初次全膝关节置换中应用倒刺缝线和传统缝线的Meta分析

Meta-analysis of barbed suture versus traditional suture in primary total knee arthroplasty

背景:在临床上新型的倒刺缝合线在一些外科领域得到了广泛应用,并且取得了良好的效果,但是在全膝关节置换中的应用较少,其临床效果仍存在争议。目的:收集相关文献进行系统评价,为倒刺缝线在全膝关节置换中的应用提供证据。方法:2名研究员独立检索PubMed、EMBASE、Cochrane library、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方数据库、维普中文科技期刊数据库中有关倒刺缝线和传统缝线在全膝关节置换中应用的随机对照试验,手工检索其余相关文献,检索时间均为建库至2019年6月。使用Cochrane手册推荐的随机对照试验偏倚风险评估工具对文献质量进行评估,采用RevMan 5.3软件进行Meta分析。结果与结论:①共有8项随机对照试验纳入,共计1004例膝关节;②结果表明,倒刺缝合可以明显缩短伤口缝合时间[MD=-5.17,95%CI(-6.26,-4.09),P<0.00001],减少伤口关闭总成本[SMD=-1.66,95%CI(-2.58,-0.75),P=0.0004],降低伤口缝合时针刺伤发生率[RR=0.14,95%CI(0.03,0.78),P=0.02];③2种缝合方法在术后并发症[RR=0.96,95%CI(0.65,1.42),P=0.85]、缝线断裂情况[RR=4.58,95%CI(0.16,128.29),P=0.37]、术后6周膝关节活动度[MD=−0.74,95%CI(-4.19,2.71),P=0.67]、术后3个月膝关节活动度[MD=−0.30,95%CI(-2.62,2.02),P=0.80]和术后6周美国膝关节协会评分[MD=-0.22,95%CI(-3.10,2.66),P=0.88]方面差异均无显著性意义,但是在术后3个月倒刺缝合组获得了较好的美国膝关节协会评分[MD=-2.04,95%CI(-3.92,-0.15),P=0.03];④提示在初次全膝关节置换中,倒刺缝线缝合是一种快速、安全有效并且低成本的缝合办法,值得临床使用,同时也需要更多的随机对照试验及更长时间的随访来进一步证实此结论。

BACKGROUND:A new barb suture has been extensively applied in clinical practice of surgery and has achieved good efficacy.However,its application in total knee arthroplasty is little,and the treatment efficacy remains controversial.OBJECTIVE:To collect the related studies for systematic analysis,so as to provide evidence for the use of barbed suture in total knee arthroplasty.METHODS:PubMed,EMBASE,Cochrane library,CBM,CNKI,Wanfang and VIP databases were retrieved by two researchers independently for the randomized controlled trials on barbed suture and traditional suture applied in total knee arthroplasty published before June 2019.Literature quality was assessed using the randomized controlled trials bias risk assessment tool recommended by the Cochrane manual,and meta-analysis was performed using RevMan 5.3 software.RESULTS AND CONCLUSION:(1)Eight randomized controlled trials were included,involving 1004 knees.(2)The results showed that barbed suture could significantly shorten the wound closure time[MD=-5.17,95%CI(-6.26,-4.09),P<0.00001]and reduce the total cost of wound closure[SMD=-1.66,95%CI(-2.58,-0.75),P=0.0004],and incidence of acupuncture injury[RR=0.14,95%CI(0.03,0.78),P=0.02].(3)There was no significant difference in the postoperative complications[RR=0.96,95%CI(0.65,1.42),P=0.85],and suture breakage[RR=4.58,95%CI(0.16,128.29),P=0.37],range of motion at postoperative 6 weeks and 3 months[MD=-0.74,95%CI(-4.19,2.71),P=0.67];[MD=-0.30,95%CI(-2.62,2.02),P=0.80]or American Knee Society Knee Score at postoperative 6 weeks[MD=-0.22,95%CI(-3.10,2.66),P=0.88].The American Knee Society Knee Score at postoperative 3 months was better in the barbed suture group[MD=-2.04,95%CI(-3.92,-0.15),P=0.03].(4)To conclude,barbed suture is a fast,low-cost,safe and effective method in primary total knee arthroplasty,which is worthy of clinical use.More randomized controlled trials and long follow-up are needed to confirm this conclusion.