~Teachingcenter的醫學筆記~

外科手綁線-雙手綁線
Two Hand Square Knot – Two Hand Tie

以下內容翻譯自
http://www.bumc.bu.edu/surgery/training/technical-training/two-hand-tie/

一、在初始的階段，右手握著繩子的短端，然後左手拇指將長端往內勾往
(1) This shows the beginning of knot construction.
Note that the short end is in the right hand, and the thumb of the left hand is beginning to create a loop by pushing the long strand to the right.

二、右手的短端繞到左手拇指之上形成繩圈，左手拇指與食指形成一個環
(2) The right hand has brought the short end toward the surgeon and across the left hand strand to form a loop. The left thumb protrudes through the loop.
Note that the left index finger contacts the thumb, so the thumb can guide the index finger down through the loop.

三、左手食指沿著拇指轉到繩圈之下
(3) The left index finger has been rotated down into the loop.

四、右手將短端置於左手的拇指和食指之間
(4) The short strand is now placed between the thumb and index finger in order to transport the short end up through the loop.

五、左手拇指向上推，將短端穿過繩圈
(5) The left hand is now rotated counterclockwise to bring the thumb back up through the loop, pushing the short end up with it.

六、將短端交還給右手
(6) The short end has now emerged completely through the loop and will be re-grasped with the right hand in order to tighten the “throw” that has been created.

七、右手將短端拉向自己，左手將長端拉往另一個方向
(7) The surgeon begins to tighten the throw by pushing the long strand away and pulling the short strand toward himself.

八、將結綁到定位綁到底
(8) The throw is now snugged down.
Note that tension is applied by pulling the two strands in opposite directions at an angle of 180 degrees.

九、左手食指向下繞在長端形成一個圈
(9) The left index finger now begins to form the loop for the next throw by sliding beneath the long strand and pushing it to the right.

十、左手向右手靠攏，右手將短端拉到左手虎口區
(10) The short strand is now brought to the left and beneath the long strand to form the new loop.

十一、左手拇指將長端往外勾，然後和食指形成一個圈
(11) The left thumb contacts the index finger and begins to rotate up into the loop.

十二、右手將短端送至左手食指和拇指中間
(12) The left thumb has now emerged from the loop, and the short strand will be pinched between the thumb and index finger of the left hand.

十三、左手食指拇指向下轉，將短端穿過繩圈
(13) The right hand releases the short end, and the left hand is now rotated in the opposite direction to drive the short end through the loop toward the surgeon.

十四、右手接回短端
(14) The short end is re-grasped by the right hand and pulled away from the surgeon, and the long strand is pulled toward the surgeon.

十五、左手將長端拉向自己，然後右手拉往另一個方向
(15) Equal tension is applied to both strands as they are pulled in opposite directions to secure a flat square knot.

十六、為了確保繩結的穩定，需要至少第三個結，故重複步驟一到八
(16) To secure the knot, a third throw will be added, using the same technique for the first throw.

十七、此與步驟二至四相同
(17) After creating the loop, the left index finger is rotated clockwise into the loop, and the short end is placed between the thumb and index finger of the left hand.

十八、此與步驟五和六相同
(18) The left hand is rotated back in a counterclockwise direction to pass the short end through the loop.

十九，此與步驟七和八相同
(19) Finally, the short end has been re-grasped with the right hand and pulled toward the surgeon as the left hand pushes the long strand away to secure the third throw.

若線的材質為多股交纏(如絲線)，一般三個結就可以穩固。
Multifilament or braided materials such as silk can usually be secured with just three throws.

三個不同方向的結交錯施行，有時為了避免在交錯的時候讓結跑位，會在其中一個結(一般來說是第一個結)讓食指和拇指來回兩次(重複步驟二到六)，在拉到底後形成雙結
The throws are alternated to create successive square knots, so with three alternating throws, one essentially creates a double square knot.

摩擦力比較不足的單股材質(如尼龍線或聚丙烯線)，可能會需要五到六個交錯的結來避免鬆脫
Slippery monofilament suture material, such as nylon or prolene, requires 5 or 6 alternating throws because it has a tendency to slip and untie itself.

也可以參考以下影片：