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Abstract：
BACKGROUND: Closed-incision negative pressure wound therapy (ciNPT) has shown promising effects for managing infected wounds. This meta-analysis explores the current state of knowledge on ciNPT in orthopedics and addresses whether ciNPT at -125 mmHg or -80 mmHg or conventional dressing reduces the incidence of surgical site complications in hip and knee arthroplasty.
METHODS: This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines and Cochrane Handbook. Prospective randomized controlled trials (RCTs) with ciNPT use compared to conventional dressings following hip and knee surgeries were considered for inclusion. Non-stratified and stratified meta-analyses of six RCTs were conducted to test for confounding and biases. A P value less than .05 was considered statistically significant.
RESULTS: The included six RCTs have 611 patients. Total hip and knee arthroplasties were performed for 51.7% and 48.2% of the included population, respectively. Of 611 patients, conventional dressings were applied in 315 patients and 296 patients received ciNPT. Two ciNPT systems have been used across the six RCTs; PREVENA Incision Management System (-125 mmHg) (63.1%) and PICO dressing (-80 mmHg) (36.8%). The non-stratified analysis showed that the ciNPT system had a statistically significant, lower risk of persistent wound drainage as compared to conventional dressing following total hip and knee arthroplasties (OR = 0.28; P = .002). There was no difference between ciNPT and conventional dressings in terms of wound hematoma, blistering, seroma, and dehiscence. The stratified meta-analysis indicated that patients undergoing treatment with high-pressure ciNPT (120 mmHg) displayed significantly fewer overall complications and persistent wound drainage (P = .00001 and P = .002, respectively) when compared to low-pressure ciNPT (80 mmHg) and conventional dressings. In addition, ciNPT is associated with shorter hospital stays. (P = .005).
CONCLUSIONS: When compared to conventional wound dressing and -80 mmHg ciNPT, the use of -125 mmHg ciNPT is recommended in patients undergoing total joint arthroplasty.
METHODS: This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines and Cochrane Handbook. Prospective randomized controlled trials (RCTs) with ciNPT use compared to conventional dressings following hip and knee surgeries were considered for inclusion. Non-stratified and stratified meta-analyses of six RCTs were conducted to test for confounding and biases. A P value less than .05 was considered statistically significant.
RESULTS: The included six RCTs have 611 patients. Total hip and knee arthroplasties were performed for 51.7% and 48.2% of the included population, respectively. Of 611 patients, conventional dressings were applied in 315 patients and 296 patients received ciNPT. Two ciNPT systems have been used across the six RCTs; PREVENA Incision Management System (-125 mmHg) (63.1%) and PICO dressing (-80 mmHg) (36.8%). The non-stratified analysis showed that the ciNPT system had a statistically significant, lower risk of persistent wound drainage as compared to conventional dressing following total hip and knee arthroplasties (OR = 0.28; P = .002). There was no difference between ciNPT and conventional dressings in terms of wound hematoma, blistering, seroma, and dehiscence. The stratified meta-analysis indicated that patients undergoing treatment with high-pressure ciNPT (120 mmHg) displayed significantly fewer overall complications and persistent wound drainage (P = .00001 and P = .002, respectively) when compared to low-pressure ciNPT (80 mmHg) and conventional dressings. In addition, ciNPT is associated with shorter hospital stays. (P = .005).
CONCLUSIONS: When compared to conventional wound dressing and -80 mmHg ciNPT, the use of -125 mmHg ciNPT is recommended in patients undergoing total joint arthroplasty.
摘要：
背景：闭合切口负压伤口治疗（ciNPT）已显示出处理感染伤口的有希望的效果。这项荟萃分析探讨了骨科中ciNPT的知识现状，并探讨了ciNPT在-125mmHg或-80mmHg或常规敷料下是否可以降低髋和膝关节置换术中手术部位并发症的发生率。
方法：本荟萃分析是根据系统评价和荟萃分析（PRISMA）指南和Cochrane手册的首选报告项目进行的。考虑纳入与髋关节和膝关节手术后常规敷料相比使用ciNPT的前瞻性随机对照试验（RCT）。对6个RCT进行非分层和分层荟萃分析，以检验混杂和偏差。P值小于0.05被认为具有统计学意义。
结果：纳入的6个RCT有611例患者。全髋关节和膝关节置换术占纳入人群的51.7%和48.2%，分别。611名患者中,315例患者应用了常规敷料，296例患者接受了ciNPT。在六个RCT中使用了两个ciNPT系统；PREVENA切口管理系统（-125mmHg）（63.1％）和PICO敷料（-80mmHg）（36.8％）。非分层分析表明，ciNPT系统具有统计学意义，与全髋关节和膝关节置换术后的常规敷料相比，持续伤口引流的风险较低（OR=0.28；P=0.002）。ciNPT和常规敷料在伤口血肿方面没有差异，起泡，血清肿,和裂开。分层荟萃分析表明，与低压ciNPT（80mmHg）和常规敷料相比，接受高压ciNPT（120mmHg）治疗的患者显示出明显更少的总体并发症和持续的伤口引流（分别为P=.00001和P=.002）。此外,ciNPT与住院时间较短有关。（P=.005）。
结论：与常规伤口敷料和-80mmHgciNPT相比，建议在接受全关节置换术的患者中使用-125mmHgciNPT.
方法：本荟萃分析是根据系统评价和荟萃分析（PRISMA）指南和Cochrane手册的首选报告项目进行的。考虑纳入与髋关节和膝关节手术后常规敷料相比使用ciNPT的前瞻性随机对照试验（RCT）。对6个RCT进行非分层和分层荟萃分析，以检验混杂和偏差。P值小于0.05被认为具有统计学意义。
结果：纳入的6个RCT有611例患者。全髋关节和膝关节置换术占纳入人群的51.7%和48.2%，分别。611名患者中,315例患者应用了常规敷料，296例患者接受了ciNPT。在六个RCT中使用了两个ciNPT系统；PREVENA切口管理系统（-125mmHg）（63.1％）和PICO敷料（-80mmHg）（36.8％）。非分层分析表明，ciNPT系统具有统计学意义，与全髋关节和膝关节置换术后的常规敷料相比，持续伤口引流的风险较低（OR=0.28；P=0.002）。ciNPT和常规敷料在伤口血肿方面没有差异，起泡，血清肿,和裂开。分层荟萃分析表明，与低压ciNPT（80mmHg）和常规敷料相比，接受高压ciNPT（120mmHg）治疗的患者显示出明显更少的总体并发症和持续的伤口引流（分别为P=.00001和P=.002）。此外,ciNPT与住院时间较短有关。（P=.005）。
结论：与常规伤口敷料和-80mmHgciNPT相比，建议在接受全关节置换术的患者中使用-125mmHgciNPT.
