Glassman S D, Anagnost S C, Parker A, Burke D, Johnson J R, Dimar J R
Departments of Orthopaedic and Neurological Surgery, University of Louisville School of Medicine, and the Kenton D. Leatherman Spine Center, Louisville, Kentucky 40202, USA.
Spine (Phila Pa 1976). 2000 Oct 15;25(20):2608-15. doi: 10.1097/00007632-200010150-00011.
The effect of cigarette smoking and smoking cessation on spinal fusion was studied in a retrospective review of 357 patients who had undergone instrumented spinal fusion.
To document the widely assumed but unreported benefit of cigarette smoking cessation on fusion rate and clinical outcome after spinal fusion surgery.
Cigarette smoking has been shown to inhibit lumbar spinal fusion and to adversely effect outcome in treatment of lumbar spinal disorders. Prior reports have compared smokers and nonsmokers, as opposed to comparing smokers and quitters.
This study retrospectively identified 357 patients who underwent a posterior instrumented fusion at either L4-L5 or L4-S1 between 1992 and 1996. Analysis of the medical record and follow-up telephone surveys were conducted. Clinical outcome and fusion status was analyzed in relation to preoperative and postoperative smoking parameters.
In this study, the nonunion rate was 14.2% for nonsmokers and 26.5% for patients who continued to smoke after surgery (P < 0.05). Patients who quit smoking after surgery for longer than 6 months had a nonunion rate of 17.1%. The nonunion rate was not significantly affected by either the quantity that a patient smoked before surgery or the duration of preoperative smoking abatement. Return-to-work was achieved in 71% of nonsmokers, 53% of nonquitters, and 75% of patients who quit smoking for more than 6 months after surgery.
These results validate the hypothetical assumption that postoperative smoking cessation helps to reverse the impact of cigarette smoking on outcome after spinal fusion.
通过对357例行器械辅助脊柱融合术患者的回顾性分析，研究吸烟及戒烟对脊柱融合的影响。
记录戒烟对脊柱融合术后融合率及临床疗效的益处，尽管这一益处被广泛假定但此前未被报道。
吸烟已被证明会抑制腰椎融合，并对腰椎疾病的治疗效果产生不利影响。既往报告多比较吸烟者与不吸烟者，而非吸烟者与戒烟者。
本研究回顾性纳入了1992年至1996年间在L4-L5或L4-S1行后路器械辅助融合术的357例患者。对病历进行分析并进行随访电话调查。根据术前和术后吸烟参数分析临床疗效及融合情况。
本研究中，不吸烟者的骨不连率为14.2%，术后继续吸烟者的骨不连率为26.5%（P<0.05）。术后戒烟超过6个月的患者骨不连率为17.1%。术前吸烟量及术前戒烟时长对骨不连率均无显著影响。不吸烟者的复工率为71%，未戒烟者为53%，术后戒烟超过6个月的患者为75%。
这些结果证实了如下假设，即术后戒烟有助于扭转吸烟对脊柱融合术后疗效的影响。
