免打结倒刺缝线应用于初次膝髋关节置换有效与安全性的荟萃分析

Effectiveness and safety of knotless barbed suture for primary total knee or hip arthroplasty: a meta-analysis

背景:免打结倒刺缝线是一种具有双向倒刺的可吸收手术缝合线,能够实现免打结连续缝合伤口。与传统打结缝线相比,免打结倒刺缝线具有缩短缝合时间、促进伤口愈合、减少感染等优势,现已广泛应用于泌尿外科、妇产科和整形外科等领域,但其在全膝、髋关节置换领域的应用目前仍存在争议。目的:通过Meta分析系统评价在初次膝、髋人工关节置换术中使用免打结倒刺缝线缝合切口的有效性和安全性。方法:计算机检索建库至2018年9月Embase、PubMed、Web of Science数据库和中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库、维普中文科技期刊数据库(VIP),查找比较免打结倒刺缝线与传统打结缝线在人工关节置换术中缝合效果差异的随机对照试验研究。根据纳入与排除标准进行文献筛选、质量评价和数据提取后,应用Revman 5.3软件对文献数据进行Meta分析。结果与结论:(1)共纳入8篇随机对照试验研究,免打结倒刺缝线组(试验组)476例,传统打结缝线组(对照组)498例;(2)Meta分析结果显示,试验组缝合时间更短[MD=-6.96,95%CI(-10.60,-3.31),P <0.001],感染发生率更低[RR=0.31,95%CI(0.14,0.69),P=0.004],术后3个月美国膝关节协会评分更高[MD=-2.04,95%CI(-3.92,-0.15),P=0.03],差异有显著性意义;在切口相关并发症[RR=0.76,95%CI(0.36,1.62),P=0.48]、术后6周美国膝关节协会[MD=-0.22,95%CI(-3.10,2.66),P=0.88]、术后6周内膝关节活动度[MD=-0.74,95%CI(-4.19,2.71),P=0.67]和3个月后膝关节活动度[MD=-1.14,95%CI(-6.10,3.82),P=0.65]方面,2组结果相当,差异无显著性意义;(3)在初次膝、髋关节置换术中使用免打结倒刺缝线缝合切口不会增加切口相关并发症的发生率,并可缩短手术时间、预防感染、促进膝关节功能恢复,是一种安全有效的切口缝合新材料。

BACKGROUND: Knotless barbed suture is an absorbable surgical suture with two-way barbs that enables continuous suture wounds. Compared with traditional knotted sutures, knotless barbed suture has the advantages of shortening suture time, promoting wound healing and reducing infection. It has been widely used in urology, obstetrics and gynecology, but its application in the field of total knee or hip arthroplasty is still controversial. OBJECTIVE: To systematically assess the effectiveness and safety of knotless barbed suture for primary total knee or hip arthroplasty by meta-analysis. METHODS: Randomized controlled trials addressing knotless barbed suture versus traditional knotted sutures for total joint arthroplasty were retrieved from Embase, PubMed, Web of Science, WanFang, CNKI, CBM, WanFang and VIP databases before September 2018. The articles were screened according to the inclusion and exclusion criteria. After quality assessment and data extraction, meta-analysis was performed on Revman 5.3 software. RESULTS AND CONCLUSION:(1) Eight randomized controlled trails were included, with 476 cases for trial group (knotless barbed suture) and 498 cases for control group (traditional knotted sutures).(2) Meta-analysis results revealed that the trail group had the shorter operation time [MD=-6.96, 95%CI (-10.60,-3.31), P < 0.001], lower incidence of infection [RR=0.31, 95%CI (0.14, 0.69), P=0.004] and higher American Knee Society scores at postoperative 3 months [MD=-2.04, 95%CI (-3.92,-0.15), P=0.03]. There was no significant difference between two groups in the incision related complications [RR=0.76, 95%CI (0.36, 1.62), P=0.48], American Knee Society scores at postoperative 6 weeks [MD=-0.22, 95%CI (-3.10, 2.66), P=0.88], range of motion within postoperative 6 weeks [MD=-0.74, 95%CI (-4.19, 2.71), P=0.67] and range of motion after 3 months postoperatively [MD=-1.14, 95%CI (-6.10, 3.82), P=0.65].(3) To conclude, knotless barbed suture applied in primary total knee or hip arthroplasty does not increase the incidence of incision-related complications, but can shorten the operation time, prevent infection and promote knee function recovery, and it is a safe and effective new material for suturing the incision.