Santiago-Torres Juan, Flanigan David C, Butler R Bryan, Bishop Julie Y
OSU Sports Medicine and Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA.
Department of Orthopaedics, Medical University of South Carolina, Charleston, South Carolina, USA.
Am J Sports Med. 2015 Mar;43(3):745-51. doi: 10.1177/0363546514533776. Epub 2014 May 23.
Several orthopaedic conditions have been reported to be adversely affected by smoking. Only a few studies have looked at outcomes related to smoking in shoulder surgery.
PURPOSE/HYPOTHESIS: To determine whether smoking has a negative influence on tendinous, ligamentous, and cartilaginous shoulder surgery. The hypothesis was that smoking has a negative influence from both a basic science and clinical outcomes perspective on soft tissue shoulder surgery.
Systematic review.
A systematic review of multiple medical databases was performed evaluating clinical outcomes and basic science studies to determine the effects of smoking on tendinous, ligamentous, and cartilaginous shoulder surgery. The search strategy was based on "shoulder AND [smoke OR smoking OR nicotine OR tobacco]." English language clinical outcomes or basic science studies following soft tissue surgery of the shoulder were included. Studies excluded consisted of those with evidence level 5, partial or total shoulder arthroplasty, fracture reduction and fixation, oncologic mass excision, and osteotomy around the shoulder.
Ten studies were identified for inclusion and analysis. Eight of these studies, which included 1 basic science study, investigated the relationship between smoking and outcomes of rotator cuff repair (RCR), and 2 examined the effects of smoking on outcomes of glenoid labrum repair. No studies were found that specifically explored the effects of smoking on cartilaginous shoulder surgery. The basic science study and 3 of the 7 clinical outcomes studies investigating smoking and rotator cuff (RTC) surgery outcomes found a statistically significant negative association resulting in decreased RTC tendon repair quality, decreased biomechanics, poorer clinical outcomes, and impaired healing of small-medium RTC tears as assessed by magnetic resonance imaging. In addition, 1 of 2 clinical outcomes studies examining smoking and glenoid labrum repair reported an increased need for surgical revision of superior labral anterior to posterior (SLAP) tears in smokers. No basic science studies were found that investigated the effects of smoking on glenoid labrum surgery.
Smoking has a negative influence on RCR clinical outcomes and is associated with decreased healing of small-medium RTC tears after repair. The current literature suggests a negative influence of nicotine and smoking on RCR from both a basic science and clinical outcomes perspective. Smoking cessation would benefit patients undergoing RCR and improve clinical outcomes. The relationship of smoking and labral/SLAP repair or articular cartilage is less clear. Further research is needed to evaluate associations with these surgeries and outcomes.
Smoking has a negative influence on RCR clinical outcomes and is associated with decreased healing of small-medium RTC tears after repair.
据报道，多种骨科疾病会受到吸烟的不利影响。仅有少数研究关注了肩部手术中与吸烟相关的结果。
目的/假设：确定吸烟是否会对肩部肌腱、韧带和软骨手术产生负面影响。假设是，从基础科学和临床结果的角度来看，吸烟会对肩部软组织手术产生负面影响。
系统评价。
对多个医学数据库进行系统评价，评估临床结果和基础科学研究，以确定吸烟对肩部肌腱、韧带和软骨手术的影响。检索策略基于“肩部 AND [吸烟 OR 抽烟 OR 尼古丁 OR 烟草]”。纳入肩部软组织手术后的英文临床结果或基础科学研究。排除的研究包括证据等级为5级的研究、部分或全肩关节置换术、骨折复位与固定、肿瘤肿块切除以及肩部周围截骨术。
确定了10项研究纳入分析。其中8项研究（包括1项基础科学研究）调查了吸烟与肩袖修复（RCR）结果之间的关系，2项研究考察了吸烟对盂唇修复结果的影响。未发现专门探讨吸烟对肩部软骨手术影响的研究。基础科学研究以及7项调查吸烟与肩袖（RTC）手术结果的临床结果研究中的3项发现，存在统计学上显著的负相关，导致RTC肌腱修复质量下降、生物力学性能降低、临床结果较差，以及磁共振成像评估显示中小型RTC撕裂的愈合受损。此外，2项调查吸烟与盂唇修复的临床结果研究中的1项报告称，吸烟者中上盂唇从前到后（SLAP）撕裂的手术翻修需求增加。未发现调查吸烟对盂唇手术影响的基础科学研究。
吸烟会对RCR临床结果产生负面影响，且与修复后中小型RTC撕裂的愈合减少有关。当前文献表明，从基础科学和临床结果的角度来看，尼古丁和吸烟会对RCR产生负面影响。戒烟将使接受RCR的患者受益并改善临床结果。吸烟与盂唇/SLAP修复或关节软骨之间的关系尚不清楚。需要进一步研究来评估与这些手术及结果的关联。
吸烟会对RCR临床结果产生负面影响，且与修复后中小型RTC撕裂的愈合减少有关。
