[A randomized controlled trial of knotless barbed sutures for wound closure in short-segment posterior lumbar decompression and fusion surgery].

Objective

To evaluate the safety and efficacy of knotless barbed sutures for wound closure in elective degenerative short-segment posterior lumbar surgery.

Methods

This is a prospective randomized controlled trial study. Patients who met the inclusion and exclusion criteria undergoing elective posterior lumbar surgery at the Department of Orthopedics,Peking University Third Hospital from March 2024 to May 2025 were enrolled and randomly assigned to either the trial group or the control group using a random number table. Wound closure in the trial group was performed using barbed sutures for the deep fascia, subcutaneous, and intradermal layers; while the control group received conventional sutures. The incision length, deep fascia, subcutaneous, and intradermal wound closure times, and total wound closure time were compared between the two groups, and the suturing speed per unit length was calculated. Postoperative drainage volume, drainage tube removal time, weight of soiled dressings at the first dressing change, total length of hospital stays (LOS), postoperative LOS, wound healing status, and incidence of incision-related complications were recorded. Functional outcomes were assessed using the Japanese Orthopaedic Association (JOA) score, Oswestry disability index (ODI), and visual analog scale (VAS) for pain at the 3-month postoperative follow-up. Data analysis was taken by independent sample t test or Mann-Whitney U test, Chi-square test or Fisher exact test.

Results

A total of 114 patients were included in this study. There were 51 males and 63 females,aged (61.1±9.0)years(range:27 to 79 years). There were 57 patients in each group. No significant difference was found in incision length between the two groups ((11.0±1.8) cm vs. (11.1±1.8) cm, t=-0.399, P=0.690). The suturing speed was significantly faster in the trial group than in the control group ((1.1±0.3) min/cm vs. (1.7±0.4) min/cm, t=-7.200, P<0.01). The trial group demonstrated significantly shorter closure times for the deep fascia, subcutaneous, intradermal layer, and total wound closure time compared to the control group (all P<0.01). No significant differences were found between the two groups in terms of total operative time, total operating room time, postoperative drainage volume, drainage tube removal time, total LOS, or 3-month postoperative JOA, VAS, and ODI scores (all P>0.05). However, the trial group had a significantly shorter postoperative LOS than the control group ((6.0±1.9) d vs. (6.8±2.9) d, t=-2.391 P=0.017).

Conclusion

For short-segment posterior lumbar surgery, barbed sutures significantly reduce layered and total wound closure times and decrease postoperative hospitalization, while demonstrating non-inferiority to conventional sutures in operative duration, drainage management, complication rates, and functional outcomes.