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骨科手术后皮肤缝合使用缝线与吻合钉的比较:系统评价与荟萃分析

Comparing sutures versus staples for skin closure after orthopaedic surgery: systematic review and meta-analysis.

作者信息

Krishnan Rohin, MacNeil S Danielle, Malvankar-Mehta Monali S

机构信息

Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.

出版信息

BMJ Open. 2016 Jan 20;6(1):e009257. doi: 10.1136/bmjopen-2015-009257.

Abstract

OBJECTIVE

To determine whether there still remains a significant advantage in the use of sutures to staples for orthopaedic skin closure in adult patients.

DESIGN

Systematic Review/ Meta-Analysis.

DATA SOURCES

MEDLINE-OVID, EMBASE-OVID, CINAHL and Cochrane Library. Grey and unpublished literature was also explored by searching: International Clinical Trial Registry, Grey Matters BIOSIS Previews, Networked Digital Library of Theses and Dissertations, ClinicalTrials.gov, UK Clinical Trials Gateway, UK Clinical Research Network Study Portfolio, Open Grey, Grey Literature Report, and Web of Science.

SELECTION CRITERIA

Articles were from any country, written in English and published after 1950. We included all randomised control trials and observational studies comparing adults (≥ 18 years) undergoing orthopaedic surgery who either received staples or sutures for skin closure. The primary outcome was the incidence of surgical site infection. Secondary outcomes included closure time, inflammation, length of stay, pain, abscess formation, necrosis, discharge, wound dehiscence, allergic reaction and health-related quality of life.

RESULTS

13 studies were included in our cumulative meta-analysis conducted using Review Manager V.5.0. The risk ratio was computed as a measure of the treatment effect taking into account heterogeneity. Random-effect models were applied. There was no significant difference in infection comparing sutures to staples. The cumulative relative risk was 1.06 (0.46 to 2.44). In addition, there was no difference in infection comparing sutures to staples in hip and knee surgery, respectively. Lastly, except for closure time, there was no significant difference in secondary outcomes comparing sutures to staples.

CONCLUSIONS

Except for closure time, there was no significant difference in superficial infection and secondary outcomes comparing sutures to staples was found. Given that there may in fact be no difference in effect between the two skin closure and the methodological limitations of included studies, authors should begin to consider the economic and logistic implications of using staples or sutures for skin closure.

PROSPERO REGISTRATION NUMBER

CRD42015017481.

摘要

目的

确定在成年患者的骨科手术皮肤缝合中,使用缝线与钉合器相比是否仍存在显著优势。

设计

系统评价/荟萃分析。

数据来源

MEDLINE - OVID、EMBASE - OVID、CINAHL和Cochrane图书馆。还通过搜索以下资源探索灰色文献和未发表文献:国际临床试验注册中心、Grey Matters BIOSIS Previews、学位论文网络数字图书馆、ClinicalTrials.gov、英国临床试验网关、英国临床研究网络研究组合、Open Grey、灰色文献报告和科学网。

入选标准

文章来自任何国家,用英文撰写且发表于1950年之后。我们纳入了所有比较接受骨科手术的成年人(≥18岁)皮肤缝合时使用钉合器或缝线的随机对照试验和观察性研究。主要结局是手术部位感染的发生率。次要结局包括缝合时间、炎症、住院时间、疼痛、脓肿形成、坏死、引流、伤口裂开、过敏反应以及与健康相关的生活质量。

结果

我们使用Review Manager V.5.0进行的累积荟萃分析纳入了13项研究。计算风险比以衡量考虑异质性后的治疗效果。应用随机效应模型。比较缝线和钉合器,感染方面无显著差异。累积相对风险为1.06(0.46至2.44)。此外,在髋关节和膝关节手术中,分别比较缝线和钉合器,感染方面也无差异。最后,除缝合时间外,比较缝线和钉合器的次要结局无显著差异。

结论

除缝合时间外,比较缝线和钉合器,浅表感染和次要结局无显著差异。鉴于两种皮肤缝合方法在实际效果上可能并无差异,且纳入研究存在方法学局限性,作者应开始考虑使用钉合器或缝线进行皮肤缝合的经济和后勤意义。

PROSPERO注册号:CRD42015017481。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb7f/4735308/86e0c2ca89d4/bmjopen2015009257f01.jpg

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