目的比较全层连续缝合法和分层缝合法在急诊腹部手术中的切口愈合效果。 方法将符合纳入标准的急诊腹部手术患者随机分为全层缝合组和分层缝合组，比较2组患者的切口愈合效果。 结果全层缝合组的关腹时间短于分层缝合组（P=0.000），但在切口液化发生率、切口感染发生率、总切口并发症发生率、切口愈合及术后住院时间方面，2组的差异均无统计学意义（P＞0.05）。26例细菌培养结果为阳性（全层缝合组10例，分层缝合组16例）的患者中，致病菌主要为大肠埃希菌（11例）和铜绿假单胞菌（7例）。 结论相较于分层缝合法，急诊腹部手术中采用全层缝合法既不增加切口并发症的发生率，又节省手术时间，对于危重患者具有重要的意义。
Objective To investigate the effectiveness of “hybrid” suture with en masse combined with double-layer repair under arthroscopy in repair of delaminated rotator cuff tear by comparison with en masse suture. MethodsFifty-six patients with delaminated rotator cuff tears met selection criteria between June 2020 and January 2022 were included in the study. Patients were divided into two groups (n=28) using a random number method. The patients in trial group underwent arthroscopic “hybrid” suture with the combination en masse and double-layer suture. The patients in control group underwent en masse suture under arthroscopy. There was no significant difference between the two groups (P>0.05) in terms of gender, age, rotator cuff tear side, tear size, cause of injury, disease duration, and preoperative American Association of Shoulder and Elbow Surgeons (ASES) score, the University of California at Los Angeles (UCLA) shoulder scoring, visual analogue scale (VAS) score, and shoulder range of motion (forward flexion and lateral external rotation). The operation time, the difference of ASES score, UCLA score, VAS score, and shoulder range of motion (forward flexion and lateral external rotation) between pre- and post-operation were recorded and compared between the two groups (P>0.05). The rotator cuff healing was examined by MRI and evaluated based on the classification criteria of rotator cuff healing proposed by Sugaya et al. Results Three cases (1 case in the trial group and 2 cases in the control group) were excluded from the study due to loss of follow-up. Twenty-seven cases in the trial group and 26 cases in the control group were included in the final study analysis. All operations of the two groups were completed successfully. There was no significant difference in the operation time between groups (P>0.05). The follow-up time was 10-12 months (mean, 10.9 months) in the trial group and 10-13 months (mean, 11.4 months) in the control group. All incisions healed by first intention. No surgery-related complications occurred. The UCLA score, ASES score, VAS score, and shoulder range of motion (forward flexion and lateral external rotation) of both groups at 9 months after operation were significantly superior to those before operation (P<0.05). The difference of UCLA score, ASES score, and VAS score between before and after operation in the trial group were significantly better than those in the control group (P<0.05). There was no significant differences between the two groups in the difference of shoulder range of motion (forward flexion and lateral lateral rotation) (P>0.05). At 9 months after operation, according to the classification criteria of rotator cuff healing proposed by Sugaya et al, MRI showed that the rotator cuff healing of the trial group was significantly better than that of the control group (P<0.05). Conclusion Compared with en masse suture, arthroscopic “hybrid” suture for the repair of delaminated rotator cuff tear has advantages in relieving pain and improving shoulder joint function, and the rotator cuff healing is better.