摘要
目的系统评价可吸收倒刺缝线与传统可吸收缝线在全膝关节置换术(total knee arthroplasty,TKA)中的应用效果。方法计算机检索PubMed、EMbase、The Cochrane Library、CBM、WanFang Data、CNKI和VIP数据库,搜集所有关于可吸收倒刺缝线与传统可吸收缝线关闭TKA手术切口的临床研究,检索时限均从建库至2017年11月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入6个随机对照试验(RCT)和5个队列研究,包括2 008例患者。Meta分析结果显示:可吸收倒刺缝线组的关节囊缝合时间[MD=–4.31,95%CI(–4.72,–3.90),P<0.000 01]、缝合时针刺伤害发生率[OR=0.14,95%CI(0.03,0.61),P=0.009]、切口并发症发生率[OR=0.56,95%CI(0.36,0.88),P=0.01]明显低于传统可吸收缝线组,但其缝线断裂发生率[OR=23.03,95%CI(3.08,172.09),P=0.002]较高,差异具有统计学意义。两组患者的浅表感染、深部感染、无菌性红肿、切口裂开发生率及术后3个月时KSS评分的差异无统计学意义(P>0.05)。结论现有证据表明,使用可吸收倒刺缝线关闭TKA手术切口可缩短关节囊缝合时间、降低针刺伤害发生率和切口并发症发生率,且不增加浅表感染、深部感染、无菌性红肿、切口裂开发生率,对术后3个月时的关节功能无明显影响,但其缝线断裂发生率更高。受纳入文献数量和质量限制,上述结论尚需开展更多高质量研究予以验证。
Objectives To systematically review the efficacy of absorbable barbed suture versus traditional absorbable suture in total knee arthroplasty（TKA）. Methods PubMed, EMbase, The Cochrane Library, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect clinical trials of absorbable barbed suture versus traditional absorbable suture in TKA from inception to November, 2017. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan5.3 software. Results A total of 6 randomized controlled trials（RCTs） and 5 cohort studies were included, involving 2008 patients. Meta-analysis showed that the joint capsule suture time of the absorbable barbed suture group [MD=–4.31,95% CI（–4.72, –3.90）, P〈0.000 01], the incidence of acupuncture injury during suture [OR=0.14, 95% CI（0.03, 0.61）,P=0.009], and incision complication rate [OR=0.56, 95% CI（0.36, 0.88）, P=0.01] were significantly lower than the traditional absorbable suture group, but the incidence of suture fracture [OR=23.03, 95% CI（3.08, 172.09）, P=0.002] was higher, yet the difference was statistically significant. There were no significant differences in the incidence of superficial infection, deep infection, aseptic redness, incision dehiscence and KSS score at 3 months after operation（P〈0.05）. Conclusions Available evidence suggests that the use of absorbable barbed sutures to close the TKA surgical incision shortens the time to suture the joint capsule, reduces the incidence of acupuncture injury as well as the overall incidence of incision complications without increasing superficial infection, deep infection, and sterility. The incidence of redness and incision splitting has no significant effects on joint function at 3 months after surgery, however the incidence of suture fracture is higher. Due to limited quality and quantity of the included studies, the above conclusions are required to be verified by more high-quality studies.
作者
王亚飞
廖云健
刘慧敏
张志涛
李红喜
逯代锋
董锋
廉永云
WANG Yafei;LIAOYunjian;LIU Huimin;ZHANGZhitao;LI Hongxi;DAI Daifeng;DONG Feng;LIAN Yongyun(Fourth Affiliated Hospital of Harbin Medical University,Harbin,150000,P.R.China)
出处
《中国循证医学杂志》
CSCD
北大核心
2018年第10期1101-1108,共8页
Chinese Journal of Evidence-based Medicine
