中国循证医学杂志

中国循证医学杂志

可吸收倒刺缝线与传统可吸收缝线在全膝关节置换术中应用效果的 Meta 分析

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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。

ObjectivesTo systematically review the efficacy of absorbable barbed suture versus traditional absorbable suture in total knee arthroplasty (TKA).MethodsPubMed, 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 RevMan 5.3 software.ResultsA total of 6 randomized controlled trials (RCTs) and 5 cohort studies were included, involving 2 008 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).ConclusionsAvailable 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.

关键词: 可吸收倒刺缝线; 传统可吸收缝线; 全膝关节置换术; 系统评价; Meta 分析; 临床研究; 关节囊缝合时间; 并发症

Key words: Absorbable barbed suture; Traditional absorbable suture; Total knee arthroplasty; Systematic review; Meta-analysis; Clinical trial; Suture time of joint capsule; Complication

引用本文: 王亚飞, 廖云健, 刘慧敏, 张志涛, 李红喜, 逯代锋, 董锋, 廉永云. 可吸收倒刺缝线与传统可吸收缝线在全膝关节置换术中应用效果的 Meta 分析. 中国循证医学杂志, 2018, 18(10): 1101-1108. doi: 10.7507/1672-2531.201801075 复制

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