CN104224253A - 缝合方法和器械 - Google Patents
缝合方法和器械 Download PDFInfo
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Abstract
本发明提供了一种带倒勾的缝线,包括外周上具有倒勾的主体、尖端、和位于一端以阻止缝线沿着所述尖端方向发生移动的锚。可以在锚上提供一个或多个翼,翼可以是具有不同长度的弓形并在缝线主体外周变化分布。提供了其它的锚设计。提供了放置单向和双向带倒勾的缝线以使伤口每一侧上的组织合拢、以及在没有伤口的情况下,比如在美容外科手术中,使组织定位和为组织提供支持的方法,可以包括末端J形针脚或S形针脚。放置方法可以通过锋利的尖端实施,所述尖端可以是针或者插入器械。本发明提供了幅值一般而言垂直于缝线最终夹持力的缝线正弦曲线模式。
Description
本申请是申请号为“200580023753.3”,发明名称为“缝合方法和器械”的发明专利申请的分案申请。
背景技术
本发明一般涉及用于在外科应用中使身体组织接合或定位的方法和器械,尤其涉及采用具有多个倒勾的缝线使身体组织接合或定位的外科缝合方法和器械,所述倒勾允许沿着一个方向拉动所述缝线通过所述组织,但防止所述缝线沿着相反方向相对于所述组织发生移动。
单向带倒勾的缝线具有多个倒勾,所述倒勾允许沿着一个方向拉动所述缝线通过所述组织,但防止所述缝线沿着相反方向在所述组织中发生移动。所述缝线可以具有一个尖形端部和另一个锚形端部,所述尖形端部使得可以沿着一个方向刺穿和通过组织,所述锚形端部在初始插入点和组织啮合以防沿着所述一个方向发生进一步的移动。双向带倒勾的缝线可以在一端具有沿着一个方向延伸的倒勾,在另一端具有反向倒勾,从而防止缝线在两个尖形端部之间沿着任一方向在组织中移动。
用于将带倒勾的缝线放置到组织中的方法包括但不限于直线形、锯齿形和曲线形模式,所述曲线形模式比如α曲线、正弦曲线和螺旋曲线。一般而言,所述模式以与其相一致的对齐方式终止,也就是说,例如,直线模式沿着直线路径终止,正弦曲线模式沿着正弦曲线路径终止,等等。
带倒勾的缝线可用于使邻近伤口或者组织分离处的组织相互靠近,或者用于在手术比如美容外科手术中对没有伤口的组织进行定位和支撑。
发明内容
根据本发明,提供了带倒勾的缝线,所述缝线包括细长主体、一个尖端、多个从主体周边延伸出来的倒勾、和一个具有锚的端部。倒勾允许缝线沿着尖端移动的方向移动穿过组织,但防止缝线沿着和尖端移动方向相反的方向发生移动。锚包括至少一个从主体周边向外延伸的程度大于倒勾的弓形翼,防止缝线沿着尖端移动的方向发生移动。提供了多种锚设计,包括但不限于如下这些锚:它们具有在主体周围间隔均匀或者不均匀的弓形翼,具有相等或者不同的长度,连接有或者没有连接段。锚可以例如折叠在一起、为钩子形状、回形针形状、“T”型形状(在该“T”上安装有段)、叉形端部、环形端部、半球形、金光菊形或者“M”形状。
同样根据本发明,提供了将带倒勾的缝线放置到身体组织中的方法。所述缝线包括至少一个尖端和具有倒勾的中心部分,所述倒勾使得所述缝线可以沿着尖端移动的方向移动穿过组织,并阻止所述缝线背离尖端移动方向发生移动。所述方法包括将缝线尖端插入组织中,然后将缝线在组织中推进以使中心部分沿着第一路径设置。缝线沿着第二路径偏离和缝线所述至少一个尖端靠近的第一路径,所述第二路径和第一途径的投影形成至少大约30度的角,缝线保留在第一路径上。
再次根据本发明,提供了将带倒勾的缝线放置到身体组织中以使伤口的每一侧上的组织合拢的方法。所述缝线包括至少一个尖端和具有倒勾的中心部分,所述倒勾使得所述缝线可以沿着尖端移动的方向移动穿过组织,并阻止所述缝线背离尖端移动方向发生移动。所述方法包括将缝线尖端插入组织中,然后将缝线在组织中沿着第一路径推进。然后缝线偏离第一路径以沿着第二路径,所述第二路径一般被设置成侧向偏离伤口。缝线进一步沿着第三路径偏离和缝线的所述至少一个尖端靠近的第二路径,所述第三路径和第二路径的投影形成至少大约30度的角,缝线保留在第二路径上。
同样根据本发明,提供了将单向带倒勾的缝线放置于身体组织中以使伤口合拢的方法。所述缝线包括细长主体、一个尖端、一个终止于锚的端部、和多个从主体外周延伸出来的倒勾。所述锚延伸到主体外周之外的程度大于所述倒勾。所述倒勾使得所述缝线可以沿着尖端移动的方向移动穿过组织并防止所述缝线沿着和尖端移动方向相反的方向发生移动。所述锚防止缝线沿着尖端移动方向发生移动。所述方法包括将缝线尖端插入到伤口的一个面,和使缝线在组织中推进,直到锚在组织中获得了足够的夹持强度以阻止在该组织中进一步移动为止,从而将所述锚埋入在组织中。
同样根据本发明,提供了采用插入器械将单向带倒勾的缝线放置于组织中的方法。所述缝线包括细长主体、一个尖端、一个终止于锚的端部、和多个从主体外周延伸出来的倒勾。所述锚当延伸时延伸到主体外周之外的程度大于所述倒勾。所述倒勾使得所述缝线可以沿着尖端移动的方向移动穿过组织并防止所述缝线沿着和尖端移动方向相反的方向发生移动。所述锚防止缝线沿着尖端移动方向发生移动。所述插入器械包括管状元件、以及具有开口的引导端和尾端,所述缝线主体至少部分首先设置在所述管状元件中,所述缝线尖端靠近所述引导端。所述方法包括将缝线尖端和插入器械的引导端在插入点处插入组织中。将缝线尖端和插入器械的引导端在组织中推进直到达到终点为止。在尾端握住并拉动插入器械,以去除插入器械。按照需要将组织沿着缝线主体手动分组和推进。
同样根据本发明,提供了采用插入器械将单向带倒勾的缝线放置于组织中的方法。所述缝线包括细长主体、一个尖端、一个终止于锚的端部、和多个从主体外周延伸出来的倒勾。所述锚当延伸时延伸到主体外周之外的程度大于所述倒勾。所述倒勾使得所述缝线可以沿着尖端移动的方向移动穿过组织并防止所述缝线沿着和尖端移动方向相反的方向发生移动。所述锚防止缝线沿着尖端移动方向发生移动。所述插入器械包括具有引导端和尾端的管状元件。所述方法包括将插入器械的引导端在插入点处插入并穿过组织直到达到终点为止,和将缝线引导端插入到插入器械中,至少直到缝线的尾端位于插入器械中为止。将柱塞插入到插入器械的尾端中,以紧靠缝线的尾端。下压柱塞以将缝线的引导端推出到插入器械之外。在尾端握住并拉动插入器械以去除插入器械,使缝线保留在原位。按照需要将组织沿着缝线主体手动分组和推进。
同样根据本发明,提供了采用双向带倒勾的缝线进行外科手术的方法。所述带倒勾的缝线包括细长主体、用于刺破组织的第一和第二锋利尖形末端、和多个从主体外周延伸出来的倒勾。在缝线第一端和主体上第一轴向位置之间的主体第一部分上的倒勾用以使得所述缝线可以沿着第一端移动的方向移动穿过组织并防止所述缝线沿着和第一端移动方向相反的方向相对组织发生移动。在缝线第二端和主体上第二轴向位置之间的主体第二部分上的倒勾用以使得所述缝线可以沿着第二端移动的方向移动穿过组织并防止所述缝线沿着和第二端移动方向相反的方向相对组织发生移动,其中所述第二轴向位置小于第二端和第一轴向位置之间的距离。采用了插入器械,所述插入器械包括管状元件并具有引导端和尾端。所述方法包括将插入器械的引导端在插入点处插入组织中,然后将插入器械的引导端在组织中推进直到到达所选点。将缝线的第一尖端插入到插入器械,至少直到一个倒勾延伸到插入器械之外为止。在尾端握住并拉动插入器械以去除插入器械,使缝线的整个长度在组织中保留在原位。按照需要将组织沿着缝线主体手动分组和推进。
同样根据本发明,提供了采用双向带倒勾的缝线进行外科手术的另一方法。所述带倒勾的缝线包括细长主体、用于刺破组织的第一和第二锋利尖形末端、和多个从主体外周延伸出来的倒勾。在缝线第一端和主体上第一轴向位置之间的主体第一部分上的倒勾用以使得所述缝线可以沿着第一端移动的方向移动穿过组织并防止所述缝线沿着和第一端移动方向相反的方向相对组织发生移动。在缝线第二端和主体上第二轴向位置之间的主体第二部分上的倒勾用以使得所述缝线可以沿着第二端移动的方向移动穿过组织并防止所述缝线沿着和第二端移动方向相反的方向相对组织发生移动,其中所述第二轴向位置小于第二端和第一轴向位置之间的距离。所述方法包括将缝线的第一端在插入点插入到组织中,然后将缝线以一般为曲线的路径推进,直到第二轴向位置位于缝线第一端的插入点并且缝线的第一端在退出点处退出组织时为止,从而使缝线的第一部分的长度保留在组织中。将缝线的第二端在缝线第一端的插入点处插入到组织中。将缝线以基本为曲线的路径远离缝线第一部分推进,直到缝线的第二端在退出点处退出组织为止,从而将缝线的第二部分的长度保留在组织中。按照需要将组织沿着缝线主体手动分组和推进。每条曲线路径的幅度一般垂直于缝线在组织上施加的最终夹持力。
同样根据本发明,提供了将第一单向带倒勾的缝线和第二单向带倒勾的缝线放置于身体组织中的方法。所述缝线每个包括细长主体、一个尖端、和一个尾端、以及多个从主体外周延伸出来的倒勾。所述倒勾使得所述缝线可以沿着尖端移动的方向移动穿过组织并防止所述缝线沿着和尖端移动方向相反的方向发生移动。所述方法包括将第一缝线的第一端在插入点处插入组织,然后将缝线以一般为曲线的路径推进,直到第一缝线的尖端在退出点处从组织中退出为止,从而将第一缝线主体的长度留在组织中。将第二缝线的尖端在第一缝线的插入点处插入到组织中,和将第二缝线以一般为曲线的路径推进,直到第二缝线的尖端在退出点处从组织中退出为止,从而将第二缝线主体的长度留在组织中。在插入点处将第一和第二缝线结扎在一起。按照需要将组织沿着每条缝线的主体手动分组和推进。每条曲线路径的幅度一般垂直于每条缝线在组织上施加的最终夹持力。
再次根据本发明,提供了将单向带倒勾的缝线放置于身体组织的方法。所述缝线包括细长主体、一个尖端、一个终止于锚的端部、以及多个从主体外周延伸出来的倒勾。所述锚延伸到主体外周之外的程度大于所述倒勾。所述倒勾使得所述缝线可以沿着尖端移动的方向移动穿过组织并防止所述缝线沿着和尖端移动方向相反的方向发生移动,而所述锚防止缝线沿着尖端移动方向发生移动。所述方法包括在组织中切开切口以限定组织的面,将缝线尖端插入到组织的所述面中。推动缝线的尖端穿过组织直至退出点。将锚放置于切口中。推动缝线的尖端穿过组织,直到锚在组织中获得足够夹持强度以阻止在组织中发生进一步移动时为止,从而将所述锚埋在组织中。
再次根据本发明,提供了采用单向带倒勾的缝线在体内将断开的内部组织的两端连接在一起以允许所述内部组织的两端可以组织愈合并重新长到一起的方法。所述缝线包括细长主体、一个尖端、一个终止于锚的端部、以及多个从主体外周延伸出来的倒勾。所述锚延伸到主体外周之外的程度大于所述倒勾。所述倒勾使得所述缝线可以沿着尖端移动的方向移动穿过组织并防止所述缝线沿着和尖端移动方向相反的方向发生移动,而所述锚防止缝线沿着尖端移动方向发生移动。所述方法包括将缝线尖端插入内部组织的第一端,和将所述尖端沿着曲线路径推动穿过内部组织,远离所述第一端前进并进一步进入组织中。握住缝线的尖端并将所述尖端从所述内部组织中拉出,从而将锚拉到靠近组织的第一端。将所述缝线尖端沿着靠近退出点的内部组织的外周推动。所述尖端被沿着曲线路径推动,然后沿着所述路径返回到第一端,和从组织的第一端中退出。将尖端插入组织的相对第二端,并将尖端沿着曲线路径推动,远离第二端前进并进一步进入组织中,然后返回到第二端,从组织的第二端中退出。将尖端插入组织的第一端,将尖端沿着曲线路径推动,远离第二端前进并进一步进入组织中,然后朝着第一端返回,并从组织中退出。
附图说明
为了更全面地理解本发明,现在应该参见附图所示并且在下面进行描述的实施方案。在图中:
图1是根据本发明的方法能够使用的具有锚的、带倒勾的缝线的实施方案的透视图。
图2-11是根据本发明具有锚的、带倒勾的缝线的实施方案的端视图。
图12-20是根据本发明具有锚的、带倒勾的缝线的实施方案的正视图。
图21是用于将缝线固定到附件的常规装置的正视图。
图22和23是根据本发明用于将缝线固定到锚上的装置的正视图。
图24和25是根据本发明具有环形端部的正视图。
图26和27是根据本发明用于将组织中张开的伤口的两侧结合到一起的方法实施方案的平面图。
图28和29是根据本发明用于将组织中张开的伤口的两侧结合到一起的方法实施方案的平面图。
图30和31是根据本发明用于将组织中的表面伤口倒置(invert)的方法实施方案的平面图。
图32-39B是根据本发明用于将组织中张开的伤口两侧结合到一起的方法的其它实施方案的平面图。
图40和41是用于使组织定位的常规方法的平面图。
图42-45是根据本发明用于使组织相对于设置在该组织中的带倒勾的缝线定位的方法实施方案的平面图。
图46-48是根据本发明的方法实施方案的剖面图。
图49和50是根据本发明用于使组织沿着设置在该组织中的带倒勾的缝线定位的方法的其它实施方案的平面图。
图51A-51C是根据本发明用于将断开的腱的两端结合在一起的实施方案的平面图。
图52-55是根据本发明进行吻合手术的实施方案的平面图。
图56是根据本发明的倒勾构造的实施方案的详图。
图57是根据本发明用于将组织中张开的伤口的两侧结合在一起的实施例的平面图。
图58是用于将组织中张开的伤口的两侧结合在一起的常规方法的实施例的平面图。
具体实施方式
本文中所用的术语“伤口”是指人体皮肤或者其它身体组织中的外科手术切口、切开、撕裂、断开的组织或者意外伤口,或者其它可能需要缝合、纤维包扎或者采用另外的组织连接器械的状况。
本文所用的术语“组织”包括组织比如皮肤、骨头、肌肉、器官和其它软组织比如腱、韧带和肌肉。
在本文中采用的一些其它术语仅仅是为了方便,而不是对本发明的限制。例如,单词比如“上”、“下”、“左”、“右”、“水平”、“垂直”、“向内”、“向外”、“向上”和“向下”仅仅描述图中所述的构造。应该理解的是所述部件可以沿着任何方向取向,所以,除非另有具体说明,应该认为术语包括这些变化。
在下列文献中描述了适用于本发明方法的带倒勾的缝线和放置方法:美国专利No.5342376,标题为“Inserting Device for a Barbed TissueConnector”;美国专利No.5931855,标题为“Surgical Methods UsingOne-Way Suture”;美国专利No.6241747,标题为“Barbed BodilyTissue Connector”;美国专利No.6599310,标题为“Suture Method”;美国专利申请No.10/065256,标题为“Suture Method”;美国专利申请No.10/065278,标题为“Barbed Suture in Combination with SurgicalNeedle”;美国专利申请No.10/065279,标题为“Barb Configurations forBarbed Sutures”;和美国专利申请No.10/065280,标题为“BarbedSutures”。美国专利No.5342376、美国专利No.5931855、美国专利No.6241747、美国专利No.6599310、美国专利申请No.10/065256、美国专利申请No.10/065278、美国专利申请No.10/065279和美国专利申请No.10/065280引入本文作为参考。
现在参考附图,其中相似的附图标记在多张图中表示相应的或者相似的元件,图1是单向带倒勾的缝线90的透视图,具有缝线主体92、尖端96和位于另一端的锚98,其中主体上具有从其周边延伸出来的倒勾94。锚98包括从缝线主体92径向向外延伸出来的、位于基本和缝线主体92的纵轴相垂直的平面内的杆,所述杆通常使带倒勾的缝线90为“T”形。如图2-11中的端视图(缝隙主体垂直于页面)的实施方案所示,许多其它形状和构造也是可行的。图2-11所示的每种锚都具有从缝线主体92径向向外延伸的距离比倒勾94更远的翼。分别在图2-5中示出的带倒勾的缝线100、102、104、106上的锚98具有一个或多个翼108,翼108通常在缝隙端部绕着其周边均匀分布。图6-8中示出的带倒勾的缝线110、112、114的实施方案具有锚98,所述锚98包括多个位于缝线主体92的端部并且仅仅从其部分周边延伸出来的翼108。图9-11示出了带倒勾的缝线116、118、120的实施方案,其中各组翼122-123、124-126、127-130中的每个都具有不同长度。
图12-20是带倒勾的缝线在一个端部的其它实施方案。图12示出的带倒勾的缝线132具有锚134,锚134具有凹向缝线另一端的翼136。图13示出的带倒勾的缝线138具有锚140,锚140具有背离所述缝线尖端向下凹的翼142。图14示出的带倒勾的缝线144具有图1所示的锚146,锚146还包括多个从杆向着缝线另一端延伸的段(segment)148。图15示出的带倒勾的缝线150具有半球形的锚152。图16示出的带倒勾的缝线154具有类似金光菊的锚156。图17示出的带倒勾的缝线158具有锚160,锚160由主体92的环形成,所述环自己交叉形成夹子,其中组织可以容纳在夹子之间。图18示出的带倒勾的缝线162具有由缝线主体92的钩子形成的锚164。图19示出的带倒勾的缝线166具有类似“M”的锚,其中缝线主体92从“M”的中间腿延伸出来。图20示出的带倒勾的缝线170具有向着缝线170另一端延伸的单一倒勾172,倒勾172比方向倒勾94大。如图12-20的多种锚设计所证明的那样,许多锚设计能够用于带倒勾的缝线,而且落在本发明的范围之内。
图1-20所示的锚可以和带倒勾的缝线的主体92一体式形成,或者,可替换地,可以安装到缝线的端部。图21-23给出了可以将锚固定到带倒勾的缝线上的方式。图21示出了图20的锚172。锚172的端部具有轴向孔178。在孔178的内侧提供了向内倾斜的齿176。缝线主体92插入到孔178中,锚172的端部卷绕着缝线主体92。图22示出的锚172包括多个位于缝线主体92端部上的分开的圈182。缝线主体92的端部插入圈182中。在缝线主体92上提供了倒勾184,倒勾184和圈182相对并通过和圈182的啮合将缝线主体92固定就位。图23示出了锚188和带倒勾的缝线主体92之间的连接件186,所述连接通过例如胶或加热建立。
图24示出了在一端具有环192的缝线190。参见图25,通过将缝线190穿过组织194然后穿过环192,将缝线190放置到组织194中。组织194由缝线190和环192夹持,从而使缝线190被锚定。
本发明的锚可以通过冲压和钻孔、注射成型、或者激光切割系统、或者本领域技术人员选择的其它方法制备。锚可以用生物吸收性材料或者本领域技术人员选择的材料制备。
各种生物吸收性聚合物包括但不限于聚二酮、聚交酯、聚乙醇酸交酯、聚己酸内酯和其共聚物。市售例子是聚二酮(PDS II,Ethicon销售外科手术缝线的商标名)、大约67%乙醇酸交酯和大约33%碳酸亚丙酯的共聚物(,American Cyanamid销售外科手术缝线的商标名)、和大约75%乙醇酸交酯与大约25%己酸内酯的共聚物(,Johnson&Johnson销售缝线和缝线缝针的商标名)。由所述生物吸收性材料制备的带倒勾的缝线可用于很多应用中。
另外,锚可以由非吸收性材料(可以是聚合物)来制备。所述聚合物包括但不限于聚丙烯、聚酰胺(也称作尼龙)、聚酯(比如聚对苯二甲酸乙二醇酯)、聚四氟乙烯(比如膨胀型聚四氟乙烯,Gore以销售)、聚醚-酯(比如polybutester,它是对苯二甲酸二甲酯、聚四亚甲基醚乙二醇、具有酯单元的聚合物(比如,聚乙醇酸交酯)和1,4-丁二醇的缩聚物,由Tyco的Davis&Geck和U.S.Surgical公司以商标名销售,它是American Cyanamid有关外科手术缝线的注册商标)或者聚尿烷。或者,非吸收性材料可以是金属(例如,钢)、金属合金或者天然纤维(例如,蚕丝、棉等等)等等。
本文所用的术语“伤口”是指人体皮肤或者其它身体组织中的外科手术切口、切开、撕裂、断开的组织或者意外伤口,或者其它可能需要缝合、纤维包扎或者采用另外的组织连接器械的状况。
图26-39B示出了根据本发明的多个实施方案将缝线置于组织中以使伤口或者分离组织的侧相互靠近的多种方法。放置缝线的方法包括一个或多个末端J形针脚或者S形针脚等等。末端J形针脚或者S形针脚等等包括如下缝线放置方法:其中,缝线端部的一部分相对于缝线的相邻部分沿着不同方向延伸。所述缝线端部部分的相对方向可以是例如和缝线相邻部分的投影途径至少成大约30度。在本文中为了方便,谈到的是J形针脚和S形针脚,但是应该理解,缝线放置可以和J形针脚或者S形针脚不同,但仍在本发明的范围之内。根据本发明的方法来放置缝线可以通过下面讨论的针或者插入器械来实施。所述放置模式可以通过操作缝线尖端并操作组织来进行,或者通过用操作组织代替操作缝线尖端来进行。如本文中描述和示出的那样,根据本发明可以将组织手工分组并沿着缝线推进。
在本文中有时谈到缝线尖端。缝线尖端可以是直的或者弯曲的。在一个实施方案中,缝线尖端可以是固定在缝线主体每个端部的外科手术针,从而使得缝线主体在两根针的柄端之间延伸。针优选由不锈钢或者其它外科手术级金属合金构成。针可以通过粘合、卷绕或型锻等固定到缝线主体上,或者可以通过热缩形管道形成所述接头。也可以采用可拆卸的连接,从而可以通过突然拖动或者拉动或者通过切割来从缝线主体上去除所述针。选择针的长度以应付待修补的组织类型,从而使针可以被完全去除,导致缝线主体留在组织内的所需位置。
在图26中,采用具有倒勾94的两条双向带倒勾的缝线254、256使组织252中的伤口250的各侧合拢。在图中,实线缝线表示缝线可见,虚线缝线表示缝线埋在组织中,点状线缝线给出的是缝线的可替换的掩埋位置。第一缝线254采用缝合方法定位,其中采用末端J形针脚260、262将两个端部置于组织中。第二缝线256采用缝合方法在组织中定位,其中采用末端S形针脚264、266将两个端部在组织中定位。所示的J形针脚260、262和S形针脚264、266指向另一缝线的方向,或者“向内”,但也可以在可替换的位置260a、262a、264a、266a中向外指向,具体取决于应用和本领域技术人员的偏好。作为放置J形针脚的例子,第一缝线254的J形针脚262的末端部分沿着A对齐,其位置和缝线254相邻部分的投影路径B成θ角,所示的为大约90度。作为放置S形针脚的例子,第二缝线256的S形针脚266的末端部分沿着C对齐,其位置和缝线256相邻部分的投影路径D成α角,所示的为大约45度。J形针脚和S形针脚的角度θ和α可以大于或小于所示的值,该缝合仍在本发明的范围之内。
图27示出了将伤口250的各侧相互靠近的单向带倒勾的缝线270、272。每条缝线270、272都有锚274、276,采用其中在相对端以末端J形针脚278或者S形针脚280结束的方法置于组织252中。可以采用另外的J形针脚或者S形针脚位置278a、280a。可以如同第一缝线270的锚274那样,通过形成小切口将锚埋在组织252中;或者可以和第二缝线272的锚276一样,位于组织上方。缝线270、272可以利用位于缝线的和锚274、276相对的引导端处的尖端来放置。所示的锚274、276是示意性的;如前所述,应该理解合适时可以采用各种锚。
为了方便,在本文的其它实施方案中,示出的大部分是J形针脚。但是,应该理解的是,在本文示出的所有用针放置缝线的实施方案中,可以用S形针脚代替任何给出的J形针脚。在将组织沿着缝线主体分组和推进的一种方法中,缝线的尖端在完成例如J形针脚之前从组织出退出。然后,将组织分组并沿着缝线主体推进,然后缝线尖端进入组织中完成J形针脚。
图28和29示出了分别采用双向带倒勾的缝线254和单向缝线270通过α形针脚模式使伤口250闭合的缝合方法。图29的采用双向带倒勾的缝线254的缝合方法在每一端具有J形针脚,所述J形针脚可以向下284、286、向上284a、286a,或者其组合。图29的采用单向缝线的缝合方法在其引导端具有J形针脚,所述J形针脚可以或者向下288或者向上288a。荷包针脚是用于修补切除部位的外科手术缝合方法,比如在需要将剩余组织内翻的阑尾切除术中。可以根据本发明的方法,分别采用图30和31所示的双向带倒勾缝线254或者单向缝线270形成荷包针脚。对图28的描述适用于图30,对图29的描述适用于图31。
图32和33示出了分别采用双向带倒勾的缝线254和带有锚274的、单向带倒勾的缝线270通过锯齿模式使伤口250的各侧合拢的缝合方法。如前面在图26中所述和在图32中所述,缝线254在J形针脚262内的端部部分的末端路径A和该缝线相邻部分的投影缝合路径B成一定角度。所示的J形针脚角度是大约135度。应该理解该角度可以改变,但仍然认为是J形针脚。
图34和35示出的是分别采用位于组织252中的双向带倒勾的缝线254和单向带倒勾的缝线270通过正弦曲线模式使伤口各侧相互靠近的缝合方法。
图36和37分别示出了通过螺旋模式位于组织252中的双向带倒勾的缝线254和带锚274的、单向带倒勾的缝线270。
就图32、34和36的双向缝线254而言,从伤口两端之间的中点开始缝合,沿着两个方向推进。在图32和34分别示出的锯齿模式和正弦模式中,缝线254的中心部分,也即倒勾94开始变向的部分,也可以位于伤口的一端,而缝线的两端顺着伤口以相互成镜像的独立模式沿相同方向推进。那么,缝线的两端都可以具有位于伤口同一端部的J形针脚或者S形针脚。图32、34和36的J形针脚可以向内260、262、向外260a、262a、或者其结合。图33、35和37的J形针脚可以向内278或者向外278a。而且,图33和35所示的缝线270可以以镜像模式折回到伤口的端部,从而使引导端的位置接近锚274,而且可以在该位置具有J形针脚或者S形针脚。
图33、35和37的锚274和组织252的表面接触。本发明的另一方法允许将锚274置于组织表面之下,如图38A和38B所示。
如图38A所示,缝线270的尖端(例如,针280)位于单向带倒勾的缝线270的引导端,插入到伤口250的面288内。当缝线270被针280拉动穿过组织时,锚274使伤口288的面紧靠在一起。当缝线被拉动以使伤口合拢时,锚274将发生移动,直到它遇到组织252中的抗力为止。组织252通常包括和组织表面平行的层。取决于锚274的形状,可以预期锚274在层之间移动并穿过伤口250的面288,埋入到相邻组织中,到达图38B所示的和伤口250的面288相隔一定具体的位置处。参见图38A,在一个实施方案中,如同本领域技术人员选择的那样,伤口端部到锚74的距离E可以和“刺穿点”之间的距离大致相同,或者和伤口面288到该模式峰值291之间的距离F大致相同。
如图39A和39B所示,采用单向带倒勾的缝线的另一种缝合方法(其中锚埋在组织中)用于使小伤口靠近。在图39A中,位于单向带倒勾的缝线270引导端处的针280插入到伤口250的面288之内。和图38A和38B所示方法相似,当通过针280拖动缝线270时,锚274使伤口250的面288相互靠近。当缝线被拉动以使伤口250的各侧合拢时,锚移动到组织252中,直到它在组织252中遇到阻力为止。在图39B中,所示的锚已经移到和伤口面288间隔一定距离的最终位置。缝线270的放置方式可以形成环,引导端可以设置成具有可替换构造278、278a的J形针脚形式。
图40-50示出了本发明的缝合方法,其中带倒勾的缝线经设置以使组织定位,该组织没有伤口,缝线位于组织表面之下,比如在美容外科手术中。图40和41示出了将常规的、不带倒勾的缝线置于组织中以进行提紧(lift)。图40的方法采用一条在顶部具有一个结头、在底部具有出口/入口点304的缝线300。收紧接头以将组织252调到所需的提紧量。图41的方法采用两条在顶部具有一个接头310、在底部具有另一接头312的缝线306、308。收紧接头以将组织252提紧到所需的量。在接头302、310、312上施加足以提紧组织的力,组织252上的载荷集中在缝线的顶部接头302、310和底部接头312或者低点304处。
图42示出了本发明的缝合方法,其中双向带倒勾的缝线254、256互相基本平行设置,在每个端部具有朝向相邻缝线,或者向内,的J形针脚260、262、264、266。图43示出了相似的缝合方法,其采用两条平行的双向带倒勾的缝线254、256,每条具有朝向外面的J形针脚260a、262a、264a、266a。图44示出了具有沿着相对方向延伸的末端J形针脚314、316的双向带倒勾的缝线254。一旦设置了缝线254、256,那么该组织可以由外科医生沿着每条缝线手动推进,以按照需要进行分组从而使组织有一定量的提紧。和图40和41的常规方法不同,带倒勾的缝线所提供的阻力沿着缝线长度分布。
图45示出了埋入的单向带倒勾的缝线270,所述缝线具有锚274和位于组织252的表面下方并终止于J形针脚278的尖端320。任选地,J形针脚278可以有不同的取向或者一起忽略。
一种将单向带倒勾的缝线270设置在组织252的表面以下的方法是采用插入器械。插入器械设计包括直线型、曲线型和螺旋型。图46示出了采用插入器械322的一种所述方法。插入器械322可以包括直管或曲管324、引导端326、尾端328、和方便使用的把柄330。采用直管(而不是曲管)操作组织可以进行一些非线性缝线安装。缝线270的尖端320可以从插入器械322的引导端326或者插入器械322的侧面开口(未示出)延伸出来。缝线270上的至少一个倒勾94必须从引导端326的开口或者通过插入器械侧面的开口延伸出来。可替换地,锚274可以从引导端326的开口或者插入器械侧面的开口延伸出来。插入器械322向前推进通过表皮并进入皮下组织334。当进入所需位置时,通过尾端328拉出插入器械322,缝线270的尖端320和倒勾94啮合在皮下组织334中,使缝线270保留在原位以限制沿着一个方向发生移动,如图48所示。锚274也被埋入,以限制沿着另一方向发生移动。
图48示出了用插入器械放置单向带倒勾缝线270的另一方法。插入器械340具有直管或曲管342、引导端344、尾端346和往复式柱塞348。锚274被设置在和插入器械340的引导端344相邻的管子342中。插入器械340向前推进通过表皮330、进入到皮下组织334中。当位于所需位置时,下压柱塞348,直到锚274被从管子342中排出进入皮下组织334为止。当插入器械340从尾端346拔出时,锚274啮合在组织中,以限制沿着一个方向的移动。倒勾94也和皮下组织334发生啮合,从而限制沿着相反方向的移动。
锚274可以是在插入器械中适配的任何设计,可以包括当位于插入器械管子内部时处于折叠状态但在释放时处于膨胀状态的折叠设计。为了方便,图中给出的是“T”形设计,当其构造使其可以沿着插入器械管子方向折叠时,可以使用。而且,图45-48所示并在上面描述过的方法也可以用来采用插入器械放置单向带倒勾的缝线,以使伤口的各侧合拢,如图27所示。
图49示出了根据本发明采用对眉毛、脸和颈部进行美容提紧的方法放置5条双向带倒勾的缝线380、400-403。在一个实施方案中,可以在每一端采用直针放置所示五条双向带倒勾的缝线380、400-403中的每一条。对于眉毛提紧而言,缝线380的端部形成内翻的“U”或者“V”型或者其变体型,从同一插入点382进入,所述插入点通常位于发迹线之上(或者发迹线的预期位置)。缝线400-403可以如下放置:端部通常沿着相对方向延伸,从通常可能高于预期发迹线的插入点404-407开始,从远端退出。在所有方法中,为了以正弦曲线模式放置缝线,将针左右移动,在一个实施方案中直到终止时才将针从组织中退出。正弦曲线模式可以比图49中所示的那些具有更大或更小的幅值和频率,都在本发明的范围之内。作为双向带倒勾的缝线380、400-403的替换方案,可以为各个缝线的每个部分384、386、408、410-416采用单向带倒勾的缝线,它们的端部在插入点382、404-407处打结到相邻缝线上。另外,在弯曲部分和退出点之间,缝线一般可以具有直线放置部分。在放置了缝线之后,将组织沿着缝线主体推进并分组,从而实现提紧以及对组织的支持。
将缝线以正弦曲线模式放置提高了缝线的“冲击吸收”能力,提供了很多机会来拉长或者拉直缝线并防止已经偏移的或者位置已经改变的组织发生复位(移动到其初始位置)。曲线模式的振幅通常和缝线的最终夹持力方向垂直,所述夹持力方向通常沿着曲线模式的轴向。图49在G处示出了示例性的振幅,在H处示出了示例性的最终夹持力。和直线放置的缝线相比,拉动组织可能导致组织复位得更多,但是由于正弦模式产生了挠曲,所以正弦曲线模式放置的缝线发生断裂的可能性更小。和线性模式放置的、数量相同、尺寸相同的缝线相比,正弦曲线模式的提紧程度可以更大或者更紧。正弦曲线模式还可以允许采用更少、更大的缝线,当病人不希望进行镇静处理时,这是很理想的。
对于眉毛提紧缝线380、400以及前额上的其它提紧而言,缝线在前额中的部分384、386、408仅仅啮合在肌肉,也即额肌,上方的真皮下组织中。真皮下组织包括乳头真皮、网状真皮和皮下组织。缝线400-403的延伸到头皮中的部分410-413和帽状腱膜以及真皮下组织相啮合。
一般而言,对于面部和颈部的缝线401-403而言,前面的部分414-416仅仅在肌肉,即颈阔肌,上方的真皮下组织中啮合,但在面颊或靠近鼻子处略微浅一些。具体而言,面部提紧缝线401在上脸部中的前面部分414朝向鼻唇摺418延伸,和真皮下组织、浅表肌肉腱膜系统、或者两者啮合。
具体而言,就面颊中的面部提紧缝线402而言,插入点406大约在后部下颌骨角处。缝线的第一端412被沿着和下颌骨边界基本平行的路径从后面推动通过真皮下组织、浅层腱膜系统或者其组合,从远端退出。缝线的第二端415被沿着和下颌骨边界基本平行的路径从前面推动通过真皮下组织、浅层腱膜系统或者其组合,也从远端退出。
对于包括颈部提紧的外科手术而言,带倒勾的缝线403的插入点大致位于上部胸骨乳突肌处。缝线的第一端413被沿着和下颌骨边界基本平行的路径从后面推动通过真皮下组织、浅层腱膜系统或者其组合,从远端退出。缝线的第二端416被沿着和下颌骨边界基本平行的路径从前面推动通过真皮下组织、浅层腱膜系统或者其组合,也从远端退出。
在本发明的范围之内,可以有另外的美容外科手术应用。例如,可以进行大腿提紧和胸部提紧。在大腿提紧中,插入点通常位于腹股沟摺处。缝线的第一端被从身体上端推动通过真皮下组织,直到缝线的第一端延伸到组织外面时为止;缝线的第二端被从身体下端推动通过真皮下组织,直到缝线的第二端延伸到大腿上的组织外面时为止。然后,使大腿组织沿着缝线主体推进和分组,从而进行提紧和组织支持。
在胸部提紧中,插入点位于胸部曲率的上面部分处。缝线的第一端被推动通过皮下组织、真皮组织和雄大肌,直到在胸部上面部分的退出点处从该组织中退出时为止。缝线的第二端从身体下端推动通过纤维和脂肪组织,直到缝线的第二端沿着胸部的前面部分或者下曲率在退出点处延伸到该组织之外时为止。然后,使胸部组织沿着缝线主体推进和分组,从而进行提紧和组织支持。
图50示出了根据本发明采用具有锚436-441的单向带倒勾的缝线430-435进行美容外科手术的缝合方法。这些缝合方法可以任选地包括末端J形针脚或者S形针脚(未示出),可以用图46-49所示的插入器械322、340或者用针来放置。例如,所述的一条缝线434沿着颚线,在其具有S形针脚的尖端终止。位于脸部上方的另一条缝线433具有和图49所示相似的曲线模式。虽然示出的是“T”形锚436-441的示意图,但是锚可以是本文所述的任何设计,有外科医生根据应用进行选择。可以或者通过采用插入器械或者切口小切口来埋入锚。所示的另一条缝线442位于前额中,在端部444、445处具有曲率,包括在眉毛处靠近端部445的J形针脚。就啮合的组织而言,对眉毛、脸部、颈部、大腿和胸部的应用和上述在相似位置的双向缝线相似和相应。在放置了缝线之后,使组织沿着缝线主体推进和分组,从而进行提紧和组织支持。作为完成所需模式,比如J形针脚,后使组织沿着缝线分组和推进的变体,缝线的尖端可以在完成J形针脚之前从组织中退出,然后使组织分组和推进,然后可以完成J形针脚。
图51A-51C示出了采用单向带倒勾的缝线270修补断开的腱的两部分450、452,为了简便,称作左部分450和右部分452。如图51A所示,缝线进入左部分450的端部454,沿着曲线路径到达退出点456。锚274紧靠着左部分450的端部454。缝线从靠近退出点456的点458处再次进入,继续沿着曲线路径形成环直到在点460处退出为止,然后在点462处进入。缝线形成完整的环,从左部分450的端454退出,然后穿过右部分452的端部464。如图51B所示,缝线沿着所需的曲线路径,通过在点466、468、470处退出以及在点472、474、476处进入,而穿过腱252向前推进,远离端部464;然后,通过在点478、480、482处从腱中退出以及从点484、486、488处进入,而返回到端部464。如图51C所示,然后再次进入左部分450的端部454,沿着所选曲线路径,在点490、492、494、496处从腱退出,在点498、500、502、504处进入,直到最终从腱周围退出506为止。
同样根据本发明,提供了采用带倒勾的缝线将身体内的管子、管状结构或者中空器官的两个部分的端部连接在一起的方法,比如在吻合手术中的血管端部。本文所用的术语“管子”包括但不限于血管、大小肠、导管等等。如图52-55所示,可以在连接之前首先将管子的端部切成一定角度,用于更有效的连接。
参见图52,示出了采用具有锚274的单向带倒勾的缝线270将管子的端部连接在一起。带倒勾的缝线270的尖端280(在本实施方案中包括针)穿过壁插入到管子第一端550的内部。然后,将缝线270的尖端通过管子第二端552的壁插入到管子内部。缝线270被拉动穿过管子的壁,直到锚274接触到管子第一端550的壁的外表面时为止,从而将管子的两个端部550、552拉到一起。然后,将缝线270在点554处再次通过管子第一端550的壁插入,所述点554和初始插入点556在圆周上处于分开位置。重复所述步骤,以使缝线270绕着管子推进。在最后一次啮合后,可以用末端J形针脚或者S形针脚完成缝线模式。
图53示出了采用和图52所示方法相似的缝线模式,利用双向带倒勾的缝线254将管子的端部550、552连接在一起的方法。从初始插入点558开始,缝线254的第一部分560的端部通过壁插入到管子第一端部552的内部。然后,将缝线254的第一部分560的端部从管子内部穿过管子第二部分550的壁。可以拉动缝线254的第一部分560使其穿过管子的壁,直到缝线254的第二部分562上的反向倒勾和管子第一端部552的壁的外表面相接触即可,用于将管子的两个端部550、552拉到一起。缝线254的第一部分560的端部在点564处穿过壁插入到管子第一端552的内部,所述点564和初始插入点558沿着第一方向在圆周上分开一定距离。缝线254的第一部分562的端部在点566处穿过壁插入到管子第二端部550的内部,所述点566和缝线254的第一部分560的端部的退出点568在圆周上间隔一定距离。然后,将缝线254的第二部分562的端部在点570处从管子内部穿过管子第一端552的壁插入,所述点570和初始插入点558沿着第二方向在圆周上分开一定距离。重复这些步骤,使带倒勾的缝线254的每一端绕着管子推进。在最后一次啮合之后,可以完成缝线模式,在每一端具有末端J形针脚或S形针脚。
图54示出了采用双向带倒勾的缝线254将身体管子的端部550、552连接到一起的另一方法。从初始插入点572开始,将缝线254的第一部分560的端部穿过管子的第一端552的壁插入。然后,将缝线254的第一部分560的端部从管子内部穿过管子的第二端550的壁。可以拉动缝线254的第一部分560穿过管子的壁,直到缝线254的第二部分562上的反向倒勾和管子的第一端552的壁的外表面相接触为止,从而将管子的两个端部550、552拉到一起。缝线254的第一部分560的端部在点574处穿过壁插入管子第一端552的内部,所述点574和初始插入点572沿着第一方向在圆周上分隔一定距离。缝线254的第二部分562的端部在点576处穿过管子的第一端552的壁,所述点576和缝线254的第一部分560的初始插入点572相邻,点572实际上充当同一插入点。然后,缝线254的第二部分562的端部在点578处从管子内部穿过管子第二端550的壁,所述点578和缝线254的第一部分560的端部的第一退出点580在圆周上分开一定距离。然后,将缝线254的第二部分562的端部在点582处穿过管子第一端552的壁,所述点582和初始插入点576沿着第二方向在圆周上分开一定距离。重复这些步骤,使得带倒勾的缝线254的每个端部绕着管子推进。在最后一次啮合后,可以完成缝合模式,在每个端部具有末端J形针脚或者S形针脚。可替换地,缝线模式可以如同所述的那样持续下去,直到缝线的端部互相交叉为止,如图55所示。即使这样,需要时缝合模式也可以用末端J形针脚或者S形针脚来完成。
在根据本发明将管子的端部结合在一起的方法中,当缝线通过管子组织推进时,缝线端部穿过管子的路径可以包括纵向分支。采用这种技术,将更长的缝线放置到管子组织中,这样可以使结合强度更佳。另外,采用所述的方法可以将管子端部在身体内更有效地连接,和带倒勾的缝线沿着自由端的周界首先从哪儿进入管子无关。
应该理解,尽管描述了将身体管子的两个端部结合到一起的方法,但是本发明不限于此。尤其是,本发明的方法可以包括其中将管子的一部分移植到初始管子的端部之间的手术。这种手术尤其用于冠状动脉旁路移植或者CABG。移植手术和本文描述的方法类似,除了采用上述方法将移植体的端部连接到管子端部之外。
通过下列非限制实施例对本发明做进一步的举例说明。
实施例
对常规结扎缝线和放置在组织中的、双向带倒勾的、每个端部具有J形针脚的缝线,进行组织夹持能力试验比较。由聚二酮(PDO)(尺寸为0)制备两种倒勾几何设计不同(A和B)的双向带倒勾的缝线。每条缝线长度为7英寸,在中间3英寸中包括78个倒勾,所述倒勾被等分成两个相反的段。A设计的螺旋度为12.8度,设计B的螺旋度为12.4度。采用10个试样测量每种设计的平均直拉拉伸强度。采用配有视频照相机的Optem Zoom显微镜(Thales Optem Inc.,Fairport,New York制备)用四个不同参数表征倒勾的几何形状:切入角(φ)、切入深度(Dc)、切入长度计算值(Lc)、和切入点之间的距离(图56)。
带倒勾缝线的直拉拉伸强度和倒勾几何形状的确定值如表1所述。
表1
参数 | 设计A | 设计B |
拉伸强度(lb.) | 7.12±0.25 | 9.89±0.34 |
切入角,φ(°) | 152.3±0.8 | 162.2±2.2 |
切入深度,Dc(mm) | 0.25±0.01 | 0.12±0.02 |
切入长度,Lc(mm) | 0.54±0.02 | 0.38±0.04 |
切入点间的距离(mm) | 0.82±0.01 | 0.91±0.04 |
参见图57和58,在死猪末端空肠530上垂直于其长度方向切成全厚度的3cm切口。所述空肠段外圆周测量值为大约10cm,厚度为5mm。切制每个伤口538,使其位于4cm×15cm组织块的中心。利用移动“反复(over-and-over)”技术,用包括图57所示的两种设计A和B的带倒勾的缝线254、或者图58所示的对照PDS II(聚二酮)缝线540封闭伤口538,其中所有伤口尺寸为0。缝线绳在浆膜542和粘膜544中啮合,但是不穿透粘膜层。对照缝线的每一端用接头(捻5次(5throws))锚定,而带倒勾的缝线254用或者不用通过相邻组织的J形针脚啮合来终结。在所有缝线类型中,啮合尺寸(4mm)、啮合点之间的距离(5mm)、以及和切口交叉的次数相等。对伤口边缘进行切割,使得仅仅靠缝线将两半夹持在一起。在Test Resources UniversalTester,型号200Q(DDL,Eden Prairie,Minnesota)上测试每种缝线的10个缝好的组织试样,载荷为250lb,计量长度为5cm,十字头速度为5cm/秒。将每个试样拉伸至破坏,其中被撕扯穿过组织到达伤口处,两片组织被分离,记录下最大载荷。
表2示出了将猪肠子伤口分开所需的平均最大力:
表2
Sutures,size 0 | Tissue Holding Capacity (lb.) |
Barbed PDO,A with terminal J-Stitch | 7.64±1.39 |
Barbed PDO,A without terminal J-Stitch | 4.53±1.07 |
Barbed PDO,B with terminal J-Stitch | 8.40±1.83 |
Control PDS II | 6.61±2.02 |
和规格为0的吸收性缝线所需的US Pharmacopoeia最低接头拉伸强度(8.60lb)相比,带倒勾的PDO设计A的拉伸强度较差。但是,在猪肠子模型中,采用末端J形针脚的设计A和相同规格对照样相比,伤口夹持能力是有利的。而且,具有末端J形针脚的设计B不仅仅超过了US Pharmacopoeia的要求,而且有比常规缝线机械性能更好的优势。省略J形针脚的设计A的伤口夹持强度比具有J形针脚的设计A的夹持能力差。所述差异部分源于没有J形针脚的缝线在组织中的长度更短,但相信该差异大部分是由于省略了J形针脚构造。
尽管仅仅就一些示例性实施方案对本发明进行了详细描述和说明,但是本领域技术人员会理解,申请人并不试图将本发明限制在所示出的、所描述的实施方案,因为可以对所公开的实施方案施用各种修改、省略和添加,而实质上不会偏离本发明的新型教导和优点,尤其在基于前述教导的情况下。例如,具有一个或多个J形针脚的带倒勾的缝线和具有锚的单向缝线可以用于各种应用中,包括但不限于Nissen胃低折术、腹腔镜手术过程中稳定肠结构、阑尾切除术、Zenker憩室外科手术、膀胱造口术、固定替换性心脏瓣膜、将外来器械固定到组织上、以及关闭血管中的轴向伤口。相应地,申请人意在覆盖所有将包括在本发明精神和范围之内的这些修改、省略、添加和等同物。
Claims (12)
1.带倒勾的缝线,包括:
具有横截面的细长主体,其中所述横截面具有横向长度;
一个尖端;
近端,在细长主体内的多个交错切口提供了从主体外周延伸的多个交错倒勾,所述倒勾在所述缝线沿着尖端移动的方向移动穿过组织期间朝向缝线主体,并且所述倒勾通过咬合到组织内而防止所述缝线在穿过组织时沿着和尖端移动方向相反的方向发生移动;
具有环的近端,所述细长主体可以穿过所述环从而以锚的形式固定组织,其中所述锚在环上不包括倒勾,所述锚防止所述缝线沿着尖端移动的方向发生移动。
2.权利要求1的带倒勾的缝线,其中所述环是可折叠的。
3.权利要求1的带倒勾的缝线,其中所述环是由生物吸收性材料形成的。
4.权利要求1的带倒勾的缝线,其中所述环是由非吸收性材料形成的。
5.权利要求4的带倒勾的缝线,其中所述非吸收性材料是聚合物。
6.权利要求1的带倒勾的缝线,其中所述细长主体的横截面一般是圆形的。
7.权利要求1的带倒勾的缝线,其中所述细长主体具有非圆形横截面形状。
8.权利要求1的带倒勾的缝线,其中所述细长主体是柔性的,并且基本上没有弹性。
9.权利要求1的带倒勾的缝线,其中所述倒勾是以螺旋模式排列的。
10.权利要求9的带倒勾的缝线,其中螺旋模式中占据一个旋转的倒勾的数目不是整数。
11.权利要求1的带倒勾的缝线,其中所述倒勾沿着细长主体分三行排列,其中围绕着细长主体外周的各行彼此之间间隔120°。
12.权利要求1的带倒勾的缝线,其中所述横向长度是约100至500微米。
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