膝关节置换术患者不同缝合方式对伤口愈合影响的研究

Comparison of clinical effects of different suture methods in total knee arthroplasty surgery

目的比较不同缝合方式在膝关节置换手术的临床疗效。方法回顾性分析自2013年1月至2016年1月行膝关节置换手术98例老年膝骨关节炎患者,其中34例采用钛镍记忆合金吻合器皮内缝合,32例采用一次性皮肤缝合器缝合,32例采用爱惜康1号慕丝线缝合,分别对三种缝合方法在缝合时间、换药次数、缝线反应、锻炼及拆线时的疼痛程度、术后切口愈合情况等方面进行统计学分析。结果 A组缝合时间、换药次数、缝线反应率、锻炼及拆线时的疼痛(VAS)评分、拆线时间、"蜈蚣症"发生率、满意度分别为(11.5±1.5)min、(4.5±1.2)次、0%、(2.0±1.0)分、(1.5±1.0)分、(12.0±1.0)天、0%、97%,B组分别为(9.0±1.4)min、(5.0±1.0)次、22%、(4.0±1.5)分、(3.5±2.0)分、(13.0±2.0)天、19%、81%,C组分别为(11.4±1.8)min、(5.5±1.5)次、38%、(5.5±1.5)分、(4.5±2.5)分、(14.0±1.0)天、41%、72%,A组在缝线反应、锻炼及拆线时VAS评分、"蜈蚣症"发生率及满意度方面,明显优于B组、C组,差异均有统计学意义(P<0.05)。结论钛镍记忆合金吻合器具有操作简单,切口美观,愈合好,无色素沉着,无丝线引起的线头及缝线拉痕,不引起"蜈蚣症",患者满意度高,值得临床推广应用。

Objective To compare different suture methods in the clinical curative effects of total knee arthroplasty surgery. Methods Ninety-eight cases of elderly people with knee osteoarthritis were chosen as the research subjects who underwent total knee arthroplasty. Digital table method was used to randomize the patients into 3 groups. In 34 cases the incision was sutured with nickel titanium memory alloy stapling intradermal suture, in 32 cases the incision was sutured with the disposable skin stapler, and in another 32 cases the incision was sutured with Ethiconone silk, respectively. The suture time, switching frequency, taking out stitches suture reaction, exercise and the level of pain and healing of postoperative incision were recorded for statistical analysis. Results For Group A, the suture, exercise time, switching frequency, sutures reaction rate and removing the stitches out pain（ VAS） score, time, centipede disease incidence, and degree of satisfaction were respectively（ 11.5 ± 1.5） min,（ 4.5 ± 1.2） times, 0%,（ 2.0 ± 1.0）,（ 1.5 ± 1.0）,（ 12.0 ± 1.0） days, 0% and 97%; for group B the parameters were respectively（ 9.0 ± 1.4） min,（ 5.0 ± 1.0） times, 22%,（ 4.0 ± 1.5）,（ 3.5 ± 2.0）,（ 13.0 ± 2.0） days, 19%, and 81%; and for group C, the parameters were respectively（ 11.4 ± 1.8） min,（ 5.5 ± 1.5） times, 38%,（ 5.5 ± 1.5）,（ 4.5 ± 2.5）,（ 14.0 ± 1.0） days, 41% and 72%. Group A had significantly better results in exercise and the VAS score, centipede disease incidence and degree of satisfaction, when compared to group B and group C（ P 0.05）. Conclusions Nickel titanium memory alloy stapling is simple to operate, with good appearance of incision, good healing, no pigmentation, no silk thread or stitching, and no centipede-like disease. The patient satisfaction is high, so it is worth popularization and application in the clinical practice.