维生素D不足对肩关节置换术后结局及并发症发生率的影响：一项单中心回顾性研究。
The effect of vitamin D insufficiency on outcomes and complication rates after shoulder arthroplasty: a single center retrospective examination.
作者信息
MacConnell Ashley E, Anderson Joshua, Stanila Thomas, Shivdasani Krishin, Hand Rob, Boubekri Amir, Garbis Nickolas, Salazar Dane
机构信息
Loyola University Medical Center, Department of Orthopaedic Surgery & Rehabilitation, Maywood, IL, USA.
Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.
出版信息
Semin Arthroplasty. 2024 Mar;34(1):182-189. doi: 10.1053/j.sart.2023.10.003. Epub 2023 Dec 2.
BACKGROUND
The impact of hypovitaminosis D in patients undergoing shoulder arthroplasty has yet to be fully determined. Our study aims to assess postoperative outcomes in patients undergoing shoulder arthroplasty, and evaluate the association between preoperative vitamin D level and postoperative outcomes.
METHODS
A retrospective review of patients undergoing hemiarthroplasty, anatomic total shoulder arthroplasty, and reverse total shoulder arthroplasty between 2012 and 2022 at a single institution was performed. Outcomes including readmission, reoperation, mortality, and medical complications, as well as preoperative and postoperative range of motion (ROM), pain scores, and functional outcome scores, were examined.
RESULTS
Between September 2012 and September 2022, 576 shoulder arthroplasties were performed at our institution, of which 94 patients had preoperative vitamin D levels recorded; 35.11% were deficient with vitamin D levels under 20 mg/mL, 29.79% were insufficient and had vitamin D levels between 20 and 29 mg/mL, and 35.11% had levels considered sufficient. There was no statistically significant association between vitamin D levels and complications on univariable analysis ( > .05). There was also no statistically significant association between preoperative vitamin D levels and use of cemented implants intraoperatively. Pain scores and ROM were not associated with vitamin D level although ROM approached statistical significance.
CONCLUSION
The association between lower vitamin D levels and worse postoperative outcomes or increased rate of short-term complications was not supported by our study. For patients without osteoporosis, a recorded low vitamin D level at the time of surgery was not associated with an increased risk of postoperative complications or poor postoperative outcome. Randomized controlled trials investigating the association between vitamin D and postoperative outcomes are needed.
LEVEL OF EVIDENCE
Level III; Retrospective Case Control Study.
背景
维生素D缺乏对接受肩关节置换术患者的影响尚未完全明确。我们的研究旨在评估接受肩关节置换术患者的术后结局，并评估术前维生素D水平与术后结局之间的关联。
方法
对2012年至2022年在单一机构接受半关节置换术、解剖型全肩关节置换术和反式全肩关节置换术的患者进行回顾性研究。检查的结局包括再入院、再次手术、死亡率和医疗并发症，以及术前和术后的活动范围（ROM）、疼痛评分和功能结局评分。
结果
2012年9月至2022年9月期间，我们机构共进行了576例肩关节置换术，其中94例患者记录了术前维生素D水平；35.11%的患者维生素D缺乏，水平低于20mg/mL，29.79%的患者维生素D不足，水平在20至29mg/mL之间，35.11%的患者水平被认为充足。单因素分析显示，维生素D水平与并发症之间无统计学显著关联（P>.05）。术前维生素D水平与术中使用骨水泥假体之间也无统计学显著关联。疼痛评分和ROM与维生素D水平无关，尽管ROM接近统计学显著性。
结论
我们的研究不支持较低的维生素D水平与较差的术后结局或短期并发症发生率增加之间存在关联。对于无骨质疏松症的患者，手术时记录的低维生素D水平与术后并发症风险增加或术后结局不佳无关。需要进行随机对照试验来研究维生素D与术后结局之间的关联。
证据级别
III级；回顾性病例对照研究。
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