间断加强的皮内连续缝合法在髋膝关节置换术中的应用

Clinical application of reinforced continuous intradermal suture in hip and knee joint replacement incisions

背景:关节活动时切口张力明显增大,致使皮内缝合在关节切口中的应用一直处于滞后状态。目的:介绍间断加强的皮内连续缝合法在髋膝关节置换术中应用的临床效果。方法:选取2017年3月至2017年8月收治的73例髋膝关节置换术患者为连续缝合组,共80个切口(48个髋关节置换术切口,32个膝关节置换术切口),切口均采用可吸收倒刺缝线进行皮内和脂肪层的连续缝合,于张力小处进行3~4针间断加强的皮内缝合。选取2016年9月至2017年2月收治的65例髋膝关节置换术患者为间断缝合组,共71个切口(42个髋关节置换术切口,29个膝关节置换术切口),切口均采用传统间断缝合。比较两组的皮肤和脂肪层缝合时间,出院时切口疼痛评分、膝关节屈伸角度以及患者满意度。结果:术后随访6~8个月,连续缝合组的切口对合平整、光滑,瘢痕不明显,无切口裂开,皮肤和脂肪层的平均缝合时间均较间断缝合组缩短,患者满意度明显高于间断缝合组,两组在切口疼痛评分、膝关节屈伸范围方面无统计学差别。结论:间断加强的皮内连续缝合法应用于髋膝关节置换术的切口安全可靠,能有效对抗髋膝关节置换术后大范围活动的切口张力,瘢痕小、美容效果满意。

Background:The incision tension significantly increases during joint activity,so that the application of intradermal suture in joint incision has been always postponed.Objective:To investigate the clinical efficacy of reinforced continuous intradermal suture in hip and knee joint replacement incisions.Methods:A total of 73 patients(80 incisions)undergoing hip or knee joint replacement were enrolled from March to August in 2017 including 48 hip incisions and 32 knee incisions considered as continuous suture group.The c ontinuous suture was used for the closure of skin and fat layer of these incisions with absorbable barbed stitches.3-4 needles of intennittent intradermal suture with big distance were used to reinforce the position of low tension.A total of 65 patients(71 incisions)including 42 hip incisions and 29 knee incisions were selected from September 2016 to February 2017 considered as intermittent suture group and all the incisions were closed hy intermittent suture.The suture time of skin and fat layer,as well as incision pain score,range of motion of knee joint and satisfaction degree at discharge were compared between the two groups.Results:All patients were followed up for 6-8 months.The incisions closed by reinforced continuous intradermal suture had flat and smooth surface,no obvious scar and no disruption.Fat layer and postoperative hospital stay were all shorter in the continuous suture group than in the intermittent suture group.The satisfaction degree in the continuous suture group was higher than that in the intermittent group.No significant difference was found in incision pain score and range of motion of knee joint between the two groups.Conclusions:The reinforced continuous intradermal suture is safe and reliable for hip and knee joint replacement incisions which can hear the tension from wide-range activ ities of hip or knee joint,have small scar and satisfied cosmetic result.