Acta Orthop Belg. 2021 Mar;87(1):55-64.
High-quality and cost-effective health care are highly recommended especially in joint replacement surgeries, particularly in total hip arthroplasty. Therefore, it is indispensable for orthopaedic surgeons to spot the potential areas of quality improvement. Evaluating the efficacy of the different ways of skin closure is an unacknowledged topic. We performed this study following both the Preferred Reporting Items for Systematic Reviews and Meta- analyses Statement (PRISMA) and the Cochrane Handbook for systematic reviews and meta-analysis. Articles were from any country, written in any language. We included all randomised control trials and retrospective cohort studies undergoing primary total hip arthroplasty who either received staples or subcuticular sutures for skin closure. The primary outcome was the incidence of wound infection. Secondary outcomes included length of stay (LOS), time to skin closure, total cost, and patient's satisfaction. We included five studies in our cumulative meta- analysis. We conducted them using Review Manager V.5.0. We computed the risk ratio as a measure of the treatment effect, taking into account heterogeneity. We used Random-effect models. Primary skin closure with subcuticular sutures had insignificant marginal advantages for wound infections, LOS, and wound oozing. On the contrary, staples were more cost- effective and had less time for closure with higher patient's satisfaction. Except for closure time and patient satisfaction , no significant difference between the two groups. The use of staples after THA may have several slight clinical advantages over the subcuticular sutures. However, owing to the complexities associated with wound closure, future clinical and laboratory studies assessing their complication outlines must be examined before an optimum technique can be determined.
高质量且具有成本效益的医疗保健受到高度推荐，尤其是在关节置换手术中，尤其是全髋关节置换术。因此，骨科医生发现潜在的质量改进领域是必不可少的。评估不同皮肤缝合方式的疗效是一个未被认可的课题。我们按照系统评价和荟萃分析的首选报告项目（PRISMA）和 Cochrane 系统评价和荟萃分析手册进行了这项研究。文章来自任何国家，用任何语言撰写。我们纳入了所有接受皮肤缝合的皮肤缝合的随机对照试验和回顾性队列研究，无论是接受订书钉还是皮下缝线。主要结局是伤口感染的发生率。次要结局包括住院时间（LOS）、皮肤闭合时间、总成本和患者满意度。我们在累积荟萃分析中纳入了五项研究。我们使用 Review Manager V.5.0 进行了分析。我们计算了风险比作为治疗效果的衡量标准，并考虑了异质性。我们使用随机效应模型。皮下缝合的初级皮肤闭合在伤口感染、 LOS 和伤口渗液方面具有显著的优势。相反，订书钉更具成本效益，且闭合时间更短，患者满意度更高。除了闭合时间和患者满意度外，两组之间没有显著差异。THA 后使用订书钉可能比皮下缝合具有一些轻微的临床优势。然而，由于与伤口闭合相关的复杂性，在确定最佳技术之前，必须对评估其并发症概况的未来临床和实验室研究进行检查。
