全膝关节置换术皮肤切口不同缝合方式的对比研究
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摘要
背景:为了提高关节置换术后患者满意度、功能评分及快速康复,切口缝合获得了越来越多的关注。目的:探讨美容缝合法与传统缝合法在全膝关节置换术(TKA)中的临床应用效果。方法:回顾性分析2017年1月至2017年10月连续收治的100例初次TKA患者,男35例,女65例;年龄51～74岁,平均(63.3±10.5)岁。根据缝合方式分为:美容缝合组50例(采用皮内缝合+皮肤粘合剂关闭切口);传统缝合组50例(采用皮肤吻合器+引流)。使用Hollander切口愈合评分(HWES)及患者-观察者瘢痕评估量表(POSAS)作为主要结局指标;切口并发症(红肿、渗出、裂开、皮下血肿、感染等)、术后膝关节活动度、缝合时间及平均住院日等作为次要结局指标,分别于术后2周、12周评价两种缝合方式在TKA中的临床效果。结果:美容缝合组的切口并发症发生率低于传统缝合组(P=0.049),HWES及POSAS较高(P<0.001,P=0.01)、平均住院日较少(P=0.045);而两组的术后膝关节活动度、缝合时间及切口疼痛评分无统计学差异(P>0.05)。结论:相比于传统缝合法,美容缝合法应用于TKA安全有效、操作简单、住院时间短、患者满意度高。
Background: Incision suture has attracted more and more attention in order to improve patient satisfaction, functional score and rapid recovery after joint replacement. Objectives: To compare the clinical effect between skin cosmetic suture and traditional method for wound closure in total knee arthroplasty(TKA). Methods: A total of 100 patients undergoing TKA from January 2017 to October 2017 were divided into two groups at random, including 35 males and 65 females, with the age ranging from 51 to 74 years old and an average of(63.3±10.5) years old. 50 patients used subcuticular suture and histoacryl topical skin adhesive(cyanoacrylate adhesive) for wound closure and the other 50 patients used traditional method(skin staples and wound drainage) for wound closure. The main outcomes included Hollander wound evaluating score(HWES) and patient-observer scar assessment score(POSAS). The secondary outcomes included incision complications like red and swollen, effusion, dehiscence,subcutaneous hematoma and infection, the knee's range of motion after the operation, duration of suture and the average hospital stay. The effect of the two suture methods were appraised at 2 and 12 weeks after TKA. Results: The incidence of incision complications was lower(P=0.049), the HWES and POSAS were higher(P<0.001,P=0.01), and the average hospital stay was shorter in patients of skin cosmetic suture than in patients of traditional method(P=0.045). There was no difference in the duration of suture,pain scores and range of motion between the two groups(P>0.05). Conclusions: Compared with the traditional method, skin cosmetic suture has many advantages of good safety and efficacy, easy operation, short hospital stay and high patient satisfaction.
Background: Incision suture has attracted more and more attention in order to improve patient satisfaction, functional score and rapid recovery after joint replacement. Objectives: To compare the clinical effect between skin cosmetic suture and traditional method for wound closure in total knee arthroplasty(TKA). Methods: A total of 100 patients undergoing TKA from January 2017 to October 2017 were divided into two groups at random, including 35 males and 65 females, with the age ranging from 51 to 74 years old and an average of(63.3±10.5) years old. 50 patients used subcuticular suture and histoacryl topical skin adhesive(cyanoacrylate adhesive) for wound closure and the other 50 patients used traditional method(skin staples and wound drainage) for wound closure. The main outcomes included Hollander wound evaluating score(HWES) and patient-observer scar assessment score(POSAS). The secondary outcomes included incision complications like red and swollen, effusion, dehiscence,subcutaneous hematoma and infection, the knee's range of motion after the operation, duration of suture and the average hospital stay. The effect of the two suture methods were appraised at 2 and 12 weeks after TKA. Results: The incidence of incision complications was lower(P=0.049), the HWES and POSAS were higher(P<0.001,P=0.01), and the average hospital stay was shorter in patients of skin cosmetic suture than in patients of traditional method(P=0.045). There was no difference in the duration of suture,pain scores and range of motion between the two groups(P>0.05). Conclusions: Compared with the traditional method, skin cosmetic suture has many advantages of good safety and efficacy, easy operation, short hospital stay and high patient satisfaction.
引文
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[13]孔祥朋,王岩,柴伟,等.人工全髋关节置换术中应用组织胶水与传统缝合法的比较研究.中国修复重建外科杂志,2016,30(12):25-29.
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[16]Zhou K,Wang H,Li J,et al.Non-drainage versus drainage in tourniquet-free knee arthroplasty:a prospective trial.ANZ J Surg,2017,87(12):1048-1052.
[17]Watanabe T,Muneta T,Yagishita K,et al.Closed suction drainage is not necessary for total knee arthroplasty:a prospective study on simultaneous bilateral surgeries of a mean follow-up of 5.5 years.J Arthroplasty,2016,31(3):641-645.
[18]Glennie RA,Korczak A,Naudie DD,et al.MONOCRYLand DERMABOND vs staples in total hip arthroplasty performed through a lateral skin incision:a randomized controlled trial using a patient-centered assessment tool.J Arthroplasty,2017,32(8):2431-2435.
[19]Khan RJ,Fick D,Yao F,et al.A comparison of three methods of wound closure following arthroplasty:a prospective,randomised,controlled trial.J Bone Joint Surg Br,2006,88(2):238-242.
[20]Ando M,Tamaki T,Yoshida M,et al.Surgical site infection in spinal surgery:a comparative study between 2-octyl-cyanoacrylate and staples for wound closure.Eur Spine J,2014,23(4):854-862.
[21]Buchweitz O,Frye C,Moeller CP,et al.Cosmetic outcome of skin adhesives versus transcutaneous sutures in laparoscopic port-site wounds:a prospective randomized controlled trial.Surg Endosc,2016,30(6):2326-2331.
[22]Hivnor CM,Hudkins ML.Allergic contact dermatitis after postsurgical repair with 2-octylcyanoacrylate.Arch Dermatol,2008,144(6):814-815.
[23]El-Dars LD,Chaudhury W,Hughes TM,et al.Allergic contact dermatitis to Dermabond after orthopaedic joint replacement.Contact Dermatitis,2010,62(5):315-317.
[2]Iorio R,Clair AJ,Inneh IA,et al.Early results of medicare's bundled payment initiative for a 90-day total joint arthroplasty episode of care.J Arthroplasty,2016,31(2):343-350.
[3]Pugely AJ,Martin CT,Gao Y,et al.The incidence of and risk factors for 30-day surgical site infections following primary and revision total joint arthroplasty.J Arthroplasty,2015,30(9 Suppl):47-50.
[4]Sadoghi P,Liebensteiner M,Agreiter M,et al.Revision surgery after total joint arthroplasty:a complication-based anal‐ysis using worldwide arthroplasty registers.J Arthroplasty,2013,28(8):1329-1332.
[5]Eggers MD,Fang L,Lionberger DR.A comparison of wound closure techniques for total knee arthroplasty.J Arthroplasty,2011,26(8):1251-1258
[6]康焱,周宗科,杨惠林,等.中国骨科手术加速康复切口管理指南.中华骨与关节外科杂志,2018,11(1):3-10.
[7]Lorenzetti AJ,Wongworawat MD,Jobe CM,et al.Cyanoacrylate microbial sealant may reduce the prevalence of positive cultures in revision shoulder arthroplasty.Clin Orthop Relat Res,2013,471(10):3225-3229.
[8]李强,黄婉琳,房洁渝.皮肤粘合剂与可吸收缝线在手术伤口愈合的应用比较.中华临床医师杂志,2011,5(17):5205-5206.
[9]Heuer F,Ulrich S,Claes L,et al.Biomechanical evaluation of conventional anulus fibrosus closure methods required for nucleus replacement.J Neurosurg Spine,2008,9(3):307-313.
[10]Miller AG,Swank ML.Dermabond efficacy in total joint arthroplasty wounds.Am J Orthop,2010,39(10):476-478.
[11]Imbuldeniya AM,Rashid A,Murphy JP.A comparison of 2-octyl cyanoacrylate with nylon for wound closure of knee arthroscopy portals.J Wound Care,2014,23(9):456-460.
[12]El-Gazzar Y,Smith DC,JK Sun,et al.The use of dermabond?as an adjunct to wound closure after total knee arthroplasty:examiningimmediate post-operative wound drainage.J Arthroplasty,2013,28(4):553-556.
[13]孔祥朋,王岩,柴伟,等.人工全髋关节置换术中应用组织胶水与传统缝合法的比较研究.中国修复重建外科杂志,2016,30(12):25-29.
[14]Draaijers LJ,Tempelman FR,Botman YA,et al.The patient and observer scar assessment scale:a reliable and feasible tool for scar evaluation.Plast Reconstr Surg,2004,113(7):1960-1965;discussion 1966-1967.
[15]Nicholas RS,Falvey H,Lemonas P,et al.Patient-related keloid scar assessment and outcome measures.Plast Reconstr Surg,2012,129(3):648-656.
[16]Zhou K,Wang H,Li J,et al.Non-drainage versus drainage in tourniquet-free knee arthroplasty:a prospective trial.ANZ J Surg,2017,87(12):1048-1052.
[17]Watanabe T,Muneta T,Yagishita K,et al.Closed suction drainage is not necessary for total knee arthroplasty:a prospective study on simultaneous bilateral surgeries of a mean follow-up of 5.5 years.J Arthroplasty,2016,31(3):641-645.
[18]Glennie RA,Korczak A,Naudie DD,et al.MONOCRYLand DERMABOND vs staples in total hip arthroplasty performed through a lateral skin incision:a randomized controlled trial using a patient-centered assessment tool.J Arthroplasty,2017,32(8):2431-2435.
[19]Khan RJ,Fick D,Yao F,et al.A comparison of three methods of wound closure following arthroplasty:a prospective,randomised,controlled trial.J Bone Joint Surg Br,2006,88(2):238-242.
[20]Ando M,Tamaki T,Yoshida M,et al.Surgical site infection in spinal surgery:a comparative study between 2-octyl-cyanoacrylate and staples for wound closure.Eur Spine J,2014,23(4):854-862.
[21]Buchweitz O,Frye C,Moeller CP,et al.Cosmetic outcome of skin adhesives versus transcutaneous sutures in laparoscopic port-site wounds:a prospective randomized controlled trial.Surg Endosc,2016,30(6):2326-2331.
[22]Hivnor CM,Hudkins ML.Allergic contact dermatitis after postsurgical repair with 2-octylcyanoacrylate.Arch Dermatol,2008,144(6):814-815.
[23]El-Dars LD,Chaudhury W,Hughes TM,et al.Allergic contact dermatitis to Dermabond after orthopaedic joint replacement.Contact Dermatitis,2010,62(5):315-317.