探究新型倒刺缝线对初次人工全膝置换(TKA)术后早期功能和疼痛的影响。

选取自2017年1月至2018年1月于哈尔滨医科大学附属第四医院骨科行初次TKA手术的患者82例(纳入标准：内外翻畸形<20°、BMI<35 kg/m²；排除标准：术区皮肤条件较差、合并有原发性或继发性下肢血管病变者、膝关节僵直者、近期行关节腔内药物注射治疗者或小针刀治疗者、长期服用免疫抑制剂、细胞抑制剂、激素类或抗凝等药物治疗者、病例资料不全者)，按照其切口缝合方式不同将其分为倒刺缝线组和常规缝合组，评估两组患者3个月内膝关节功能状态、疼痛情况，记录两组患者围手术期情况，并采用t检验比较计量资料、采用卡方检验比较计数资料。

两组患者切口长度、曲马多使用量、平均住院时间以及术后并发症比较无明显差异(P>0.05)；倒刺缝线组缝合时间和术中引流量明显少于常规缝合组(t＝2.713、4.896，P<0.05)。两组患者术后视觉模拟疼痛评分(VAS)较术前有明显改善，且均呈明显下降趋势；常规缝合组患者VAS评分在术后3 d、1周及2周时明显低于倒刺缝线组(t＝3.235、4.359、4.269，P<0.05)；术后6周及12周时，两组患者VAS评分无明显差异(P>0.05)。两组患者术后美国特种外科医院膝关节评分(HSS)和关节活动范围(ROM)均呈明显上升趋势，且常规缝合组患者在术后3 d、1周及2周时的HSS评分和ROM均高于倒刺缝线组(t＝3.374、2.487、3.803，t＝3.300、2.068、2.356，P<0.05)；术后6周及12周时，两组患者HSS评分及ROM无明显差异(P>0.05)。

采用新型倒刺缝线关闭TKA手术切口在术后2周内的功能锻炼时疼痛程度较强、膝关节活动度和功能恢复较差，在术后6周和12周时的疗效与常规缝合组基本一致；此外新型倒刺缝线可明显缩短缝合时间和减少术中出血量，对降低切口并发症、静息痛以及缩短住院时间无明显益处。

To explore the effect of new barbed suture on early function and pain after primary total knee arthroplasty.

From January 2017 to January 2018, 82 patients with first TKA operation in orthopaedics department of the Fourth Affiliated Hospital of Harbin Medical University were selected(inclusion criteria: valgus deformity <20 °, BMI <35 kg/m²; exclusion criteria: poor skin condition, patients with primary or secondary lower extremity vascular disease, knee joint stiffness, recent intra-articular drug injection or small needle knife therapy, long-term use of immunosuppressive agents, cell inhibitors, hormones or anticoagulants, and incomplete case data). According to the different ways of incision suture, they were divided into the barbed suture group and the routine suture group. The knee joint function and pain of the two groups were evaluated within three months, and the perioperative conditions of the two groups were recorded. The measurement data were compared by t-test and counted data were analyzed by chi-square test.

There was no significant difference in incision length, tramadol usage, average hospitalization time and postoperative complications between the two groups (P >0.05); the suture time and intraoperative drainage volume in the barbed suture group were significantly less than those in the conventional suture group (t=2.713, 4.896, P <0.05). The visual analogue scale (VAS) score of the two groups were significantly improved after the operation and showed a downward trend. The VAS score of the routine suture group was significantly lower than that of the barbed suture group at the 3^rd day, one week, and two weeks postoperatively (t=3.235, 4.359, 4.269, P <0.05). There was no significant difference in VAS score between the two groups at six weeks and 12 weeks after the operation (P >0.05). The Hospital for Special Surgery (HSS) score and range of motion(ROM )of the two groups increased significantly after the operation, and the HSS score and ROM of the conventional suture group were higher than those of the barbed suture group at the 3^rd day, one week, and two weeks postoperatively (t=3.374, 2.487, 3.803, t =3.300, 2.068, 2.356, P<0.05). There was no significant difference in HSS score and ROM between the two groups at six weeks and 12 weeks after operation (P>0.05).

The TKA incision closed with a new type of barbed suture presents strong pain, poor knee joint mobility and functional recovery during functional exercise within two weeks after the operation. The curative effect at six and 12 weeks after the operation is basically the same as that of the conventional suture. The new barbed suture can significantly shorten the suture time and reduce the amount of bleeding during the operation, and has no obvious benefit in reducing incision complications, resting pain or shortening hospital stay.