Nunna Ravi S, Ostrov Philip B, Ansari Darius, Dettori Joseph R, Godolias Periklis, Elias Elias, Tran Angela, Oskouian Rod J, Hart Robert, Abdul-Jabbar Amir, Jackson Keith L, Devine John G, Mehta Ankit I, Adogwa Owoicho, Chapman Jens R
7287Swedish Neuroscience Institute, Seattle, WA, USA.
12247University of Illinois at Chicago College of Medicine, Chicago, IL, USA.
Global Spine J. 2022 Apr;12(3):526-539. doi: 10.1177/21925682211046899. Epub 2021 Sep 28.
Systemic review and meta-analysis.
To review and establish the effect of tobacco smoking on risk of nonunion following spinal fusion.
A systematic search of Medline, Embase, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews from inception to December 31, 2020, was conducted. Cohort studies directly comparing smokers with nonsmokers that provided the number of nonunions and fused segments were included. Following data extraction, the risk of bias was assessed using the Quality in Prognosis Studies Tool, and the strength of evidence for nonunion was evaluated using the GRADE working group criteria. All data analysis was performed in Review Manager 5, and a random effects model was used.
Twenty studies assessing 3009 participants, which included 1117 (37%) smokers, met inclusion criteria. Pooled analysis found that smoking was associated with increased risk of nonunion compared to not smoking ≥1 year following spine surgery (RR 1.91, 95% CI 1.56 to 2.35). Smoking was significantly associated with increased nonunion in those receiving either allograft (RR 1.39, 95% CI 1.12 to 1.73) or autograft (RR 2.04, 95% CI 1.54 to 2.72). Both multilevel and single level fusions carried increased risk of nonunion in smokers (RR 2.30, 95% CI 1.64 to 3.23; RR 1.79, 95% CI 1.12 to 2.86, respectively).
Smoking status carried a global risk of nonunion for spinal fusion procedures regardless of follow-up time, location, number of segments fused, or grafting material. Further comparative studies with robust methodology are necessary to establish treatment guidelines tailored to smokers.
系统评价与荟萃分析。
回顾并确定吸烟对脊柱融合术后骨不连风险的影响。
对Medline、Embase、Cochrane对照试验中央注册库以及Cochrane系统评价数据库进行了从建库至2020年12月31日的系统检索。纳入直接比较吸烟者与不吸烟者且提供了骨不连数量和融合节段数的队列研究。在数据提取后，使用预后研究质量工具评估偏倚风险，并使用GRADE工作组标准评估骨不连的证据强度。所有数据分析均在Review Manager 5中进行，并采用随机效应模型。
20项评估3009名参与者的研究符合纳入标准，其中包括1117名（37%）吸烟者。汇总分析发现，与脊柱手术后不吸烟≥1年相比，吸烟与骨不连风险增加相关（风险比1.91，95%置信区间1.56至2.35）。吸烟与接受同种异体骨移植（风险比1.39，95%置信区间1.12至1.73）或自体骨移植（风险比2.04，95%置信区间1.54至2.72）者骨不连增加显著相关。吸烟者进行多级和单级融合时骨不连风险均增加（风险比分别为2.30，95%置信区间1.64至3.23；风险比1.79，95%置信区间1.12至2.86）。
无论随访时间、部位、融合节段数或移植材料如何，吸烟状态对脊柱融合手术均存在骨不连的总体风险。需要开展更多采用可靠方法的比较研究，以制定针对吸烟者的治疗指南。
