WO2001052751A1 - Suture for operation with rings - Google Patents

Suture for operation with rings Download PDF

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Publication number
WO2001052751A1
WO2001052751A1 PCT/JP2001/000274 JP0100274W WO0152751A1 WO 2001052751 A1 WO2001052751 A1 WO 2001052751A1 JP 0100274 W JP0100274 W JP 0100274W WO 0152751 A1 WO0152751 A1 WO 0152751A1
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Prior art keywords
needle
thread
surgical suture
suture
pin
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Application number
PCT/JP2001/000274
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French (fr)
Japanese (ja)
Inventor
Tomoaki Koseki
Original Assignee
Matsuda Medical Co.,Ltd
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Publication date
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Publication of WO2001052751A1 publication Critical patent/WO2001052751A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0487—Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06066—Needles, e.g. needle tip configurations
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06166—Sutures
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
    • A61B2017/0461—Means for attaching and blocking the suture in the suture anchor with features cooperating with special features on the suture, e.g. protrusions on the suture
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0464—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors for soft tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06004—Means for attaching suture to needle
    • A61B2017/06042—Means for attaching suture to needle located close to needle tip
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B2017/06057—Double-armed sutures, i.e. sutures having a needle attached to each end
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06166—Sutures
    • A61B2017/06176—Sutures with protrusions, e.g. barbs

Definitions

  • the present invention relates to the improvement of sutures used during surgery ,.
  • the surgeon can perform normal suture knots without difficulty, but if the operation is deep or small incision, the surgeon can tie the knot as desired. It is difficult to slide down.
  • the present invention provides one or more loops in the middle or at the end of the surgical suture.
  • the thread is straightened due to tension and does not damage the passing tissue.
  • it can be easily tightened using the hole of the ring.
  • the structure has a sharp tip and a depression (1) in the middle.
  • the thread can be passed through a loop of yarn, solidified by crimping or welding, and remote operation is possible by using a pin (4) as a substitute for a knot.
  • the operation is simple and quick if multiple pins with one pin are mounted in advance.
  • FIG. 1 illustrates a surgical suture according to claim 1.
  • a knitting machine such as torsion, knit straight lines and loops continuously at regular intervals. There is no difference in strength from the case of knitting only with a straight line because the knitting is performed with the same number of threads.
  • the mesh In order to smooth the passage of tissue during suturing, the mesh should be set so that when the ends are pulled and strained, the loop is almost as flat as the straight part.
  • the material is silk, polyester, polyg, which is often used in blade type (braid). Licolic acid (absorptive) is suitable,
  • FIG. 2 shows a surgical suture needle connected to both ends according to claim 2 :
  • Surgical suture needles are often curved, and the body has a round or triangular cross section. There is a hole in the rear end, and after inserting the thread, crimp the periphery. In cardiovascular surgery, a thread with needles at both ends is often used.
  • FIG. 3 shows an example of performing sternum (3) suturing using the hook according to the third aspect.
  • the sternum is a strip of bone that bundles the ribs in the anterior chest.
  • the center is divided vertically (median sternotomy) and the operation is performed.
  • a hook is inserted from above into the sternum (3), which is divided into left and right sides, and a ring is hung up in the depression (1) at the tip and pulled up.
  • the grip may be plastic, but the tip needle is preferably SUS304 stainless steel, which is hard to crack and has hardness.
  • the hemisphere-shaped stump (2) can be easily rotated when penetrating the sternum by rotating it.
  • FIG. 4 shows an example in which a pin (4) used as a substitute for a knot is solidified by welding according to claims 4 and 5.
  • the pin may be solidified and fixed at any position. However, if the pin is attached to the rear end of the thread in advance, the operation is simple and a stronger fastening strength is secured.
  • the shape of the pre-installed pins is such that one end protrudes while the ring is sandwiched between them. As shown in the figure, every other pin is mounted at an appropriate position at the rear end of the thread. C In this case, the mounted pins are fixed so that they are alternately turned upside down. After the needle has passed through the tissue, pass the needle through the hole just before the pin closest to the needle (first pin).
  • the present invention is embodied in the form described above and has the following effects.
  • the sternum suture allows the use of sutures, does not cause any image disturbances in the postoperative magnetic resonance diagnostic apparatus, and allows for a quick reopening surgery. Thick knots can be easily performed in other operations. In valve replacement surgery and the like, the operation time is reduced.
  • FIG. 1 is an external view of a surgical suture having a loop.
  • Figure 2 is an external view of a looped surgical suture with needles at both ends:
  • FIG. 3 is a cross-sectional view of a sternum suture using a hook for lifting a surgical suture having a loop.
  • Fig. 4 is an external view of a surgical suture having a loop with a pin attached in advance to perform tissue suturing.
  • Figure 5 is an external view of the applier. Explanation of reference numerals

Abstract

A suture for operation with rings, wherein rings are provided in the middle of or at the end of a suture, pins are passed through the rings, and the pins are crimped or soldered for fixing so as to use the pins as substitutes for knots, whereby the knots can be formed easily when a seamed portion is deep or a small open-cut operation is performed.

Description

明 細 書 輪をもつ手術用縫合糸 技術分野  Surgical sutures with a written ring
本発明は、 外科手術時に用いる縫合糸の改良に関する,:. 従来の技術  The present invention relates to the improvement of sutures used during surgery ,.
手術用縫合糸はナイロン、 ボリフ口ビ レン、 ポリディォクサノン等のモノフイラ メント （単繊維） のタイブとシルク、 ポリエステル、 ボリグリコール酸等のブレ一 ド （編組） タイプとに大別される。 各々に体内で溶ける吸収性、 溶けずに抗張力を 持続する非吸収性のタイプがある。 最近では糸の片端或いは両端に予め針が接続さ れている針付き糸が多く用いられる。 これらの手術用縫合糸は外科結び等の結節方 法により締結される。 発明が解決しようとする課題  Surgical sutures are broadly classified into monofilament tie types such as nylon, boliffe beren, and polydioxanone, and braided types such as silk, polyester, and polyglycolic acid. . There are non-absorptive types that absorb in the body and maintain tensile strength without melting. Recently, needle-attached yarns in which needles are previously connected to one or both ends of the yarn are often used. These surgical sutures are fastened by a knotting method such as a surgical knot. Problems to be solved by the invention
表層部に近くあるいは切開創が大きい場合、 術者は苦労なく通常の縫合結節を行 うことができるが、 深部であったり小切開の手術である場合、 術者は結び目を思う ように締結部位まで滑り下ろすことが困難である。  If the incision is close to the superficial part or the incision is large, the surgeon can perform normal suture knots without difficulty, but if the operation is deep or small incision, the surgeon can tie the knot as desired. It is difficult to slide down.
胸骨 （3 ) 縫合は通常金属ワイヤ一で締結することが一般的であるが、 糸により 縫合すると術後の磁気共鳴診断装置での画像の乱れがない等のメリットが得られる 力';、 強い抗張力を求められるので太い糸を使わざるを得ない。 糸はその形状の特性 から、 太ければ太いほど結びにくくほどけやすい。  Sternum (3) Normally, sutures are usually fastened with a single metal wire. However, suturing with a thread provides advantages such as no disturbance of the image on the post-operative magnetic resonance diagnostic device. You have to use a thick thread because it requires tensile strength. Due to the shape of the yarn, the thicker the yarn, the harder it is to tie and easier to unravel.
弁置換手術等では弁輪及び人工弁周囲を縫合する際、 糸表面の平滑性が要求され る。 糸表面が滑るということは、 同時に結び目がほどけやすいという欠点を合わせ 持つ。 結節回数 （結び目の数） を 5回から 6回行レ、これを補うが、 通常弁置換術で は 16本から 20本糸を使用する。即ち一個の弁を交換するのに術者は 80回から 120 回の結節を行っているのである。 In valve replacement surgery and the like, when suturing around an annulus and a prosthetic valve, the yarn surface must be smooth. The slippage of the yarn surface also has the disadvantage that the knot is easy to unwind. The number of knots (number of knots) is increased 5 to 6 times to make up for this. Use 16 to 20 yarns. That is, the surgeon performs 80 to 120 nodules to change one valve.
内視鏡下での手術が近年著しい増加傾向にあるが、 細いポートを通じて器具によ り行う縫合結節は術者にとって大変ス ト レスのかかる作業である。 特に組織を通過 させた糸を正確に結び合わせるには熟練を要し、 内視鏡下での手術時間を長引かせ る大きな原因となっている。 課題を解決するための手段  Endoscopic surgery has been increasing significantly in recent years, but suturing with instruments through narrow ports is a very stressful operation for the surgeon. In particular, it requires skill to accurately tie the thread that has passed through the tissue, which is a major cause of prolonging the operation time under an endoscope. Means for solving the problem
上記の問題点を解決するために、 本発明は手術用縫合糸の途中又は糸末端に一個 あるいは複数の輪を設けた。 端部に付けられた針が組織を通過する際は緊張により 糸が直線状となり通過組織に損傷を与えな L、。 結節時には輪の穴を利用し簡便に締 結できる。  In order to solve the above problems, the present invention provides one or more loops in the middle or at the end of the surgical suture. When the needle attached to the end passes through the tissue, the thread is straightened due to tension and does not damage the passing tissue. At the time of knotting, it can be easily tightened using the hole of the ring.
針を付けない場合、 組織あるいは骨に貫通させた後先端に輪を引っ掛けて引き出 してくるフックを利用する。 先端が鋭利になっており途中に窪み （1 ) を有してい る構造を持つ。  If a needle is not attached, use a hook that is pulled out by hooking a loop on the tip after penetrating tissue or bone. The structure has a sharp tip and a depression (1) in the middle.
糸の輪に通し、 圧着又は溶着により固形化し、 結び目の代用となるピン （4 ) を 用いると遠隔操作が可能になる。 ピンが一個ある L、は複数個予め装着してあると操 作が簡便で早い。 発明の実施の形態  The thread can be passed through a loop of yarn, solidified by crimping or welding, and remote operation is possible by using a pin (4) as a substitute for a knot. The operation is simple and quick if multiple pins with one pin are mounted in advance. Embodiment of the Invention
以下、 本発明の実施の形態を図面に基づいて説明する。  Hereinafter, embodiments of the present invention will be described with reference to the drawings.
図 1は請求項 1に係る手術用縫合糸を例示している。 トーシヨン等の編み機を用い て直線、 輪を一定間隔で連続して編み上げる。 同じ糸数で編むので直線のみに編ん だ場合と強度に差はない。 縫合時の組織通過を平滑にするため、 両端を引き緊張を 掛けた時、 輪の部分は直線部分とほぼ同等に扁平になるよう網目を設定する。 素材 はブレードタイプ （編組） において多用されているシルク、 ポリエステル、 ポリグ リコール酸 （吸収性） 等が適している,： FIG. 1 illustrates a surgical suture according to claim 1. Using a knitting machine such as torsion, knit straight lines and loops continuously at regular intervals. There is no difference in strength from the case of knitting only with a straight line because the knitting is performed with the same number of threads. In order to smooth the passage of tissue during suturing, the mesh should be set so that when the ends are pulled and strained, the loop is almost as flat as the straight part. The material is silk, polyester, polyg, which is often used in blade type (braid). Licolic acid (absorptive) is suitable,
図 2は請求項 2に係る両端に手術用縫合針を接続したものを示している : 手術用 縫合針は湾曲したものが多く、 胴部の断面は丸か三角の形状である。 後端部に穴が 明いており、 糸を揷入した後周囲を圧着する。 心臓血管外科では糸の両端に針が付 いたものが多用される。 FIG. 2 shows a surgical suture needle connected to both ends according to claim 2 : Surgical suture needles are often curved, and the body has a round or triangular cross section. There is a hole in the rear end, and after inserting the thread, crimp the periphery. In cardiovascular surgery, a thread with needles at both ends is often used.
図 3は請求項 3に係るフックを用いて胸骨 （3 ) 縫合を行う際の例示である。 胸 骨は肋骨を前胸部で束ねる帯状の骨で胸部手術の際、 中央を縦割り （胸骨正中切開） にしてオペを行い、 通常は切開創を金属製ワイヤ一で締結する:， 図 3上では左右に 分かれた胸骨 （3 ) にフックを上から刺入し、 先端の窪み （ 1 ) に輪を掛けて引き 上げている。 グリップはプラスチックでもよいが、 先端針は鲭びにくく硬度がある SUS304ステンレスがよい。 手元側半球型の断端 （2 ) は回転式にしておくと胸骨 に刺入する際、 容易に貫通する。  FIG. 3 shows an example of performing sternum (3) suturing using the hook according to the third aspect. The sternum is a strip of bone that bundles the ribs in the anterior chest. During thoracic surgery, the center is divided vertically (median sternotomy) and the operation is performed. Then, a hook is inserted from above into the sternum (3), which is divided into left and right sides, and a ring is hung up in the depression (1) at the tip and pulled up. The grip may be plastic, but the tip needle is preferably SUS304 stainless steel, which is hard to crack and has hardness. The hemisphere-shaped stump (2) can be easily rotated when penetrating the sternum by rotating it.
図 4は請求項 4、及び 5に係る溶着により固形化し、結び目の代用となるピン（ 4 ) を使用した例である。 組織を通過させた後、 任意の位置でピンを固形化し固定して もいいが、 予め糸後端に装着されていると操作が簡便でより強い締結強度が確保さ れる。 予め装着されているピンの形状は輪を挟み込んだ状態のどちらか一端が突起 している構造がよレ、。図のように糸後端の適当な位置に一つおきにピンを装着する c, この場合装着されたピンは順番に上下が互い違いになるよう固定する。 針が組織を 通過した後、 最も針に近いピン （第一番目のピン） のひとつ手前の穴に針を通す。 この時必ず、 通した後出てきた輪が第一番目のピンの突起側に出るように通す。 充 分に組織を締め付けるように針側の糸を引いた後、 適当な輪に第一番目のピンを通 す。 次に図 5に示すようなアプライャ一でピンを溶着する。 結節強度不足が予想さ れる時は次の穴に糸を通し、 同じ要領で繰り返し溶着する。 ピンの材質は非吸収性 の場合ナイ口ン、ボリエステル、ボリアコピレン、吸収性の場合ポリグリコール酸、 ポリ乳酸等を固形化したものを用いる。 溶着は熱より超音波による方が素材の変形 が安定している。 両端針の場合は糸中央に同じ要領でピンを装着しておく。 発明の効果 FIG. 4 shows an example in which a pin (4) used as a substitute for a knot is solidified by welding according to claims 4 and 5. After passing through the tissue, the pin may be solidified and fixed at any position. However, if the pin is attached to the rear end of the thread in advance, the operation is simple and a stronger fastening strength is secured. The shape of the pre-installed pins is such that one end protrudes while the ring is sandwiched between them. As shown in the figure, every other pin is mounted at an appropriate position at the rear end of the thread. C In this case, the mounted pins are fixed so that they are alternately turned upside down. After the needle has passed through the tissue, pass the needle through the hole just before the pin closest to the needle (first pin). At this time, make sure that the ring that comes out after passing through the first pin protrudes from the projection side. After pulling the thread on the needle side to fully tighten the tissue, thread the first pin through the appropriate loop. Next, the pins are welded by an applier as shown in FIG. If insufficient knot strength is expected, thread the thread through the next hole and repeat welding in the same manner. For the material of the pin, use non-absorbent solidified material such as nylon, polyester, and boriacopyrene; and for absorbing, use solidified polyglycolic acid or polylactic acid. In welding, the deformation of the material is more stable with ultrasonic waves than with heat. In the case of a double-ended needle, a pin is attached to the center of the thread in the same manner. The invention's effect
本発明は以上説明したような形態で実施され以下に記載されるような効果を奏す る。  The present invention is embodied in the form described above and has the following effects.
縫合結節部位が深部であったり小切開の手術である場合、 術者は遠隔操作により 確実な結節を行うことができる。  When the suture knot is deep or small incision surgery, the surgeon can remotely perform a reliable knot.
胸骨縫合は糸の使用が可能となり、 術後の磁気共鳴診断装置での画像の乱れが発 生せず、 再開胸手術も手早く行える。 他の手術でも太い糸の結節が簡単に行える。 弁置換手術等では手術時間が短縮される。  The sternum suture allows the use of sutures, does not cause any image disturbances in the postoperative magnetic resonance diagnostic apparatus, and allows for a quick reopening surgery. Thick knots can be easily performed in other operations. In valve replacement surgery and the like, the operation time is reduced.
内視鏡下での手術では細レ、ボートを通じての縫合結節作業を簡便に行うことが可 能となる。 手術時間を大幅に短縮できる。 図面の簡単な説明  In the operation under the endoscope, it becomes possible to easily perform the suture knotting work through a fine and boat. The operation time can be significantly reduced. BRIEF DESCRIPTION OF THE FIGURES
図 1は、 輪をもつ手術用縫合糸の外観図である。  FIG. 1 is an external view of a surgical suture having a loop.
図 2は、 輪をもつ手術用縫合糸の両端に針を付けた外観図である：  Figure 2 is an external view of a looped surgical suture with needles at both ends:
図 3は、 輪をもつ手術用縫合糸を引き上げるフックを使った胸骨縫合の断面図で ある。  FIG. 3 is a cross-sectional view of a sternum suture using a hook for lifting a surgical suture having a loop.
図 4は、 輪をもつ手術用縫合糸にピンを予め装着し、 組織縫合を行っている外観 図である。  Fig. 4 is an external view of a surgical suture having a loop with a pin attached in advance to perform tissue suturing.
図 5は、 アプライヤーの外観図である。 符号の説明  Figure 5 is an external view of the applier. Explanation of reference numerals
1 フック先端の窪み  1 Hook tip recess
2 半球型の断端  2 Hemispheric stump
3 胸骨  3 sternum

Claims

青 求 の 範 囲 請求項 1. 糸途中又は糸末端に一個あるいは複数の輪をもち、 縫合時には緊張によ り糸が直線状となり、 結節時には輪の穴を利用し締結しゃすく した手術用縫合糸。 請求項 2. 片端あるいは両端に直針、 湾曲針等の手術用縫合針を接続した請求項 1 記載の手術用縫合糸。  Blue claim Claim 1. One or more loops in the middle or at the end of the thread. At the time of suturing, the thread is straightened by tension, and at the time of knotting, the surgical suture is fastened using the hole of the loop. yarn. Claim 2. The surgical suture according to claim 1, wherein a surgical needle such as a straight needle or a curved needle is connected to one or both ends.
請求項 3. 先端が鋭針となっており途中に窪み （1) を有し、 手元側の断端 （2) は回転式で、 組織を貫通させた後請求項 1記載の手術用縫合糸の輪を窪みに引っ掛 けて引き出してくるフック。 Claim 3. The surgical suture according to claim 1, wherein the distal end is a sharp needle and has a recess (1) in the middle, and the stump (2) on the proximal side is of a rotary type and after penetrating the tissue. A hook that hooks the ring into the dent and pulls it out.
請求項 4.請求項 1記載の手術用縫合糸の輪に通し、圧着又は溶着により固形化し、 結び目の代用となるピン （4)。 A pin (4) which passes through the loop of the surgical suture according to claim 1, solidifies by crimping or welding, and serves as a knot.
請求項 5. 請求項 4記載のピン （4) を一個あるいは複数個予め装着している請求 項 1又は 2記載の手術用縫合糸。 Claim 5. The surgical suture according to claim 1 or 2, wherein one or more pins (4) according to claim 4 are mounted in advance.
PCT/JP2001/000274 2000-01-18 2001-01-17 Suture for operation with rings WO2001052751A1 (en)

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