初次关节置换术双向倒刺缝线关闭切口的临床对照研究

A controlled clinical study of the application of bidirectional barbed suture in the primary arthroplasty

目的回顾初次关节置换术使用双向倒刺缝线的临床结果，并与可吸收缝线对比，观察二者之间的差异。方法回顾分析2013年1月～2014年8月初次关节置换术患者839例，其中初次全髋关节置换术428例，初次全膝关节置换术411例，手术过程顺利，489例采用双向倒刺缝线，350例采用可吸收缝线。髋关节组内和膝关节组内又根据缝线类型分为倒刺线组和可吸收线组。分析各组在性别、年龄、体质量指数（BMI）的差异，并比较各组患者在缝合时间、住院天数和渗出、感染、水疱等切口并发症的差异。结果年龄、性别、BMI的组间差异没有统计学意义。在髋关节置换术中，双向倒刺缝线组的并发症发生率（10．98％）显著高于可吸收缝线组（2．89％，P=0．002），其中皮缘水疱发生率（3．92％）与可吸收缝线组（0．00％）比较，差异有统计学意义（P=0．007）。在膝关节置换术中，倒刺线组并发症发生率（14．53％）显著高于可吸收缝线组（5．08％，P=0．002），其中切口渗出发生率（6．84％）显著高于可吸收缝线组（1．13％，P=0．005）。双向倒刺缝线组在膝关节和髋关节置换术中，并发症发生率没有统计学差异（P=0．149）。对于髋关节置换术，倒刺线组手术时间（62．62±7．85）min与可吸收缝线组（68．03±6．93）min相比，显著缩短（P〈0．001）；对于膝关节置换术，双向倒刺缝线组的手术时间（74．65±7．14）rain与可吸收缝线组（80．62±7．55）min相比，显著缩短（P〈0．01）。结论双向倒刺缝线使用方便，可显著缩短手术时间，但可能有较高的切口并发症发生率，包括渗出、皮缘水疱等。因此，需要严格按照缝线的使用说明，熟练掌握其缝合技术，并根据伤口适应证合理运用，以取得最好疗效。

Objective The present study aims to examine the different clinical characteristics in intraoperative usage and postoperative wound healing between the bidirectional barbed suture and the absorable suture used in the primary arthroplasty. Methods The present study reviewed 839 required clinical cases of patients from January 2013 to August 2014,who were well operated on through total hip arthroplasty （THA） （n = 428） or total knee arthroplasty （TKA） （n = 411）.The incision was sutured with the bidirectional barbed suture （n = 489） or the absorable suture （n = 350）. Based on the surgical site,the patients were divided into two groups： THA group and TKA group. The patients were further divided into two types for each group, the bidirectional barbed suture and the absorable suture. The differences in gender, age,body mass index （BMI） were statistically analyzed. The suture time, effusion,infection and vesicle were respectively recorded and compared to evaluate the clinical results. Results There were no significantly statistical differences in age, gender, BMI ,length of stay. In the group of THA, the complication percentage of the bidirectional barded suture （10.98%） was significantly higher than that of the absorable suture （2.89%） （P = 0.002）. There were ten vesicles in the bidirectional barded suture type, and none in the absorable suture type. In the group of TKA, the complication incidence rate of the bidirectional barbed suture （14.53%） was significantly higher than that of the absorable suture （5.08%）（P = 0.002）, Moreover,the incidence rate of incision effusion was higher in the bidirectional barbed suture group （6.84%） than in the absorable suture group（1.13%）, indicating significant difference（P = 0.005）. However, there was no significantly statistical difference between TKA and THA in the bidirectional barded suture group. Concerning the operation time it took,in the THA group, the bidirectional barbed suture time （62.62 ± 7.85 minutes）was significantly shorter than that of the absorable suture （68.03 ± 6.93 minutes） （P 〈 0.001 ）. Similarly,in the TKA group, the bidirectional barbed suture took （74.65 ±7.14 minutes）, which was significantly shorter than that of the absorable suture （80.62 ± 7.55 minutes） （P 〈 0.001）. Conclusion The complication incidence rate of the bidirectional barbed suture is potentially higher than that of the absorable suture, including effusion, infection, vesicle, etc. However, this suture is more convenient and significantly efficient in the joint arthroplasty. Therefore, the bidirectional barbed suture should be reasonably applied based on the specific situations, so as to achieve the most effective result.