计结构可取得更佳的“水密”屏 障—腔隙较少，张力更均一，更好地抓握住缝合处l Reliability为什么可靠？离体和临床试验表明，Quill在张力强度和组织维 持能力方面，均优于同型号的传统缝合材料 突出优势腹壁正中线缝合强度试验Are Barbed Suture Lines as Strong as Smooth, Knotted Suture Lines? 免打结线结线与打结线结线一样样牢靠吗吗lA recent study of porcine gastrointestinal closure burst-strength pressures in wounds closed with barbed suture were no different than repairs performed with traditional knotted, smooth suture lines. 离体试验表明，QuillTM在张力强度和组织维持能力方面 ，均优于同型号的传统缝合材料Demyttenaere SV, Nau P, Henn M, et al. Barbed suture for gastrointestinal closure: a randomized control trial. Surg Innov. 2009;16:237-242. Biomechanical Proof of Barbed Sutures for the Efficacy of Laparoscopic Pyeloplasty JOURNAL OF ENDOUROLOGY Volume 25, Number 0, 2011Are Barbed Suture Lines as Strong as Smooth, Knotted Suture Lines? 免打结线结线与打结线结线一样样牢靠吗吗Demyttenaere SV, Nau P, Henn M, et al. Barbed suture for gastrointestinal closure: a randomized control trial. Surg Innov. 2009;16:237-242. Are Barbed Suture Lines as Strong as Smooth, Knotted Suture Lines? 免打结线结线与打结线结线一样样牢靠吗吗1. Ruff G. Techniques and uses for absorbable barbed sutures. Aesthet Surg J 2006;26:620–8. 2. Murtha AP, Kaplan AL, Paglia MJ, et al. Evaluation of a novel technique for wound closure using a barbed suture. Plast Reconstr Surg 2006;117:1769–80. 3. Dattilo PP, King MW, Leung JC. Tissue holding performance of knotless absorbable sutures. In: Programs and abstract in the Society for Biomaterials 29th Annual Meeting Transactions. 2003. p. 101. 4. Dattilo PP, King MW, Cassill NL, et al. Medical textiles: an application of an absorbable, barbed, bi- directional surgical suture. Journal of Textile and Apparel, Technology and Management 2002; 2:1–5. 5. Leung JC, Pritt S. Barbed bi-directional surgical sutures: in vivo strength and histopathology evaluations. In: Programs and abstracts in the Society for Biomaterials 29th Annual Meeting Transactions.2003. p. 100. 6. Leung JC. Barbed suture technology: recent advances. In: Proceedings Medical Textiles 2004. Advances in biomedical textiles and healthcare products conference. Pittsburg; 2004. p. 62–80.In all of these in vitro studies, thebidirectional, barbed, nonknotted, self- retaining sutures were significantly stronger than the conventional sutures of the same polymer of 1 size smaller (because of the barbs compromising。