免打结抗菌倒刺线在肥胖患者颈后路手术切口缝合中的有效性及安全性

The efficacy and safety of knot-free anti-bacterial barbed sutures for incision closurein in obese patients undergoing posterior cervical surgery

目的:评价肥胖患者在颈后路手术切口缝合中使用免打结抗菌倒刺线的有效性及安全性。方法:选取2021年1月至2022年12月行颈后路手术治疗的脊髓型颈椎病或颈椎管狭窄症肥胖患者(BMI≥28 kg/m2)92例,均接受颈后路减压融合内固定手术,2021年入院的53例患者为常规缝合组,采用普通慕丝线缝合深筋膜层、皮下层及皮肤;2022年入院的39例患者为倒刺线缝合组,采用免打结抗菌倒刺线缝合深筋膜层、皮下层及皮肤。比较两组患者术后3个月随访的日本骨科学会(JOA)评分、颈椎功能障碍指数(NDI)及疼痛视觉模拟评分(VAS)情况;比较两组患者的切口长度、皮下脂肪厚度、切口缝合时间、切口缝合速度、切口愈合率、切口并发症发生率;比较两组中发生脑脊液渗漏患者切口感染及切口开裂的发生率。结果:两组患者的切口长度及皮下脂肪厚度比较差异无统计学意义(P均>0.05);两组患者术后3个月的NDI评分及VAS评分比较差异无统计学意义(P均>0.05)。倒刺线缝合组患者的切口缝合时间明显短于常规缝合组(P<0.01),缝合速度显著快于常规缝合组(P<0.01),切口愈合率高于常规缝合组(P<0.05),切口并发症发生率低于常规缝合组(P<0.05)。两组发生脑脊液渗漏患者的切口感染发生率差异无统计学意义(P>0.05),但切口开裂的发生率低于常规缝合组(P<0.05)。结论:免打结抗菌倒刺线在肥胖患者颈后路手术切口缝合中效果满意,减少切口并发症的发生,更有利于切口愈合。

Objective:To evaluate the efficacy and safety of knot-free anti-bacterial barbed sutures for incision closurein obese patients undergoing posterior cervical surgery.Methods:A total of 92 obese patients(body mass index≥28 kg/m2)diagnosed with cervical spondylotic myelopathy or cervical spinal stenosis who underwent posterior cervical surgery between January 2021 and December 2022 were enrolled.Fifty-three patients admitted in 2021 were enrolled in the conventional suture group,with the deep fascia layer,subcutaneous layer,and skin closed with common silk sutures.Thirty-nine patients admitted in 2022 were enrolled in the barbed suture group,with the deep fascia,subcutaneous layer and skin closed with Knot-free anti-bacterial barbed sutures.The Japanese Orthopedic Association(JOA),Neck Disability Index(NDI),and Visual Analog Scale(VAS)scores at 3 months after surgery between the two groups of patients were compared.The incision length,subcutaneous fat thickness,incision suture time,incision suture speed,incision healing rate,incision complication rate,and the incidence of incision infection and incision dehiscence in patients with cerebrospinal fluid leakage were compared between the two groups.Results:There were no significant differences between the two groups in terms of the incision length,subcutaneous fat thickness,NDI,and VAS scores at 3 months after surgery(all P>0.05).In the barbed suture group,the incision suturing time was significantly shorter(P<0.01),and the suturing speed was significantly faster(P<0.01)compared to the conventional suture group.Additionally,the incision healing rate was higher(P<0.05),and the incidence of incision-related complications was lower(P<0.05)compared to the conventional suture group.The incidence rate of incision infection among patients with cerebrospinal fluid leakage showed no statistically significant difference between the two groups(P>0.05).However,the occurrence rate of incision dehiscence was lower in the barbed suture group than in the conventional suture group(P<0.05).Conclusions:The use of Knot-free anti-bacterial barbed sutures for wound closure in obese patients undergoing posterior cervical spine surgery has satisfactory outcomes,reducing the incidence of complications and promoting improved incision healing.