Sharma Gaurav, Lee Sang Wook, Atanacio Oliver, Parvizi Javad, Kim Tae Kyun
Knee Surgery and Sports Medicine, Joint Reconstruction Centre, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Seoul, 463-707, Republic of Korea.
Sidney Kimmel School of Medicine, The Rothman Institute at Thomas Jefferson University Hospital, Sheridan Building, Suite 1000, 125 S 9th Street, Philadelphia, PA, 19107, USA.
Int Orthop. 2017 Jul;41(7):1295-1305. doi: 10.1007/s00264-017-3484-4. Epub 2017 May 11.
Various types of dressing materials are available for wound care following hip and knee arthroplasty. However, it is unclear if one material is more beneficial than the others in terms of wound complications and fluid handling capacity.
We performed a meta-analysis of randomized controlled trials comparing alternative wound dressing materials for the post-operative management of wounds following THA and TKA with respect to (1) incidence of wound complications including infection and (2) fluid handling capacity.
Randomized controlled trials comparing alternative dressing materials, for post-operative management of wounds following TKA and THA were included in the review. Databases searched included the MEDLINE and the EMBASE from inception to February 2017. Two authors performed study selection, risk of bias assessment and data extraction. Where levels of clinical and statistical heterogeneity permitted, data were pooled for meta-analysis.
Twelve randomized trials with data for the primary outcome were identified. Data were available for meta-analysis for two comparisons. Wounds managed with film dressings (odds ratio, 0.35; 95% confidence interval [CI], 0.21-0.57) or with hydrofiber dressings (odds ratio, 0.28; 95% confidence interval [CI], 0.20-0.40) were significantly less likely to have wound complications than those managed with passive dressings. There was no evidence that any dressing significantly reduced surgical-site infection rates compared with any other dressing. Hydrofibre dressings showed better fluid handling capacity than passive dressings in terms of mean number of dressing changes (mean difference 1.36; 95% confidence interval [CI], 0.15-2.57) and number of patients requiring early dressing change (odds ratio, 8.60; 95% confidence interval [CI], 4.68-15.83).
The evidence available in the current literature suggests that advanced dressings such as film and Hydrofibre dressings have fewer wound complications and better fluid handling capacity. However, insufficient evidence is available to determine whether the use of these advanced dressings reduce periprosthetic joint infection.
髋膝关节置换术后伤口护理有多种敷料可供选择。然而，就伤口并发症和液体处理能力而言，尚不清楚哪种材料比其他材料更具优势。
我们对随机对照试验进行了荟萃分析，比较了全髋关节置换术（THA）和全膝关节置换术（TKA）术后伤口管理中不同伤口敷料在以下方面的差异：（1）伤口并发症（包括感染）的发生率；（2）液体处理能力。
本综述纳入了比较TKA和THA术后伤口管理中不同敷料的随机对照试验。检索的数据库包括自创建至2017年2月的MEDLINE和EMBASE。两名作者进行了研究筛选、偏倚风险评估和数据提取。在临床和统计异质性水平允许的情况下，对数据进行汇总以进行荟萃分析。
确定了12项有主要结局数据的随机试验。有两项比较的数据可用于荟萃分析。与使用被动敷料相比，使用薄膜敷料（优势比，0.35；95%置信区间[CI]，0.21 - 0.57）或水凝胶敷料（优势比，0.28；95%置信区间[CI]，0.20 - 0.40）处理的伤口发生伤口并发症的可能性显著降低。没有证据表明与任何其他敷料相比，任何一种敷料能显著降低手术部位感染率。就敷料更换的平均次数（平均差1.36；95%置信区间[CI]，0.15 - 2.57）和需要早期更换敷料的患者数量（优势比，8.60；95%置信区间[CI]，4.68 - 15.83）而言，水凝胶敷料比被动敷料显示出更好的液体处理能力。
当前文献中的证据表明，薄膜和水凝胶等高级敷料伤口并发症更少，液体处理能力更好。然而，尚无足够证据确定使用这些高级敷料是否能降低假体周围关节感染。
