Chan Vincent W K, Chan Ping-Keung, Chiu Kwong-Yuen, Yan Chun-Hoi, Ng Fu-Yuen
Division of Joint Replacement Surgery, Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, SAR, China.
J Arthroplasty. 2017 May;32(5):1474-1477. doi: 10.1016/j.arth.2016.12.015. Epub 2016 Dec 21.
Wound closure is key to prevent infection, facilitate immediate rehabilitation, and improve efficiency of total knee arthroplasty (TKA). Continuous knotless suturing with barbed suture can potentially save time and distribute tension more evenly. However, its role in TKA in terms of cost-effectiveness and wound complications is not clear. This study aims at comparing barbed and traditional sutures' wound closure time and cost in primary TKA.
One hundred nine knees were randomized into either barbed or traditional group. Synthetic absorbable sutures (Vicryl, Ethicon Inc) and bidirectional barbed sutures (Stratafix, Ethicon Inc) were used. Arthrotomy and subcutaneous wound closure time, wound complications, and rehabilitation parameters in terms of range of motion and Knee Society Score were compared. Patients were followed up to 3 months.
Traditional sutures had significantly more positive leak tests (10 vs 2, P value <.05) and wound complications (11 vs 2, P value <.05). No differences in range of motion and Knee Society Score were noted. Arthrotomy and subcutaneous closure time were significantly shorter with barbed sutures (arthrotomy 325 seconds vs 491 seconds; subcutaneous 306 seconds vs 381 seconds, P value <.05). Concerning cost of suture material and operation time, barbed suture on average saved USD 48.7 per TKA in our local institute.
Bidirectional barbed suture improves the cost-effectiveness of TKA through reducing wound closure time and wound complications.
伤口闭合对于预防感染、促进早期康复以及提高全膝关节置换术（TKA）的效率至关重要。使用倒刺缝线进行连续无结缝合可能会节省时间并更均匀地分布张力。然而，其在TKA中关于成本效益和伤口并发症方面的作用尚不清楚。本研究旨在比较倒刺缝线和传统缝线在初次TKA中的伤口闭合时间和成本。
109例膝关节被随机分为倒刺缝线组或传统缝线组。分别使用合成可吸收缝线（爱惜康公司的薇乔缝线）和双向倒刺缝线（爱惜康公司的Stratafix缝线）。比较关节切开术和皮下伤口闭合时间、伤口并发症以及运动范围和膝关节协会评分等康复参数。对患者进行长达3个月的随访。
传统缝线的阳性渗漏试验显著更多（10例对2例，P值<.05），伤口并发症也更多（11例对2例，P值<.05）。在运动范围和膝关节协会评分方面未发现差异。倒刺缝线的关节切开术和皮下闭合时间显著更短（关节切开术325秒对491秒；皮下306秒对381秒，P值<.05）。关于缝线材料成本和手术时间，在我们当地机构，倒刺缝线平均每例TKA节省48.7美元。
双向倒刺缝线通过减少伤口闭合时间和伤口并发症提高了TKA的成本效益。
