Rui Min, Zheng Xin, Sun Shao-Song, Li Cheng-Yu, Zhang Xing-Chen, Guo Kai-Jin, Zhao Feng-Chao, Pang Yong
Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou - China.
Min Rui and Xin Zheng equally contributed to this work.
Hip Int. 2018 Jan;28(1):101-105. doi: 10.5301/hipint.5000534.
As an essential step of total hip arthroplasty (THA), an effective and secure skin closure technique after primary THA is important. Metallic staples closure and subcuticular suture are the 2 common techniques for skin closure. However, which closure technique is the optimal skin-closure method remains unclear. The purpose of this prospective randomised clinical study was to compare the clinical outcomes and costs between staples and subcuticular suture techniques.
In this clinical study, 165 patients who underwent primary unilateral THA through a posterolateral approach from August 2014 to May 2015 were included. According to skin closure technique, the patients were randomised into staples group (interrupted suture with staples, 83 cases) and sutures group (running 4-0 absorbable subcuticular suture, 82 cases). The same operative and perioperative care were provided to all patients. The surgical site infections (SSIs) rate, closure time, time to dry wounds and postoperative hospital stay were recorded and compared. Besides, cosmetic results and patient's satisfaction were evaluated with Hollander wound evaluation score (HWES) and VAS score at postoperative 3 months follow-up respectively. Relative total costs were recorded as well.
It was shown that no infections developed in sutures group, while 2 postoperative superficial infections (2.4%) occurred in the staples group. There was a statistically significant difference in the time to dry surgical incisions and postoperative hospital stay favoring sutures (4.8 vs. 5.0 days, p = 0.028; 6.0 vs. 12.0 days, p<0.001, respectively). The cutaneous incision closure using staples consumed significantly less time than that with subcuticular suture (24.7 vs. 357.7 seconds, p<0.001). Moreover, there was no significant difference in HWES and patient's satisfaction between the 2 groups. Finally, the application of subcuticular suture saved an average of $82.2 per case.
Closure with running subcuticular suture is cheaper and appears to have a clinical advantage when compared with metallic staples skin closure in primary THA surgery. However, additional operating time may be incurred.
作为全髋关节置换术（THA）的重要步骤，初次全髋关节置换术后有效且安全的皮肤闭合技术至关重要。金属吻合钉闭合和皮下缝合是两种常见的皮肤闭合技术。然而，哪种闭合技术是最佳的皮肤闭合方法仍不明确。这项前瞻性随机临床研究的目的是比较吻合钉和皮下缝合技术的临床结果及成本。
在这项临床研究中，纳入了2014年8月至2015年5月期间通过后外侧入路接受初次单侧全髋关节置换术的165例患者。根据皮肤闭合技术，将患者随机分为吻合钉组（用吻合钉间断缝合，83例）和缝合组（连续4-0可吸收皮下缝合，82例）。所有患者均接受相同的手术及围手术期护理。记录并比较手术部位感染（SSIs）率、闭合时间、伤口干燥时间及术后住院时间。此外，分别在术后3个月随访时用霍兰德伤口评估评分（HWES）和视觉模拟评分（VAS）评估美容效果和患者满意度。同时记录相对总成本。
结果显示，缝合组未发生感染，而吻合钉组发生了2例术后浅表感染（2.4%）。在手术切口干燥时间和术后住院时间方面，缝合组具有统计学显著差异（分别为4.8天对5.0天，p = 0.028；6.0天对12.0天，p<0.001）。使用吻合钉进行皮肤切口闭合比皮下缝合消耗的时间显著更少（24.7秒对357.7秒，p<0.001）。此外，两组在HWES和患者满意度方面无显著差异。最后，皮下缝合的应用平均每例节省82.2美元。
在初次全髋关节置换手术中，连续皮下缝合闭合比金属吻合钉皮肤闭合更便宜，且似乎具有临床优势，但可能会增加手术时间。
