可吸收线结合皮肤吻合器在颅骨修补术头皮切口缝合中的应用

Application of absorbable line combined with skin stapler for scalp incision suture in cranioplasty

目的探讨可吸收线结合皮肤吻合器在颅骨修补手术头皮缝合中的应用价值。方法回顾性分析2015年1月至2018年4月在中国人民解放军第251医院神经外科住院行颅骨修补手术的66例患者的临床资料,按术中头皮缝合方法分组,其中采用可吸收线皮下连续缝合+皮肤吻合器缝合切口的36例作为可吸收线缝合组,采用传统的丝线分层间断缝合切口的30例作为传统缝合组,比较两组患者的切口缝合时间、术后切口甲级愈合率、线结排异反应或皮缘坏死等指标的差异。结果可吸收线缝合组患者的缝合时间为(18.36±2.50)min;甲级愈合35例,乙级愈合1例,发生线结排异反应1例;传统缝合组患者的缝合时间为(25.46±2.12)min;甲级愈合25例,乙级愈合5例,发生线结排异反应或皮缘坏死16例,颅骨修补材料外露3例。两组患者的切口缝合时间和线结排异反应发生率比较差异均有统计学意义(P<0.05),而手术切口甲级愈合比较差异无统计学意义(P>0.05)。结论可吸收线皮下连续缝合结合皮肤吻合器用于颅骨修补术中头皮切口缝合,可以减少缝合时间,避免线结排异反应、皮缘坏死、减少术后头皮感染。

Objective To explore the application value of absorbable line combined with skin stapler for scalp suture in cranioplasty. Methods A retrospective analysis of the clinical data was performed for 66 patients who underwent cranioplasty in the Department of Neurosurgery in the 251 thHospital of PLA from January 2015 to April 2018. According to the methods of incision suture, the patients were divided into two groups： 36 patients were selected as the absorbable suture group who were treated with subcuticular continuous suture closure using absorbable line and skin stapler; and 30 patients were enrolled as the traditional suture group who were treated with interrupted layered suture closure using traditional threads（non-absorbable sutures）. The differences in incision-suture time, grade A postoperative wound healing rate, suture knot rejection or skin edge necrosis were compared between the two groups. Results In the absorbable suture group, the suture time of patients was（18.36±2.50） minutes; there were 35 cases of grade A healing, 1 case of grade B healing, and 1 case of suture knot rejection. In the traditional suture group, the suture time of patients was（25.46 ± 2.12） minutes, and there were 25 cases of grade A healing, 5 cases of grade B healing, 16 cases of suture knot rejection or skin edge necrosis, and 3 cases of skull repair materials exposure. There were statistically significant differences in incision-suture time and the incidence of suture knot rejection between the two groups（P〈0.05）, but there was no significant difference in the grade A wound healing rate between the two groups（P〉0.05）. Conclusion Subcuticular continuous suture closure with absorbable line and skin stapler for the scalp incision suture in cranioplasty can reduce suture time, avoid suture knot rejection, skin edge necrosis, and reduce postoperative scalp infection.