许宏;谢锦伟;雷一霆;曹国瑞;张少云;陈果;裴福兴;

• 1:四川大学华西医院骨科

摘要(Abstract)：

[目的]探讨免打结倒刺缝线在初次全膝关节置换术中应用的临床效果。[方法]利用计算机检索pubmed,web of science,EMBASE,Cochrane Library,中国期刊全文数据库(CNKI),维普中文科技期刊数据库(VIP)中关于免打结倒刺缝线在全膝关节置换术中的相关研究,同时手工检索相关文献,检索截止至2018年3月,提取数据,采用Rev Man 5.0软件进行Meta分析,根据分析结果得出结论。[结果]共纳入前瞻性临床随机对照研究6篇,Meta分析结果显示,与传统缝合相比,使用免打结倒刺缝线缝合不仅可以减少初次全膝关节置换术中切口的平均缝合时间(MD=-4.01,95%CI:-4.74~-3.29,P<0.001);而且可以减少术中针刺伤的发生率(RR=0.13,95%CI:0.02~0.71,P=0.02)。但两者术中缝线断裂的发生率(RR=0.57,95%CI:0.01~25.25,P=0.77)、术后伤口并发症的发生率(RR=0.64,95%CI:0.38~1.08,P=0.10),以及术后的膝关节协会评分(KSS)(MD=-1.63,95%CI:-3.42~0.14,P=0.07)差异均无统计学意义。[结论]在初次全膝关节置换术中,使用免打结倒刺缝线缝合在不增加术后伤口并发症发生率的情况下不仅可以减少切口的缝合时间,而且可以降低术中针刺伤的发生率。

关键词(KeyWords)： 全膝关节置换术;倒刺缝线;并发症;荟萃分析

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 许宏;谢锦伟;雷一霆;曹国瑞;张少云;陈果;裴福兴;

Email:

DOI:

参考文献(References)：

• [1]Alipour M,Tabariet M,Keramati M,et al.Effectiveness of oral tranexamic acid administration on blood loss after knee artroplasty:a randomized clinical trial[J].Transfus Apher Sci,2013,49(3):574-577.
• [2]Zhang P,Li JF,Wang X.Combined versus single application of tranexamic acid in total knee and hip arthroplasty:a meta-analysis of randomized controlled trials[J].Int J Surg,2017,43(2):171-180.
• [3]Ma J,Huang ZY,Shen B,et al.Blood management of staged bilateral total knee arthroplasty in a single hospitalization period[J].J Orthop Surg Res,2014,9(1):116.
• [4]Kurtz S,Ong K,Lau E,et al.Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030[J].J Bone Joint Surg Am,2007,89A(4):780-785.
• [5]Oleske DM,Bonafede MM,Jick S,et al.Electronic health databases for epidemiological research on joint replacements:considerations when making cross-national comparisons[J].Ann Epidemiol,2014,24(9):660-665.
• [6]张卓,周勇刚,林峰,等.可吸收倒刺缝合线在人工全膝关节置换术中应用的病例对照研究[J].中国骨伤,2016,29(9):809-813.
• [7]Patel RM,Cayo M,Patel A,et al.Wound complications in joint arthroplasty:comparing traditional and modern methods of skin closure[J].Orthopedics,2012,35(5):E641-E646.
• [8]Zhang W,Xue DT,Yin HF,et al.Barbed versus traditional sutures for wound closure in knee arthroplasty:a systematic review and meta-analysis[J].Sci Rep,2016,6(6):19764.
• [9]Trocchia AM,Aho HN,Sobol G.A re-exploration of the use of barbed sutures in flexor tendon repairs[J].Orthopedics,2009,32(10):250-252.
• [10]Schwarzkopf R,Hadley S,Weatherall JM,et al.Barbed sutures for arthroplasty closure--does it decrease the risk of glove perforation[J].Bulletin NYU,2012,70(4):250-253.
• [11]Gililland JM,Anderson LA,Baeney JK,et al.Barbed versus standard sutures for closure in total knee arthroplasty:a multicenter prospective randomized trial[J].J Arthroplasty,2014,29(9 Suppl):135-138.
• [12]Sah AP.Is there an advantage to knotless barbed suture in TKA wound closure?A randomized trial in simultaneous bilateral TKAs[J].Clin Orthop,2015,473(6):2019-2027.
• [13]Chan VWK,Chan PK,Chiu KY,et al.Does barbed suture lower cost and improve outcome in total knee arthroplasty?A randomized controlled trial[J].Arthroplasty,2017,32(5):1474-1477.
• [14]Malhotra R,Jain V,Kumar V,et al.Evaluation of running knotless barbed suture for capsular closure in primary total knee arthroplasty for osteoarthritis-a prospective randomized study[J].Int Orthop,2017,41(10):2061-2066.
• [15]Ting NT,Moric MM,Della Valle CJ,et al.Use of knotless suture for closure of total hip and knee arthroplasties:a prospective,randomized clinical trial[J].J Arthroplasty,2012,27(10):1783-1788.
• [16]赵光辉,马建兵,王志远,等.倒刺缝线在初次全膝关节置换术中的随机对照研究[J].实用骨科杂志,2017,23(9):827-829.
• [17]赵恒,殷庆丰,刘文广,等.新型倒刺缝线在髋膝关节置换深层组织缝合中的应用[J].山东大学学报(医学版),2015,53(8):53-56.
• [18]Ingle NP,King MW.Optimizing the tissue anchoring performance of barbed sutures in skin and tendon tissues[J].J Biomech,2010,43(2):302-309.
• [19]Cortez R,Lazcano E,Miller T,et al.Barbed sutures and wound complications in plastic surgery:an analysis of outcomes[J].Aesthetic Surg J,2015,35(2):178-188.
• [20]Rosen AD.Use of in absorbable running barbed suture and progressive tension technique in abdominoplasty:a novel approach[J].Plastic Reconstr Surg,2010,125(3):1024-1027.
• [21]Meyer R,Sivan E,Sharon N,et al.Infectious morbidity following cesarean deliveries:a comparison of barbed to standard suture for myometrial closure[J].Am J Obstetrics Gynecol,2018,218(1):S335-S336.
• [22]Borzio RW,Pivec R,Kapadia BH,et al.What is the evidence?A meta-analysis[J].Int Orthop,2016,40(2):225-231.
• [23]van Kasteren MEE,Mannien J,Ott A,et al.Antibiotic prophylaxis and the risk of surgical site infections following total hip arthroplasty:timely administration is the most important factor[J].Clin Infectious Dis,2007,44(7):921-927.
• [24]Gililland JM,Anderson LA,Sun G,et al.Perioperative closure-related complication rates and cost analysis of barbed Suture for closure in TKA[J].Clin Orthop,2012,470(1):125-129.
• [25]Zaruby J,Gingras K,Taylor J,et al.An in vivo comparison of barbed suture devices and conventional monofilament sutures for cosmetic skin closure:biomechanical wound strength and histology[J].Aesthetic Surg J,2011,31(2):232-240.
• [26]Mujeeb SA,Khatri Y,Khanani R.Frequency of parenteral exposure and seroprevalence of HBV,HCV,and HIV among operation room personnel[J].J Hospital Infection,1998,38(2):133-137.
• [27]Nett M,Avelar R,Sheehan M,et al.Water-tight knee arthrotomy closure:comparison of a novel single bidirectional barbed self-retaining running suture versus conventional interrupted sutures[J].J Knee Surg,2011,24(1):55-59.