人工全髋关节置换术中应用组织胶水与传统缝合法的比较研究

COMPARISON OF HISTOACRYL TOPICAL SKIN ADHESIVE AND TRADITIONAL METHOD FOR WOUND CLOSURE IN TOTAL HIP ARTHROPLASTY

目的通过与传统缝合法比较，探讨组织胶水用于人工全髋关节置换术（total hip arthroplasty，THA）的可行性及疗效。方法将2015年1月-10月收治并符合选择标准的159例初次THA患者纳入研究，其中80例（100髋）术中采用可吸收缝合线及组织胶水闭合切口（试验组）；79例（100髋）采用传统皮钉闭合切口（对照组）。两组患者性别、年龄、体质量指数、病因等一般资料比较，差异均无统计学意义（P〉0．05）。记录并比较两组手术时间、住院时间，术后15d行切口疼痛视觉模拟评分（VAS）、切口愈合评分、切口愈合分级及切口满意度评价。结果两组患者均获随访，随访时间3～6个月，平均4-7个月。试验组手术时间与对照组相比，差异无统计学意义（z=-0．527，P=O．598）；但住院时间较对照组缩短（z=-2．004，P=0．045）。术后试验组1例（1髋）发生切口渗出，1例（1髋）切口裂开；对照组2例（2髋）发生切口周围红肿，2例（2髋）切口持续渗出，4例（4髋）引流口加压包扎后仍有渗液，1例（1髋）误缝引流管。术后15d两组VAS评分比较差异无统计学意义（Z=-0．125，p=0．901）；但试验组切口愈合评分显著高于对照组（z=-2．943，P=O．003）。试验组切口甲级愈合98髋、乙级愈合2髋，对照组分别为92髋、8髋，比较差异有统计学意义（X2=3．789，P=0．048）。试验组切口满意度评分显著高于对照组（z=-2．626，P=0．009）。结论与传统缝合法相比，初次THA术中应用组织胶水闭合切口，术后切口并发症发生率低，且操作简便、安全，患者满意度高。

Objective To compare the effectiveness between histoacryl topical skin adhesive and traditional method for wound closure in total hip arthroplasty （THA）. Methods A total of 159 patients undergoing THA were divided into 2 groups between January and October in 2015. Subcuticular suture and histoacryl topical skin adhesive （cyanoacrylate adhesive） were used in 80 patients （100 hips） （test group）, and traditional method （skin staples and wound drainage） was used in 79 patients （100 hips） （control group） for wound closure. There was no significant difference （P〉0.05） in gender, age, body mass index, and etiology between 2 groups. The operation time, length of stay, incision pain visual analogue scale （VAS） score and healing of incision, and incision satisfaction evaluation, and classification were compared between 2 groups. Results All patients were followed up 3-6 months （mean. 4.7 months）. There was no significant difference in operation time between 2 groups （Z= -0.527, P=0.598）; but the length of stay of test group was less than that of control group （Z= -2.004, P=0.045）. Incision exudation and dehiscence occurred in 1 case （1 hip） and 1 case （1 hip） of test group respectively; incision swollen, persistent wound exudation, exudation, and sutured drainage tube occurred in 2 cases （2 hips）, 2 cases （2 hips）, 4 cases （4 hips）, and 1 case （1 hip） of control group. No statistically significant difference was found in VAS score between 2 groups at 15 days after operation （Z= -0.125, P=0.901）, but wound healing score of test group was significantly higher than that of control group （Z= -2.943, P=0.003）. Wound healing was class A in 98 hips and class B in 2 hips in test group, and was class A in 92 hips and class B in 8 hips in control group, and difference was statistically significant （X2=3.789, P=0.048）. The incision satisfaction of test group was significantly higher than that of control group （Z= -2.626, P=0.009）. Conclusion Compared with traditional method, histoacryl topical skin adhesive has decreased wound complication rate, and it is an easy and safe method with high satisfaction.