皮内缝合联合皮肤黏合剂关闭切口对全膝关节置换术患者预后的影响

陈 静　单 燕　陈 敏

[關键词]全膝关节置换术;皮内缝合;皮肤黏合剂;切口愈合;瘢痕;膝关节活动度

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2021）12-0017-05

Effect of Intradermal Suture Combined with Skin Adhesive Closing Incision on Prognosis of Patients Undergoing Total Knee Arthroplasty

CHEN Jing，SHAN Yan，CHEN Min

（Department of Orthopedics，No.904 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army，Wuxi 214041，Jiangsu，China）

Abstract： Objective  To explore the effect of intradermal suture combined with skin adhesive to close the incision on incision healing， scarring and knee joint range of motion in patients undergoing total knee arthroplasty （TKA）. Methods  A total of 114 patients （126 knees） underwent TKA in our hospital from May 2017 to June 2019 were selected and divided into the observation group and the control group according to the random number table method. Fifty-seven cases （64 knees） with intradermal suture combined with skin adhesive to close the incision were used as the observation group， and 57 cases （62 knees） with traditional suture to close the incision were used as the control group. The incision suture time， the number of dressing changes， the length of hospital stay， the postoperative incision pain （VAS） score， and the Hollander wound evaluating score （HWES） ， patient scar assessment score （PSAS）， observer scar assessment score （OSAS）， and range of motion of the knee joint before and after the operation were compared between the two groups， and the incision complications and the patient's satisfaction with the incision aesthetics were statistically compared of the two groups. Results  The dressing change times and hospital stay in the observation group were shorter than those in the control group， the differences were statistically significant （P<0.05）. The VAS score of the incision in the observation group was lower than those of the control group at 3，5，and 7 days after operation and at discharge （P<0.05）. The HWES score of the observation group was higher than that of the control group at 1，2，6，12 and 24 weeks after operation， and the PSAS and OSAS scores were lower than those of the control group （P<0.05）. The knee extension， flexion and flexion radian of the two groups were significantly improved at 12 and 24 weeks after operation （P<0.05）. But there was no significant difference between the two groups （P>0.05）. The incidence of incision complications in the observation group was lower than that in the control group （P<0.05）. The patients' satisfaction with incision aesthetics in the observation group was higher than that in the control group （P<0.05）. Conclusion  Intradermal suture combined with skin adhesive to close the incision can shorten the hospital stay of TKA patients， reduce the number of dressing changes， reduce postoperative pain， promote incision healing， knee joint function recovery， and improve incision scars. Patients are highly satisfied with the appearance of the incision.

Key words： total knee arthroplasty; intradermal suture; skin adhesive; incision healing; scar; knee joint range of motion

全膝关节置换术（Total knee arthroplasty，TKA）为国内外较为成熟的纠正膝关节畸形、改善膝关节功能的外科处理方法，美国预计到2030年TKA数量将达350万例[1-3]。但据统计，受疼痛、感染、瘢痕外观、切口等相关并发症的影响，TKA不满意率高达20%[4]。减少疼痛、并发症及遗留较小瘢痕可提高TKA患者满意度。骨科手术缝合方式各有优劣、缝合材料也种类繁多，而TKA术中组织缝合方式、缝合材料选择还需要进行大量临床研究。相关文献指出，皮内缝合无需对皮肤层进行缝合，可减少活动过程中产生的张力，有助于减少切口牵拉造成的术后疼痛。但该方法未完全封闭切口，随着生物胶皮肤黏合剂在外科领域的出现，可更好弥补传统关闭切口方法不足，在颌面部微小创口应用中已取得满意效果[5]。因TKA切口较长，局部张力较大，术后早期进行功能锻炼时能否提供足够张力保持创面闭合性值得临床进一步深入探究。基于此，本研究尝试从切口愈合、瘢痕、美观满意度、并发症及膝关节活动度等方面探讨皮内缝合联合皮肤黏合剂关闭切口在TKA中的应用价值。

1  资料和方法

1.1 一般资料：选取笔者医院2017年5月-2019年6月行TKA患者114例（126膝），按照随机数字表法分为观察组57例（64膝）与对照组57例（62膝）。两组患者年龄、体质量、性别、疾病类型、患肢位置、并发症情况比较差异无统计学意义（P>0.05），均衡可比，见表1。……