Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
Hip Int. 2023 Jan;33(1):34-40. doi: 10.1177/11207000211012669. Epub 2021 May 2.
In the United States, over 1,000,000 total joint arthroplasty (TJA) surgeries are performed annually and has been forecasted that this number will exceed 4,000,000 by the year 2030. Many different types of dressing exist for use in TJA surgery, and it is unclear if any of the newer, hydrofibre dressings are superior to traditional dressings at reducing rates of infections or improving wound healing. Thus, the aim of this systematic review and meta-analysis was to assess the impact of hydrofiber dressings on reducing complications.
A systematic review and meta-analysis was performed using the online databases MEDLINE and the Cochrane Library. Randomized controlled trials (RCTs) comparing hydrofibre dressings to a standard dressing were included. Summary measures are reported as odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs). Our primary outcome was prosthetic joint infection (PJI). Secondary outcomes included blisters, dressing changes and wound irritation.
5 RCTs were included. Hydrofibre dressing had no observable effect on PJI or wound irritation (OR 0.53; 95% CI, 0.14-1.98; = 0.35). Hydrofibre dressings reduced the rate of blisters (OR 0.36; 95% CI, 0.14-0.90; = 0.03) and number of dressing changes (MD -1.89; 95% CI, -2.68 to -1.11).
In conclusion, evidence suggests hydrofibre dressings have no observable effect on PJI and wound irritation. Evidence for reduction in blisters and number of dressings is modest given wide CIs and biased trial methodologies. Use of hydrofibre dressings should be considered inconclusive for mitigating major complications in light of current best evidence.
在美国，每年有超过 100 万例全关节置换术（TJA），预计到 2030 年，这一数字将超过 400 万例。TJA 手术中存在许多不同类型的敷料，目前尚不清楚新型水纤维敷料是否比传统敷料更能降低感染率或促进伤口愈合。因此，本系统评价和荟萃分析旨在评估水纤维敷料在减少并发症方面的影响。
使用在线数据库 MEDLINE 和 Cochrane 图书馆进行系统评价和荟萃分析。纳入比较水纤维敷料与标准敷料的随机对照试验（RCT）。汇总指标报告为比值比（OR）和均数差（MD）及 95%置信区间（CI）。我们的主要结局是人工关节感染（PJI）。次要结局包括水疱、敷料更换和伤口刺激。
纳入 5 项 RCT。水纤维敷料对 PJI 或伤口刺激无明显影响（OR 0.53；95%CI，0.14-1.98； = 0.35）。水纤维敷料可降低水疱发生率（OR 0.36；95%CI，0.14-0.90； = 0.03）和敷料更换次数（MD-1.89；95%CI，-2.68 至-1.11）。
总之，证据表明水纤维敷料对 PJI 和伤口刺激无明显影响。鉴于试验方法学存在偏倚和宽置信区间，水疱减少和敷料更换次数减少的证据说服力不强。鉴于当前最佳证据，水纤维敷料的使用在减轻主要并发症方面的作用尚不确定。
