Systematic review of absorbable vs non-absorbable sutures used for the closure of surgical incisions

AIM: To report a systematic review of published randomized controlled trials(RCTs) investigating the role of absorbable suture(AS) against non-AS(NAS) used for the closure of surgical incisions.METHODS: RCTs investigating the use of AS vs NAS for the closure of surgical incisions were statistically analysed based upon the principles of meta-analysis and the summated outcomes were represented as OR.RESULTS: The systematic search of medical literature yielded 10 RCTs on 1354 patients. Prevalence of wound infection(OR = 0.97; 95%CI: 0.56, 1.69; Z = 0.11; P = 0.92) and operative morbidity(P = 0.45) was comparable in both groups. Nonetheless, the use of AS lead to lower risk of wound break-down(OR = 0.12; 95%CI: 0.04, 0.39; Z = 3.52; P 【 0.0004).CONCLUSION: This meta-analysis of 10 RCTs demonstrates that the use of AS is similar to NAS for skin closure for surgical site infection and other operative morbidities. AS do not increase the risk of skin wound dehiscence,rather lead to a reduced risk of wound dehiscence compared to NAS.

Fabrication and Tissue Anchoring Performance of Nylon and Polypropylene Barbed Surgical Sutures

Barbed surgical sutures have attracted worldwide attention in recent years. The plurality of barbs projecting out and penetrating into surrounding tissue eliminates the need for tying a knot. In the current study,nylon and polypropylene( PP) barbed sutures with two different barb geometries designed to anchor in porcine skin and tendon tissues were fabricated by a specially designed mechanical cutting machine. The tensile properties were compared between the barbed and unbarbed control sutures. The in vitro tissue anchoring ability was measured by two tissue /suture pullout tests,one for skin and the other for tendon tissue. Regardless of the type of tissue,the PP barbed suture with its higher modulus had a superior anchoring ability. Given the same suture material,improved anchoring performance was shown in tendon tissue.

Prospective randomized controlled trial investigating the type of sutures used during hepatectomy

AIM: To determine whether absorbable sutures or non-absorbable sutures are better in preventing surgical site infection (SSI), in this paper we discuss the results of a randomized clinical trial which examined the type of sutures used during hepatectomy. METHODS: All hepatic resections performed from January 2007 to November 2008 at the Department of Surgery at Iizuka Hospital in Japan were included in this study. There were 125 patients randomly assigned to an absorbable sutures (Vicryl) group or non-absorbable sutures (Silk) group. RESULTS: SSI was observed in 13.6% (17/125) patients participating in this study, 11.3% in the Vicryl group and 15.8% in the Silk group. Incisional SSI including superficial and deep SSI, was observed in 8% of the Vicryl group and 9.5% of the Silk group. Organ/ space SSI was observed in 3.2% of the Vicryl group and 6.0% of the Silk group. There were no significant differences, but among the patients with SSI, the period for recovery was significantly shorter for the Vicryl group compared to the Silk group.CONCLUSION: The incidence of SSI in patients receiving absorbable sutures and silk sutures is not significantly different in this randomized controlled study; however, the period for recovery in patients with SSI was significantly shorter for absorbable sutures.

Evaluation in vitro of an Experimental Antibacterial Silk Suture

Because of good clinical performance and low cost,silk braided surgical suture becomes one of excellent and widely used sutures. But as a kind of natural protein fiber,silk easily trends to microbial infection. Beyond that,braided structure may increase the risk of hide of bacteria. Hence,the project of this study is to develop a novel antibacterial silk braided suture. Silk braided sutures were treated with antimicrobial solution which added antimicrobial agent4-quinolones into 5% polycaprolactone( PCL) solution. Then sutures were tested for in vitro efficacy against Staphylococcus aureus(S. aureus) and Escherichia coli(E. coli) by a zone of inhibition assay,and sustained efficacy assay,release of antibacterial agent,SEM photographs against S. aureus. Treated sutures exhibited distinct zones of inhibition against S. aureus and E. coli. They also kept antimicrobial property against S. aureus for 7 d,which were almost equal with coated VICRYL*Plus sutures. The highest release concentration of treated suture was 1. 53 mg /L,which was lower than Cmaxof 4-quinolones,proved the safety of antibacterial silk suture. SEM photographs gave both the change of the surface and different bacteria growth situations on the surface before and after treating.

Surgical Repair of Dorsal Capsulo-Ligamentous Complex for Dislocation of the Thumb Carpometacarpal Joint

Background: Acute dislocation of the thumb carpometacarpal (CMC) joint is a rare and challenging injury, and its treatment remains controversial. The purpose of the study was to evaluate the clinical outcome after surgical repair of the dorsal capsulo-ligamentous complex. Materials and methods: Eight patients with a mean age of 39.8 years (range, 23 - 56 years) treated for the thumb CMC joint were treated in our hospital between 2008 and 2018. The ruptured dorsal capsulo-ligamentous complex was repaired using suture anchors in all patients, and the joint was immobilized with a Kirschner wire pinning and splint for 3 weeks. The clinical outcome was assessed by measuring the range of motion of the thumb CMC joint and the Japanese Society for Surgery of the Hand version of the Quick Disability of the Arm, Shoulder, and Hand (Q-DASH-JSSH) score. Results: The mean radial abduction of the thumb CMC joint was 66°, and the volar abduction was 63°. The mean Q-DASH-JSSH score was 4.8 (range, 0 - 15.6). There were no cases of infection, nerve disturbance, or osteoarthritis. Anatomical reduction was observed in seven patients at the final follow-up and in a rugby football player at 6 months of follow-up;however, subluxation of the thumb CMC joint at 12 months of follow-up due to reinjury was observed. Conclusion: Surgical repair of the dorsal capsulo-ligamentous complex with suture anchors is a reliable and simple treatment for acute unstable dislocation of the thumb CMC joint.

Tissue Holding Performance of Barbed Sutures

A new technology of knotless barbed surgical sutures has made its mark in cosmetic surgery around the world. Although this technology is still under development, it has been approved by the Federal Drug Administration in USA, and is now used for facelift and eyelid ptosis procedures. The objectives of this study were to review the different types of knotless sutures, assess the tissue holding capacity of barbed sutures and perform image analysis to better understand the mechanism of energy absorption by the barbs under loading by the forces of surrounding tissues. A two dimensional finite element analysis was also performed to identify the areas of stress concentration, which are the main precursors for the peeling of the barbs beyond the maximun tissue holding force for a particular polymer. It was found that barbed sutures exhibit tissue holding capacities comparable to that of knotted sutures. This technology needs to be investigated further so as to optimize the barb geometry for superior holding capacity in a variety of different tissues.

Comparison of modified gunsight suture technique and traditional interrupted suture in enterostomy closure

BACKGROUND Prophylactic enterostomy surgery is a common surgical approach used to reduce the risk of anastomotic leakage in patients who have undergone partial intestinal resection due to trauma or tumors.However,the traditional interrupted suturing technique used in enterostomy closure surgery has several issues,including longer surgical incisions and higher incision tension,which can increase the risk of postoperative complications.To address these issues,scholars have proposed the use of a“gunsight suture”technique.This technique involves using a gunsight incision instead of a traditional linear incision,leaving a gap in the center for the drainage of blood and fluid to reduce the risk of infection.Building on this technique,we propose an improved gunsight suture technique.A drainage tube is placed at the lowest point of the incision and close the gap in the center of the gunsight suture,which theoretically facilitates early postoperative mobility and reduces the burden of dressing changes,thereby reducing the risk of postoperative complications.AIM To compare the effectiveness of improved gunsight suture technique with traditional interrupted suture in closing intestinal stomas.METHODS In this study,a retrospective,single-center case analysis was conducted on 270 patients who underwent prophylactic ileostomy closure surgery at the Department of Colorectal Surgery of Qilu Hospital from April 2017 to December 2021.The patients were divided into two groups:135 patients received sutures using the improved gunsight method,while the remaining 135 patients were sutured with the traditional interrupted suture method.We collected data on a variety of parameters,such as operation time,postoperative pain score,body temperature,length of hospital stays,laboratory indicators,incidence of incisional complications,number of wound dressing changes,and hospitalization costs.Non-parametric tests and chi-square tests were utilized for data analysis.RESULTS There were no statistically significant differences in general patient information between the two groups,including the interval between the first surgery and the stoma closure[132(105,184)d vs 134(109,181)d,P=0.63],gender ratio(0.64 vs 0.69,P=0.44),age[62(52,68)years vs 60(52,68)years,P=0.33],preoperative body mass index(BMI)[23.83(21.60,25.95)kg/m²vs 23.12(20.94,25.06)kg/m²,P=0.17].The incidence of incision infection in the improved gunsight suture group tended to be lower than that in the traditional interrupted suture group[(n=2/135,1.4%)vs(n=10/135,7.4%),P<0.05],and the postoperative hospital stay in the improved gunsight suture group was significantly shorter than that in the traditional interrupted suture group[5(4,7)d vs 7(6,8)d,P<0.05].Additionally,the surgical cost in the modified gunsight suture group was slightly lower than that in the traditional suture group[4840(4330,5138)yuan vs 4980(4726,5221)yuan,P>0.05],but there was no significant difference in the total hospitalization cost between the two groups.CONCLUSION In stoma closure surgery,the improved gunsight technique can reduce the incision infection rate,shorten the postoperative hospital stay,reduce wound tension,and provide better wound cosmetic effects compared to traditional interrupted suture.

Computer Aided Modeling and Dynamic Analysis of A New Surgical Instrument

One major difference among surgical instruments is the level of bodily disruption and tissue trauma that surgical devices might cause the patients. This newly designed and developed surgical instrument aims at minimally invasive therapy procedure, more reliable and durable function, less operational force, and reduced manufacturing cost. The computer aided modeling and simulation have been applied to help this new instrument design and analysis. This improved new surgical instrument is designed to use in general surgery to prevent patient's vessels and tissues from being damaging due to reliable motion control of surgical clips with no unexpected clip drop. It can also be applied to surgical education purpose to educate medical students for their future surgical careers. The prototype testing indicated that the handle operational force to close surgical clips is lower than current surgical clip instruments, product manufacturing is cost-effective due to less dimensional tolerance control of this new instrument design, more reliable instrument function, and good mechanical advantage.

Cosmetic outcome and surgical site infection rates of antibacterial absorbable （Polyglactin 910） suture compared to Chinese silk suture in breast cancer surgery： a randomized pilot research

Background The primary objective of this multicenter post-market study was to compare the cosmetic outcome of triclosan-coated VICRYL＊ Plus sutures with Chinese silk sutures for skin closure of modified radical mastectomy. A secondary objective was to assess the incidence of surgical site infection （SSI）.Methods Patients undergoing modified radical mastectomy were randomly assigned to coated VICRYL＊ Plus antibacterial （Polyglactin 910） suture or Chinese silk suture. Cosmetic outcomes were evaluated postoperatively at days 12 （±2） and 30 （±5）, and the evidence of SSI was assessed at days 3, 5, 7, 12 （±2）, 30 （±5）, and 90 （±7）. Cosmetic outcomes were independently assessed via visual analogue scale （VAS） score evaluations of blinded incision photographs （primary endpoint） and surgeon-assessed modified Hollander Scale （mHCS） scores （secondary endpoint）. SSI assessments used both CDC criteria and ASEPSIS scores.Results Six Chinese hospitals randomized 101 women undergoing modified radical mastectomy to closure with coated VICRYL＊ Plus suture （n=51） or Chinese silk suture （n=50）. Mean VAS cosmetic outcome scores for antibacterial suture （67.2） were better than for Chinese silk （45.4） at day 30 （P 〈0.0001））. Mean mHCS cosmetic outcome total scores, were also higher for antibacterial suture （5.7） than for Chinese silk （5.0） at day 30 （P=0.002）.Conclusions Patients using coated VICRYL＊ Plus suture had significantly better cosmetic outcomes than those with Chinese silk sutures. Patients using coated VICRYL＊ Plus suture had a lower SSI incidence compared to the Chinese silk sutures, although the difference did not reach statistical significance. （ClinicalTrials.gov NCT 00768222）

Influence of surgical suture properties on the tribological interactions with artificial skin by a capstan experiment approach

Tribological interactions between surgical suture and human tissue play an important role in the stitching process.The purpose of the paper is to understanding the tribological behavior of surgical suture interacting with artificial skin,with respect to surgical suture material and structure,by means of a capstan experiment approach and a contact area model.The results indicated that structure and surface topography of the surgical suture had a pronounced effect on the tribological interactions.The apparent coefficient of friction of vicryl surgical suture was the smallest among the three surgical suture materials.As the sliding velocity increased,or the applied load decreased,the coefficient of friction increased.Furthermore,stick-slip phenomena were observed during the sliding procedure.

Facile scalable one-step wet-spinning of surgical sutures with shape memory function and antibacterial activity for wound healing

Surgical suture is commonly used in clinic due to its action in accelerating the process of wound healing.However,difficultly handling in minimally invasive surgery and bacteria-induced infection usually limit its use in a wide range of applications.Here,we report a facile scalable strategy to fabricate surgical sutures with shape memory function and antibacterial activity for wound healing.Specifically,a shape memory polyurethane(SMPU)with a transition temperature(Ttrans)at 41.3℃was synthesized by adjusting the mole ratio of the hard/soft segment,and then the shape memory surgical sutures containing polyhexamethylene biguanide hydrochloride(PHMB)as a model drug for antibacterial activity were fabricated by a facile scalable one-step wet-spinning approach,in which PHMB was directly dissolved in the coagulation bath that enable its loading into the sutures through the dual diffusion during the phase separation.The prepared sutures were characterized by their morphology,mechanical properties,shape memory,antibacterial activity,as well as biocompatibility before the wound healing capability was tested in a mouse skin suture-wound model.It was demonstrated that the optimized suture is capable of both shape memory function and antibacterial activity,and promote wound healing,suggesting that the facile scalable one-step wet-spinning strategy provides a promising tool to fabricate surgical sutures for wound healing.

Dopamine hydrochloride and carboxymethyl chitosan coatings for multifilament surgical suture and their influence on friction during sliding contact with skin substitute

In order to reduce the damage to tissue and fill the interstices between fibers,multifilament sutures are frequently treated with certain coating materials.The objective of this study was to create and characterize dopamine hydrochloride(DA)and carboxymethyl chitosan(CMCS)coatings on surgical sutures and investigate their effects on the frictional performance of the surgical sutures during sliding through a skin substitute.The effects of the treatment on the physical and chemical characteristics of the surgical sutures were evaluated.The friction force of the surgical sutures during sliding through the skin substitute was experimentally determined using a penetration friction apparatus.The coefficient of friction(COF)was calculated using a linear elastic model and was used to estimate the frictional behavior of the surgical suture‐skin interactions.The results showed that the DA coating could evenly deposit on the surface of the etched multifilament surgical suture surfaces in a weakly alkaline buffer solution.The CMCS coating material could form a uniform film on the surface of the sutures.Minor changes in the surface roughness of the multifilament surgical sutures with different treatments occurred in this study.The friction force and the COF of the multifilament surgical sutures with DA and CMCS coating showed little change when compared with untreated multifilament surgical sutures.

Use of antibacterial sutures for skin closure in controlling surgical site infections: a systematic review of published randomized, controlled trials

Objective:The objective of this article is to systematically analyse the randomized,controlled trials that compare the use of antibacterial sutures(ABS)for skin closure in controlling surgical site infections.Methods:Randomized,controlled trials on surgical patients comparing the use of ABS for skin closure in controlling the surgical site infections were analysed systematically using RevMan^(■)and combined outcomes were expressed as odds ratios(OR)and standardized mean differences(SMD).Results:Seven randomized,controlled trials evaluating 1631 patients were retrieved from electronic databases.There were 760 patients in the ABS group and 871 patients in the simple suture group.There was moderate heterogeneity among trials(Tau^(2)=0.12;chi^(2)=8.40,df=6[P<0.01];I^(2)=29%).Therefore in the random-effects model,the use of ABS for skin closure in surgical patients was associated with a reduced risk of developing surgical site infections(OR,0.16;95%CI,0.37,0.99;z=2.02;P<0.04)and postoperative complications(OR,0.56;95%CI,0.32,0.98 z=2.04;P=0.04).The durations of operation and lengths of hospital stay were similar following the use of ABS and SS for skin closure in patients undergoing various surgical procedures.Conclusion:Use of ABS for skin closure in surgical patients is effective in reducing the risk of surgical site infection and postoperative complications.ABS is comparable with SS in terms of length of hospital stay and duration of operation.

带线锚钉重建喙锁韧带、肩锁韧带与锁骨钩钢板固定治疗肩锁关节脱位的疗效比较

目的比较带线锚钉重建喙锁韧带、肩锁韧带和锁骨钩钢板内固定两种术式治疗肩锁关节脱位的短期疗效差异。方法回顾性分析2018年1月至2023年6月广州市花都区人民医院手术治疗的59例RockwoodⅢ~Ⅴ型肩锁关节脱位患者的临床资料。患者根据手术方式的不同分入韧带重建组(使用带线锚钉重建喙锁韧带及肩锁韧带,n=27)和钢板内固定组(使用锁骨钩钢板固定,n=32)。比较两组患者的手术时间、术中出血量和住院时间,记录随访期间肩关节活动范围(ROM)、视觉模拟量表(VAS)评分和Constant-Merly评分,测量末次随访喙锁间距。结果患者获得6~26个月(平均11.3个月)随访。韧带重建组手术时间长于钢板内固定组(P<0.05);两组患者术中出血量、住院时间以及术后1、3个月VAS评分相近(P>0.05);韧带重建组患者术后6个月VAS评分,末次随访Constant-Merly总评分及肩关节活动范围、日常活动、疼痛程度3个分项评分均优于钢板内固定组(P<0.05),比较两组末次随访肩关节力量分项评分和喙锁间距,差异无统计学意义(P>0.05)。结论对于肩锁关节脱位患者,应用缝合锚钉重建喙锁韧带、肩锁韧带与锁骨钩钢板内固定两种术式均能获得良好疗效,其中韧带重建术式尽管手术时间相对较长,但在改善肩关节功能、提高生活质量等方面具有一定优势,同时可避免二次手术。

缝线类型对胃十二指肠溃疡穿孔患者微创修补术治疗效果的影响

目的研究缝线类型对胃十二指肠溃疡穿孔患者微创修补术治疗效果的影响。方法选取胃十二指肠溃疡穿孔患者78例,采用随机数字表法分为观察组和对照组,每组39例。两组均行微创修补术治疗,观察组采用2-0聚乙醇酸可吸收手术缝线,对照组采用2-0普通丝线。比较两组溃疡愈合率、手术指标和临床指标、术后疼痛程度、肠道屏障功能、并发症发生率及生活质量。结果观察组溃疡愈合率为97.44%,对照组为74.36%,两组溃疡愈合率比较差异有统计学意义(P<0.05)。观察组术后疼痛程度1级17例,2级19例,3级2例,4级1例;对照组术后疼痛程度1级9例,2级18例,3级8例,4级4例。两组术后疼痛程度比较差异有统计学意义(P<0.05)。观察组并发症发生率为2.56%,低于对照组的20.51%,差异有统计学意义(P<0.05)。观察组手术时间与对照组比较,差异无统计学意义(P>0.05)。观察组下床时间、肠道功能恢复时间、住院时间分别为(2.26±0.76)、(2.54±0.97)、(6.56±1.31)d,短于对照组的(2.85±1.01)、(3.18±1.15)、(7.19±1.47)d(P<0.05)。术后3 d,观察组血清二胺氧化酶(DAO)(118.42±8.46)U/ml、D-乳酸(D-Lac)(23.19±2.08)μg/ml低于对照组的(139.53±9.85)U/ml、(29.47±2.77)μg/ml(P<0.05)。术后8周,观察组胃肠道生活质量指数(GIQLI)评分(125.45±9.65)分高于对照组的(107.91±8.37)分(P<0.05)。结论聚乙醇酸可吸收手术缝线在胃十二指肠溃疡穿孔微创修补术中的使用能够促进溃疡愈合,改善患者生活质量,降低术后并发症风险,且对肠道屏障功能的影响较小。

关节镜下三点缝合前交叉韧带治疗胫骨止点撕脱骨折的效果及术后功能评价

目的探究关节镜下运用三点手术缝合前交叉韧带(ACL)方法治疗胫骨止点撕脱骨折的临床疗效,并对术后功能恢复情况进行评价。方法前瞻性选取2020年6月—2022年6月中国人民解放军南部战区海军第二医院关节骨科收治的101例胫骨止点撕脱骨折患者,男性45例,女性56例;年龄19~62岁,平均48.6岁;道路交通伤33例,运动损伤32例,其他36例。信封法随机分两组:两点缝合组(n=51)行关节镜下ACL传统两点缝合术,三点缝合组(n=50)行关节镜下ACL三点缝合治疗,术后均进行常规康复训练,随访1年。记录两组手术时间、术后引流量、骨折愈合时间、住院时间及负重开始时间,比较组间VAS、国际膝关节文献委员会(IKDC)评分、Lysholm评分、SF-36健康调查简表及术后并发症情况。结果两组间手术时间、术后引流量比较差异无统计学意义(P>0.05),三点缝合组骨折愈合时间、住院时间、负重开始时间均短于两点缝合组[(4.55±0.65)月vs.(4.91±0.46)月、(8.99±2.11)d vs.(10.22±2.12)d、(36.55±5.56)d vs.(44.23±6.15)d,P<0.05]。两组VAS在治疗和康复训练后均较术前下降,且术后3d及术后7d三点缝合组VAS低于两点缝合组[(3.66±0.71)分vs.(4.26±0.64)分、(1.88±0.66)分vs.(3.33±0.34)分,P<0.05]。经治疗及康复训练,两组IKDC评分、Lysholm评分均有所升高,且术后1个月及术后6个月三点缝合组的IKDC评分及Lysholm评分均高于两点缝合组[IKDC评分:术后1个月:(61.09±2.48)分vs.(49.88±3.65)分、术后6个月:(75.22±3.31)分vs.(66.33±2.78)分;Lysholm评分:术后1个月:(67.66±3.21)分vs.(56.88±3.64)分、术后6个月:(82.11±3.56)分vs.(69.45±4.66)分,P<0.05]。在进行治疗和康复训练后,两组生活质量均有所提高,且与两点缝合组相比,三点缝合组各维度评分均升高[物质生活:(60.11±5.98)分vs.(69.77±6.12)分、躯体:(69.44±6.45)分vs.(78.11±4.55)分、心理:(67.22±7.16)分vs.(78.33±6.89)分、社会功能:(61.23±8.78)分vs.(71.23±6.16)分,P<0.05]。三点缝合组术后畸形愈合、伤口感染、关节僵硬、神经损伤总发生率低于两点缝合组(6.0%vs.19.6%,P<0.05)。结论关节镜下运用三点手术缝合ACL方法治疗胫骨止点撕脱骨折患者的效果优于传统ACL两点缝合,术后膝关节功能评价及患者生活质量明显优于传统ACL两点缝合组。

双层软组织缝合封闭技术在下颌骨中早期药物相关性颌骨骨坏死患者手术治疗中的应用

目的:探究双层软组织缝合封闭技术在单纯应用抗骨吸收药物引起的发生在下颌骨的中早期药物相关性颌骨骨坏死(medication-related osteonecrosis of the jaw,MRONJ)患者手术治疗中的临床应用效果。方法:选择2021年10月至2022年9月于北京大学口腔医院四病区经手术治疗的中早期下颌骨MRONJ患者的病历资料进行回顾性分析,收集患者术前基线临床资料,包括原发疾病、伴发疾病、用药方案(药物种类、用药时长)、MRONJ分期、临床症状、影像学表现等,所有患者在手术中行下颌骨边缘切除术去除坏死骨,运用双层软组织缝合封闭技术关闭伤口,术后定期复查随访,评价双层软组织缝合封闭技术的治疗效果及并发症,并对患者进行疼痛评分和功能状态评价。结果:研究共纳入13例患者(女12例,男1例),年龄(66.69±13.14)岁。原发疾病包括骨质疏松7例,肺癌2例,乳腺癌3例,前列腺癌1例;2例伴发糖尿病,2例伴发心血管疾病,1例伴发干燥综合征。9例患者静脉注射唑来膦酸,平均用药时间(37.7±20.0)个月,7例患者同时服用了来曲唑片等其他药物;3例患者应用地舒单抗注射液,平均用药时间(10.3±11.9)个月;5例患者服用阿仑膦酸钠片,平均用药时间(55.20±27.20)个月,2例患者不同程度地服用醋酸泼尼松片或阿卡波糖片。MRONJ 1期4例,2期9例。13例患者均采用双层软组织缝合封闭技术关闭伤口,术后平均随访11.9个月(9~17个月),13例患者皆治愈,无溢脓等并发症发生。患者术前Karnofsky功能状态评分量表(Karnofsky performance status,KPS)评分为(68.46±14.05)分,术后评分为(82.31±15.36)分,差异有统计学意义(P<0.05)。患者术前疼痛评估视觉模拟评分量表(visual analogue scale,VAS)评分为(5.77±0.73)分,术后评分为(0.38±0.51)分,差异有统计学意义(P<0.001)。结论:双层软组织缝合封闭技术在中早期单纯使用抗骨吸收类药物的下颌骨MRONJ患者中可以取得良好的临床治疗效果,可为用药情况更加复杂的MRONJ患者提供临床治疗思路。

半月板缝合术治疗膝关节半月板损伤的效果及对膝关节本体感觉、骨性标志物、关节滑液炎症因子的影响

目的前瞻性研究半月板缝合术治疗膝关节半月板损伤的效果及对膝关节本体感觉(KP)、骨性标志物、关节滑液炎症因子的影响。方法前瞻性选取2021年1月至2022年12月南京医科大学第四附属医院收治的膝关节半月板损伤患者104例为研究对象,按照随机数字表法将其分为试验组(n=52)和对照组(n=52)。试验组行半月板缝合术,对照组行关节镜半月板切除术(AM)。观察两组的围手术期指标,包括手术时间、术后功能锻炼开始时间及术后住院时间;术前及术后12个月膝关节功能;术后6周、6个月的KP情况;术前及术后6个月的血清骨钙素、骨碱性磷酸酶(BALP)、Ⅰ型前胶原羧基端肽(PⅠCP)等骨性标志物水平;术前及术后7 d的膝关节滑液肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6、IL-1β等炎症因子水平以及术后并发症发生情况。结果试验组的手术时间为(52.65±5.47)min,长于对照组[(47.27±4.98)min],试验组术后功能锻炼开始时间及术后住院时间分别为(3.26±0.34)、(8.96±0.92)d,均短于对照组[(4.16±0.43)、(11.53±1.32)d],差异均有统计学意义(P<0.05)。术后12个月,试验组Tegner评分、Lysholm评分分别为(7.29±0.74)、(88.29±8.95)分,均高于对照组[(6.87±0.70)、(82.90±8.42)分],差异均有统计学意义(P<0.05)。术后12个月,试验组15°、45°、75°等KP角度差值分别为(2.31±0.25)°、(2.18±0.22)°、(2.44±0.29)°,均小于对照组[(2.48±0.27)°、(2.33±0.24)°、(2.61±0.28)°],差异均有统计学意义(P<0.05)。术后6个月,试验组血清骨钙素、BALP、PⅠCP水平分别为(4.61±0.48)μg/L、(321.43±34.65)U/L、(158.07±17.28)μg/L,均大于对照组[(4.32±0.45)μg/L、(301.96±32.60)U/L、(147.13±15.86)μg/L],差异均有统计学意义(P>0.05)。术后7 d,试验组膝关节滑液TNF-α、IL-6、IL-1β水平分别为(5.74±0.59)pg/mL、(5.21±0.54)ng/mL、(0.15±0.02)pg/mL,均低于对照组[(6.13±0.62)pg/mL、(5.55±0.60)ng/mL、(0.17±0.03)pg/mL],差异均有统计学意义(P<0.05)。试验组术后并发症发病率为5.77%,小于对照组(21.15%),差异有统计学意义(P<0.05)。结论半月板缝合术治疗膝关节半月板损伤创伤小,术后恢复快,术后并发症少,可有效改善膝关节功能及KP,且可提高血清骨性标志物水平,降低关节滑液炎症因子水平。

以健侧为镜像治疗单侧冠状缝早闭症疗效分析

目的探讨婴幼儿单侧冠状缝早闭症的临床特点及手术治疗方法。方法回顾性分析湖南省儿童医院神经外科2019年3月至2023年3月收治的27例单侧冠状缝早闭症患儿临床资料。患儿年龄均大于3个月,头颅外观均呈不同程度前斜头畸形,均经头面部CT平扫加三维重建明确诊断,行3D打印设计骨瓣,根据颅骨畸形特点、畸形程度及就诊年龄制定手术方案。手术均以健侧为镜像行患侧眼眶重塑整形、以成形眶骨瓣为基线与额骨瓣契合成为"新额部"。观察患儿前斜头畸形改善情况以及颅腔容积变化。结果27例单侧冠状缝早闭症患儿术后平均随访2.4年(3个月至4年),双侧前额与双侧眼眶均位于同一冠状面,前斜头畸形与患侧额叶发育均较术前明显改善,无一例再次手术病例。结论对于大于3月龄的单侧冠状缝早闭患儿,采取以健侧为镜像重塑患侧眼眶,以成形眶骨瓣为基线重塑额骨瓣形成"新额头"的颅骨重塑整形手术,可获得满意疗效。

可吸收手术缝合线研究进展

可吸收手术缝合线是当今国际生物医用纺织领域的研究热点之一。为了掌握可吸收手术缝合线的创新方向以及临床和产业化需求提升我国可吸收手术缝合线的自主知识产权;首先介绍了可吸收缝合线的发展历程以及性能要求;其次列举了羊肠线、胶原线、甲壳质和海藻酸盐4种天然材料在天然可吸收缝合线方面的应用并总结分析最新国内外相关研究;然后综述了聚乳酸、聚乙醇酸、聚己内酯和聚乙烯醇4类合成高分子材料在可吸收缝合线方面的应用并总结分析国内外最新相关研究;系统对比了各种制备原料开发可吸收手术缝合线的优缺点,并侧重分析了可吸收手术缝合线的力学性能、降解性能以及附加抗菌性能3个重要指标。分析认为:目前市面上的可吸收手术缝合线仍以国外进口为主导,我国对于可吸收手术缝合线的开发仍处于实验室阶段,较少能够投入市场以及临床应用,另外,对用天然材料开发的可吸收手术缝合线研究甚少。同时,提出各类材料作为可吸收手术缝合线的优缺点,为新型可吸收手术缝合线的开发提供参考。