倒刺缝线用于髋膝关节置换安全性和有效性的荟萃分析

Efficacy and safety of barbed sutures in total hip arthroplasty and total knee arthroplasty: a meta-analysis

目的评估倒刺缝合线在初次髋、膝关节置换术中应用的临床效果.方法进行荟萃分析,在包括Web of Science、Embase、PubMed、Cochrane Controlled TriMs Register、Cochrane Library、Highwire数据库、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、中国科技期刊全文数据库(VIP)、中国万方数据库在内的文献数据库中搜索对比倒刺线和传统缝线在全髋或全膝关节置换中应用对比的随机对照试验,截止日期为2019年1月.最后,11篇文章(12项RCT研究)1 629例髋关节或膝关节置换术纳入本研究.采用Review Manager软件对荟萃分析进行评估.结果与常规缝合相比,倒刺线伤口缝合时间要更短(P<0.001),发生瘀斑和针刺伤的风险更低(均P<0.05).两组在总的伤口相关并发症,包括浅表感染、缝线脓肿、水疱、渗出、缝线断裂和术后6周膝关节运动范围及膝关节评分(KSS)方面差异均无统计学意义(均P>0.05).结论根据现有Ⅰ级证据,免打结倒刺缝线可能是初次髋膝关节置换术后伤口闭合的更好方法.

Objective To appraise the clinical outcomes of barbed suture in closure of total hip and total knee arthroplasty. Methods Databases (Web of Science, Embase, PubMed, Cochrane Controlled Trials Register,Cochrane Library,Highwire,China Biology Medicine disc (CBM), China National Knowledge Infrastructure (CNKI),VIP and Wanfang database) were searched for randomized controlled trials comparing barbed sutures and conventional sutures in total hip and total knee arthroplasty published before January, 2019. Finally, 11 articles (12 randomized controlled trials) involving 1 629 hips or knees were included in this study. The meta-analysis was performed using the Review Manager software. Results Compared with conventional sutures,barbed sutures resulted in shorter total wound closure time (P<0.001), less ecchymosis and needle prick (both P<0.05).There was no significant differences in terms of wound related complications, superficial infection, stitch abscess, blister, exudation, broken sutures, range of motionand KSS between barbed sutures and conventional sutures(all P>0.05). Conclusions Based on available level Ⅰ evidence, it indicated that knotless barbed suture maybe a better approach for wound closure in total hip and total knee arthroplasty.