吸烟对解剖型全肩关节置换术后临床疗效和长期生存率的影响。
The impact of tobacco use on clinical outcomes and long-term survivorship after anatomic total shoulder arthroplasty.
作者信息
White Christopher A, Patel Akshar V, Wang Kevin C, Cirino Carl M, Parsons Bradford O, Flatow Evan L, Cagle Paul J
机构信息
Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, USA.
出版信息
J Orthop. 2023 Jan 7;36:99-105. doi: 10.1016/j.jor.2023.01.002. eCollection 2023 Feb.
INTRODUCTION
Postoperative outcomes following total shoulder arthroplasty can be affected by preoperative health factors such as tobacco usage.
METHODS
The charts of patients who underwent anatomic total shoulder arthroplasty were retrospectively analyzed and stratified based on smoking status. The primary data included range of motion and patient reported outcomes. Additionally, demographic, radiographic, and survivorship analyses were conducted. All data were analyzed using statistical inference.
RESULTS
There were 78, 49, and 16 non-smoker, former smoker, and current smoker shoulders respectively with no significant differences in sex, American Society of Anesthesiologists status, body mass index, or mean follow-up time (average: 10.7 yrs). Smokers (51.5 ± 10.4 years) were younger than both non-smokers (64.9 ± 8.1 years; p < 0.01) and former smokers (65.1 ± 9.1years; p < 0.01) at the time of surgery. For non-smokers and former smokers, all range of motion and patient reported outcome scores significantly improved. Smokers reported significant improvements in all patient reported outcomes and external and internal rotation. Visual Analog Scale, American Shoulder and Elbow, and Simple Shoulder Test scores were lower for smokers comparatively, but these differences did not reach significance. Forward elevation was higher postoperatively for non-smokers (149.7 ± 17.2) and former smokers (147.1 ± 26.0) compared to current smokers (130.9 ± 41.2; p = 0.017). No differences between the cohorts were found in the radiographic analysis. Revision rates were lower in the non-smoking cohort (7.7%) compared to both former (20.4%; p = 0.036) and current smokers (37.5%; p < 0.01). Survival curves showed that non-smoker implants lasted longer than those of current smokers.
CONCLUSION
After a decade, patients generally had improved shoulder range of motion, functionality, and pain regardless of smoking status. However, current smokers required shoulder replacements sooner and revision surgery more frequently.
引言
全肩关节置换术后的结果可能会受到术前健康因素的影响，比如吸烟情况。
方法
对接受解剖型全肩关节置换术的患者病历进行回顾性分析，并根据吸烟状况进行分层。主要数据包括活动范围和患者报告的结果。此外，还进行了人口统计学、影像学和生存率分析。所有数据均采用统计推断进行分析。
结果
分别有78例、49例和16例非吸烟者、既往吸烟者和当前吸烟者的肩关节，在性别、美国麻醉医师协会分级、体重指数或平均随访时间（平均：10.7年）方面无显著差异。吸烟者（51.5±10.4岁）在手术时比非吸烟者（64.9±8.1岁；p<0.01）和既往吸烟者（65.1±9.1岁；p<0.01）都年轻。对于非吸烟者和既往吸烟者，所有活动范围和患者报告的结果评分均显著改善。吸烟者报告所有患者报告的结果以及外旋和内旋均有显著改善。相比之下，吸烟者的视觉模拟评分、美国肩肘外科评分和简单肩关节测试评分较低，但这些差异未达到显著水平。与当前吸烟者（130.9±41.2）相比，非吸烟者（149.7±17.2）和既往吸烟者（147.1±26.0）术后前屈角度更高（p=0.017）。在影像学分析中未发现各队列之间存在差异。非吸烟队列的翻修率（7.7%）低于既往吸烟者（20.4%；p=0.036）和当前吸烟者（37.5%；p<0.01）。生存曲线显示，非吸烟者的植入物比当前吸烟者的持续时间更长。
结论
十年后，无论吸烟状况如何，患者的肩关节活动范围、功能和疼痛总体上都有所改善。然而，当前吸烟者需要更早进行肩关节置换，且翻修手术更频繁。
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