Konstantinidis Ioannis, Christidis Panagiotis, Konstantinou Panagiotis, Kostretzis Lazaros, Pinto Iosafat, Papadopoulos Polichronis, Ditsios Tryfon, Palechoros Georgios, Ditsios Konstantinos
Orthopaedic Department of Mälarsjukhuset, Eskilstuna, Sweden.
Department of Orthopedic Surgery, General Hospital of Katerini, Greece.
Orthop Rev (Pavia). 2022 May 31;14(3):35446. doi: 10.52965/001c.35446. eCollection 2022.
The purpose of this study is to compare the vascularized bone flaps (VBF) that are used in operations for scaphoid non-union in smokers and non-smokers and to scrutinize if the better biological potential of the VBFs can counteract the negative influence of smoking on healing.
Our study included articles published until 2016, with scaphoid non-union patients who were operated on with a VBF or a VBG.
Eighteen articles met eligibility criteria with 335 non-smokers and 136 smokers totally. Healing of the scaphoid non-union was significantly more probable in the non-smoking group (OR=5.54, p<0.001). Patients with avascular necrosis in the proximal pole of the scaphoid (AVNPP) and non-AVNPP showed that non-smoking favors a better healing rate in both of these subgroups (p<0.001 and p<0.001, respectively). Non-smokers have 11 times and the non-AVNPP patient's 7.7 times greater probability of healing of the non-union. Meta-analysis of the data for time for healing showed a longer time in the smokers' group by 2.46 weeks, though non-statistically significant. The analysis could not prove that smoking is a predisposing factor for the development of AVNPP (spearman=0.094, p<0.05). Despite that, preoperative smoking cessation proved to be an inadequate healing moderator (OR=3.5, p=0.268). Finally, VBFs showed a significantly better healing rate compared with nVBGs in smokers (p=0.001).
A hand surgeon should always take into consideration that smoking negatively influences the healing potential of a scaphoid non-union despite the theoretically superior biological background that VBFs offer. In patients who refuse to quit smoking, a VBF may be considered a better choice than a conventional graft.
本研究的目的是比较吸烟者和非吸烟者在舟骨不愈合手术中使用的带血管蒂骨瓣（VBF），并探究VBF更好的生物学潜能是否能抵消吸烟对愈合的负面影响。
我们的研究纳入了截至2016年发表的文章，这些文章涉及接受VBF或血管化骨移植（VBG）手术的舟骨不愈合患者。
18篇文章符合纳入标准，共纳入335例非吸烟者和136例吸烟者。舟骨不愈合在非吸烟组的愈合可能性显著更高（OR = 5.54，p < 0.001）。舟骨近端极缺血性坏死（AVNPP）患者和非AVNPP患者均显示，非吸烟有利于这两个亚组的愈合率提高（分别为p < 0.001和p < 0.001）。非吸烟者不愈合的愈合概率是吸烟者的11倍，非AVNPP患者不愈合的愈合概率是吸烟者的7.7倍。对愈合时间数据的荟萃分析显示，吸烟组的愈合时间长2.46周，尽管无统计学意义。分析无法证明吸烟是AVNPP发生的 predisposing因素（spearman = 0.094，p < 0.05）。尽管如此，术前戒烟被证明不是一个充分的愈合调节因素（OR = 3.5，p = 0.268）。最后，与非VBF相比，VBF在吸烟者中的愈合率显著更高（p = 0.001）。
手外科医生应始终考虑到，尽管VBF在理论上具有更好的生物学背景，但吸烟会对舟骨不愈合的愈合潜能产生负面影响。对于拒绝戒烟的患者，VBF可能被认为是比传统移植更好的选择。 （注：predisposing未找到合适中文释义，保留英文）
