Hlubek R, Walder P, Káňa J, Salounová D
Ortopedické oddělení FN Ostrava.
Acta Chir Orthop Traumatol Cech. 2014;81(3):233-7.
Surgical incision closure, as well as total joint replacement itself, plays a key role in the overall outcome of an arthroplasty procedure. Uncomplicated wound healing is the essential condition of successful rehabilitation and the patient's return to normal activities. Although there are many innovative suturing techniques which offer advantages, their safety is still being discussed. The aim of this prospective non-blind randomised study was to evaluate wound healing and complications in relation to skin incision closure with either conventional suture or metal staples.
A total of 72 patients, 21 men and 51 women, who underwent a standard primary total knee arthroplasty (TKA) at our department in the period from January till June 2013, were evaluated. They were allocated to two groups by random assignment based on the patient's date of birth (even or odd day of birth). In group 1 (n=39) skin was closed using metal staples (Leukosan Skin Stapler), in group 2 (n=33), conventional continuous Donati suture was used. The groups, previously assessed as independent and comparable in terms of age, gender and BMI, were compared in the following criteria: suturing time, duration of wound drainage, wound healing, complications, resuturing when necessary, and their relation to the body mass index, skin plica thickness and co-morbidities potentially complicating soft tissue healing. The differences were statistically evaluated by parametric and non-parametric tests, i.e., the median test, χ(2)-test, Student's t-test, Fisher's exact test and Pearson's correlation coefficient. The statistical significance of differences was set at a level of 0.05.
A significant difference (p<0.005) between the groups was found in suturing time; the median time for staples was 81 sec in comparison with 290 sec for conventional suture. In both groups, staples or sutures were removed on the 12 th postoperative day and there was no difference in wound drainage (median time, 5 days; p=0.891 for both). Treatment for late discharge was required in two sutured wounds (6.1%) and in three stapled wounds (7.7%). One of the latter was due to early deep wound infection, which later resulted in revision TKA. The groups did not differ in the values of either BMI or plica thickness (Pearson's r).
Views on alternative suture techniques for skin closure in orthopaedic surgery vary. In this study, the use of metal staples or conventional suture is compared between two groups of patients undergoing TKA, i.e., the same type of procedure. The advantage of staples involves a quick and simple application but, as reported, removal may be more painful with staples than with stitches, and much depends on the technique of staple application. The continuous suture technique may produce skin strangulation at wound margins, which will complicate healing. Staples minimise this risk and are therefore commonly used in TKA surgery. However, only very few studies comparing these two suture techniques in TKA patients have been published.
Correctly performed skin suturing by means of metal staples is not associated with a higher complication rate and is therefore a simple, rapid, efficient and economical alternative to the conventional suture technique.
手术切口闭合以及全关节置换本身，在关节置换手术的整体结果中起着关键作用。伤口顺利愈合是成功康复以及患者恢复正常活动的必要条件。尽管有许多创新的缝合技术具有优势，但其安全性仍在讨论之中。这项前瞻性非盲随机研究的目的是评估采用传统缝线或金属吻合钉进行皮肤切口闭合时的伤口愈合情况及并发症。
对2013年1月至6月期间在我院接受标准初次全膝关节置换术（TKA）的72例患者进行评估，其中男性21例，女性51例。根据患者出生日期（出生日期为偶数或奇数）随机分为两组。第1组（n = 39）使用金属吻合钉（Leukosan皮肤吻合器）闭合皮肤，第2组（n = 33）使用传统的连续多纳蒂缝线。这两组在年龄、性别和BMI方面先前被评估为独立且具有可比性，对其进行以下标准的比较：缝合时间、伤口引流持续时间、伤口愈合情况、并发症、必要时再次缝合情况，以及它们与体重指数（BMI）、皮肤皱襞厚度和可能使软组织愈合复杂化的合并症之间的关系。通过参数检验和非参数检验对差异进行统计学评估，即中位数检验、χ²检验、学生t检验、费舍尔精确检验和皮尔逊相关系数。差异的统计学显著性设定为0.05水平。
两组在缝合时间上存在显著差异（p < 0.005）；吻合钉的中位时间为81秒，而传统缝线为290秒。两组均在术后第12天拆除吻合钉或缝线，伤口引流无差异（中位时间，5天；两组p = 0.891）。2例缝合伤口（6.1%）和3例吻合钉伤口（7.7%）需要进行延迟出院治疗。后者中有1例是由于早期深部伤口感染，后来导致了TKA翻修手术。两组在BMI值或皱襞厚度方面无差异（皮尔逊r）。
骨科手术中用于皮肤闭合的替代缝合技术的观点各不相同。在本研究中，对两组接受TKA的患者（即相同类型的手术）使用金属吻合钉或传统缝线进行了比较。吻合钉的优点是应用快速简单，但据报道，拆除吻合钉可能比拆除缝线更痛苦，而且很大程度上取决于吻合钉的应用技术。连续缝合技术可能会在伤口边缘造成皮肤绞窄，这会使愈合复杂化。吻合钉将这种风险降至最低，因此常用于TKA手术。然而，仅有极少数研究比较了TKA患者的这两种缝合技术。
正确使用金属吻合钉进行皮肤缝合不会导致更高的并发症发生率，因此是一种简单、快速、高效且经济的传统缝合技术替代方法。
