Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Changping District, Beijing, China.
J Knee Surg. 2021 Dec;34(14):1516-1526. doi: 10.1055/s-0040-1710373. Epub 2020 May 27.
Newer methods of wound closure such as barbed sutures hold the potential to reduce closure time and equivalent wound complications in various surgeries. However, few studies have compared barbed suture and conventional wound closure techniques in total knee arthroplasty (TKA). The purpose of this review was to appraise the efficacy and safety of the barbed suture in closure of TKA. We conducted a meta-analysis to identify relevant randomized-controlled trials involving barbed sutures and conventional sutures in TKA in electronic databases, including Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, Wanfang database, up to August 2019. Finally, we identified 1,472 TKAs (1,270 patients) assessed in 13 randomized-controlled trials. Compared with conventional wound closure techniques, barbed sutures resulted in shorter total wound closure time ( < 0.001), fewer needle puncture injuries to members of the surgical team ( = 0.02). There were no significant differences in terms of blister formation ( = 1.0), superficial infection ( = 0.82), range of motion ( = 0.94), incisional exudate ( = 0.75), suture abscess ( = 0.26), or suture breakage ( = 0.11), wound-related complications ( = 0.10), ecchymosis ( = 0.08) between barbed and conventional wound closure. Based on the available level I evidence, we thus conclude that a knotless barbed suture is a safe and effective approach for wound closure in TKA. Given the relevant possible biases in our meta-analysis, more adequately powered and better-designed randomized-controlled trials studies with long-term follow-up are required to recommend barbed sutures for routine administration in TKA.
新型的伤口闭合方法，如带倒刺的缝线，有可能缩短各种手术的闭合时间和等效的伤口并发症。然而，很少有研究比较过带倒刺缝线和传统的全膝关节置换术（TKA）伤口闭合技术。本综述的目的是评估带倒刺缝线在 TKA 中的闭合效果和安全性。我们进行了一项荟萃分析，以确定电子数据库中涉及 TKA 中带倒刺缝线和传统缝线的相关随机对照试验，包括 Web of Science、Embase、PubMed、Cochrane 对照试验登记处、Cochrane 图书馆、Highwire、CBM、CNKI、VIP、万方数据库，截至 2019 年 8 月。最后，我们确定了 13 项随机对照试验评估的 1472 例 TKA（1270 例患者）。与传统的伤口闭合技术相比，带倒刺缝线可使总伤口闭合时间更短（ < 0.001），减少手术团队成员的针穿刺损伤（ = 0.02）。在水疱形成（ = 1.0）、浅表感染（ = 0.82）、运动范围（ = 0.94）、切口渗出物（ = 0.75）、缝线脓肿（ = 0.26）和缝线断裂（ = 0.11）、伤口相关并发症（ = 0.10）、瘀斑（ = 0.08）方面，带倒刺缝线与传统缝线之间无显著差异。基于现有的一级证据，我们得出结论，无结带倒刺缝线是 TKA 伤口闭合的一种安全有效的方法。鉴于我们的荟萃分析中存在相关的偏倚，需要更多具有长期随访的充分效能和设计更好的随机对照试验研究来推荐带倒刺缝线用于 TKA 的常规应用。
