Feng Shuo, Zhang Ye, Zhang Feng, Yang Zhi, Chen Xiang-Yang, Zha Guo-Chun
Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China (mainland).
Postgraduate Department, Harbin Medical University, Harbin, Heilongjiang, China (mainland).
Med Sci Monit. 2020 Aug 5;26:e922783. doi: 10.12659/MSM.922783.
BACKGROUND The use of barbed suture in total knee arthroplasty (TKA) remains controversial. We performed a prospective study to investigate the clinical outcomes of bidirectional barbed suture for incision closure in TKA. MATERIAL AND METHODS We conducted a single-center, randomized controlled trial to determine the efficiency and safety of barbed suture in TKA at our institution between December 2017 and April 2019. Eligible patients were randomly assigned to different suture methods for skin closure. Randomization was conducted via computerized randomization list. Our primary endpoint was the incidence of wound complications within 3 months of surgery. This trial was registered at ClinicalTrials.gov, number ChiCTR-IPR-17013677. RESULTS A total of 582 patients were enrolled, consisting of 193 who received full-layer barbed suture (group A), 195 who received barbed suturing of the joint capsule (group B), and 194 who received suturing of the joint capsule by traditional absorbable suture (group C). The incidence of incision complications in group A (19.7%) was significantly higher than that in group B (7.2%) and C (9.3%) (P<0.0125). The incidence rate for incision complications in group B was similar to that in group C (P>0.0125). The time for incision closure in groups A (13.5±2.0 min) and B (16.1±1.9 min) was significantly shorter than that in group C (25.0±2.0 min) (P<0.001). CONCLUSIONS The use of full-thickness bidirectional barbed suture for incision closure after TKA may increase postoperative incision complications, and therefore is not recommended. However, the use of barbed suture for the joint capsule has shown effectiveness, reducing suture time with no increase in incision complications.
背景 倒刺缝线在全膝关节置换术（TKA）中的应用仍存在争议。我们进行了一项前瞻性研究，以探讨双向倒刺缝线用于TKA切口闭合的临床效果。
材料与方法 我们于2017年12月至2019年4月在本机构开展了一项单中心随机对照试验，以确定倒刺缝线在TKA中的有效性和安全性。符合条件的患者被随机分配至不同的皮肤闭合缝合方法。随机分组通过计算机随机列表进行。我们的主要终点是术后3个月内伤口并发症的发生率。该试验已在ClinicalTrials.gov注册，注册号为ChiCTR-IPR-17013677。
结果 共纳入582例患者，其中193例接受全层倒刺缝线缝合（A组），195例接受关节囊倒刺缝线缝合（B组），194例接受传统可吸收缝线关节囊缝合（C组）。A组切口并发症发生率（19.7%）显著高于B组（7.2%）和C组（9.3%）（P<0.0125）。B组切口并发症发生率与C组相似（P>0.0125）。A组（13.5±2.0分钟）和B组（16.1±1.9分钟）的切口闭合时间显著短于C组（25.0±2.0分钟）（P<0.001）。
结论 TKA术后使用全层双向倒刺缝线进行切口闭合可能会增加术后切口并发症，因此不推荐使用。然而，倒刺缝线用于关节囊已显示出有效性，可缩短缝合时间且不增加切口并发症。
