全膝关节置换术皮肤切口不同缝合方式的对比研究

Comparison of skin cosmetic suture and traditional method for wound closure in total knee arthroplasty

背景:为了提高关节置换术后患者满意度、功能评分及快速康复,切口缝合获得了越来越多的关注。目的:探讨美容缝合法与传统缝合法在全膝关节置换术(TKA)中的临床应用效果。方法:回顾性分析2017年1月至2017年10月连续收治的100例初次TKA患者,男35例,女65例;年龄51～74岁,平均(63.3±10.5)岁。根据缝合方式分为:美容缝合组50例(采用皮内缝合+皮肤粘合剂关闭切口);传统缝合组50例(采用皮肤吻合器+引流)。使用Hollander切口愈合评分(HWES)及患者-观察者瘢痕评估量表(POSAS)作为主要结局指标;切口并发症(红肿、渗出、裂开、皮下血肿、感染等)、术后膝关节活动度、缝合时间及平均住院日等作为次要结局指标,分别于术后2周、12周评价两种缝合方式在TKA中的临床效果。结果:美容缝合组的切口并发症发生率低于传统缝合组(P=0.049),HWES及POSAS较高(P<0.001,P=0.01)、平均住院日较少(P=0.045);而两组的术后膝关节活动度、缝合时间及切口疼痛评分无统计学差异(P>0.05)。结论:相比于传统缝合法,美容缝合法应用于TKA安全有效、操作简单、住院时间短、患者满意度高。

Background:Incision suture has attracted more and more attention in order to improve patient satisfaction,functional score and rapid recovery after joint replacement.Objectives:To compare the clinical effect between skin cosmetic suture and traditional method for wound closure in total knee arthroplasty(TKA).Methods:A total of 100 patients undergoing TKA from January 2017 to October 2017 were divided into two groups at random,including 35 males and 65 females,with the age ranging from 51 to 74 years old and an average of(63.3±10.5)years old.50 patients used subcuticular suture and histoacryl topical skin adhesive(cyanoacrylate adhesive)for wound closure and the other 50 patients used traditional method(skin staples and wound drainage)for wound closure.The main outcomes included Hollander wound evaluating score(HWES)and patient-observer scar assessment score(POSAS).The secondary outcomes included incision complications like red and swollen,effusion,dehiscence,subcutaneous hematoma and infection,the knee's range of motion after the operation,duration of suture and The average hospital stay.The effect of the two suture methods were appraised at 2 and 12 weeks after TKA.Results:The incidence of incision complications was lower(P=0.049),the HWES and POSAS were higher(P<0.001,P=0.01).and the average hospital stay was shorter in patients of skin cosmetic suture than in patients of traditional method(P=0.045).There was no difference in the duration of suture,pain scores and range of motion between the two groups(P>0.05).Conclusions:Compared with the traditional method,skin cosmetic suture has many advantages of good safety and efficacy,easy operation,short hospital stay and high patient satisfaction.