吸烟对解剖型全肩关节置换术功能结果和种植体存活率的影响。
The effect of smoking on functional outcomes and implant survival of anatomical total shoulder arthroplasty.
机构信息
College of Medicine, University of Florida, Gainesville, Florida, USA.
Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida, USA.
出版信息
Bone Joint J. 2024 Nov 1;106-B(11):1263-1272. doi: 10.1302/0301-620X.106B11.BJJ-2024-0202.R1.
AIMS
We sought to compare functional outcomes and survival between non-smokers, former smokers, and current smokers who underwent anatomical total shoulder arthroplasty (aTSA) in a large cohort of patients.
METHODS
A retrospective review of a prospectively collected shoulder arthroplasty database was performed between August 1991 and September 2020 to identify patients who underwent primary aTSA. Patients were excluded for preoperative diagnoses of fracture, infection, or oncological disease. Three cohorts were created based on smoking status: non-smokers, former smokers, and current smokers. Outcome scores (American Shoulder and Elbow Surgeons (ASES), Constant-Murley score, Shoulder Pain and Disability Index (SPADI), Simple Shoulder Test (SST), University of California, Los Angeles activity scale (UCLA)), range of motion (external rotation (ER), forward elevation (FE), internal rotation, abduction), and shoulder strength (ER, FE) evaluated at two- to four-year follow-up were compared between cohorts. Evaluation of revision-free survival was performed using the Kaplan-Meier method to final follow-up.
RESULTS
We included 428 primary aTSAs with a mean follow-up of 2.4 years (SD 0.6). Our cohort consisted of 251 non-smokers, 138 former smokers who quit a mean 21 years (SD 14) prior to surgery (25 pack-years (SD 22)), and 39 current smokers (23 pack-years (SD 20)). At two- to four-year follow-up, former smokers had less favourable SPADI, SST, and FE strength compared to non-smokers, and current smokers had less favourable SPADI, SST, ASES score, UCLA score, Constant-Murley score, FE, abduction, and ER strength compared to non-smokers. Non-smokers exhibited higher revision-free survival rates at two, five, eight, and ten years postoperatively compared to former smokers and current smokers, who had similar rates.
CONCLUSION
Our study suggests that smoking has a negative effect on aTSA functional outcomes that may persist even after quitting.
目的
我们旨在比较非吸烟者、前吸烟者和当前吸烟者在接受解剖型全肩关节置换术（aTSA）后的功能结果和生存率，该研究纳入了大量患者。
方法
对 1991 年 8 月至 2020 年 9 月期间前瞻性收集的肩关节置换数据库进行回顾性分析，以确定接受初次 aTSA 的患者。排除术前诊断为骨折、感染或肿瘤疾病的患者。根据吸烟状态创建了三个队列：非吸烟者、前吸烟者和当前吸烟者。比较两组术后 2 至 4 年的功能评分（美国肩肘外科医师协会（ASES）评分、Constant-Murley 评分、肩关节疼痛和残疾指数（SPADI）、简易肩部测试（SST）、加利福尼亚大学洛杉矶活动量表（UCLA））、活动范围（外旋（ER）、前屈上举（FE）、内旋、外展）和肩部力量（ER、FE）。使用 Kaplan-Meier 方法评估无翻修生存率，直至最终随访。
结果
我们纳入了 428 例初次 aTSA，平均随访 2.4 年（标准差 0.6）。我们的队列包括 251 名非吸烟者、138 名戒烟平均 21 年（标准差 14）的前吸烟者（25 包年（标准差 22））和 39 名当前吸烟者（23 包年（标准差 20））。在术后 2 至 4 年的随访中，与非吸烟者相比，前吸烟者的 SPADI、SST 和 FE 力量较差，而当前吸烟者的 SPADI、SST、ASES 评分、UCLA 评分、Constant-Murley 评分、FE、外展和 ER 力量较差。与前吸烟者和当前吸烟者相比，非吸烟者在术后 2、5、8 和 10 年的无翻修生存率更高，而前吸烟者和当前吸烟者的生存率相似。
结论
我们的研究表明，吸烟对 aTSA 功能结果有负面影响，即使在戒烟后也可能持续存在。
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