即使术后磁共振成像显示修复的冈上肌腱完好无损，吸烟者获得视觉模拟量表和美国肩肘外科医生评分的最小临床重要差异率也低于不吸烟者

Q3 Medicine Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2024-02-13 DOI:10.1016/j.asmr.2023.100877

W P Yau M.B.B.S., F.R.C.S.Ed., F.R.C.S.Ed. (Ortho.), F.H.K.C.O.S., F.H.K.A.M. (Orthopaedic Surgery)

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引用次数: 0

摘要

目的研究在术后磁共振成像中发现修复完整的冈上肌腱患者中，吸烟对修复后临床结果的影响。如果没有术后磁共振成像扫描或随访时间少于 2 年，则排除患者。在2年随访期间对视觉模拟评分（VAS）、美国肩肘外科医生（ASES）评分和主动前屈进行了评估。报告了获得最小临床重要差异（MCID）的患者比例。吸烟者的愈合率为 77%，非吸烟者为 90%。吸烟是导致 2 年 VAS（P < .001）和 ASES（P < .001）评分较差的独立预测因素。无论修复肌腱是否完整或是否吸烟，手术前和两年随访期间的临床结果都有显著改善（P < .001）。如果修复的肌腱完好无损，与吸烟者相比，非吸烟者在两年的 VAS 和 ASES 评分中达到 MCID 的几率更大。与 82% 的吸烟者相比，99% 的非吸烟者在 2 年的随访中 VAS 达到 MCID（P = .023）。结论在这项研究中，与不吸烟者相比，吸烟与较差的临床结果有关，包括较高的2年VAS疼痛评分和较低的2年ASES评分，即使在修复的冈上肌腱没有发生全厚度再撕裂的情况下也是如此。

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Smokers Achieved Minimal Clinically Important Difference for Visual Analog Scale and American Shoulder and Elbow Surgeons Scores at a Lower Rate Than Nonsmokers Even When Repaired Supraspinatus Tendons Were Intact on Postoperative Magnetic Resonance Imaging

Purpose

To investigate the impact of smoking on clinical outcomes after repair of supraspinatus tendon in patients who had an intact repair found on postoperative magnetic resonance imaging.

Methods

Patients who received primary complete repair of supraspinatus tendon tear between 2014 and 2020 were retrospectively identified. Patients were excluded if a postoperative magnetic resonance imaging scan was not available or if the follow-up was less than 2 years. Visual analog score (VAS), American Shoulder and Elbow Surgeons (ASES) score, and active forward flexion were assessed at the 2-year follow-up. The percentage of patients acquiring minimal clinically important difference (MCID) was reported.

Results

One hundred primary supraspinatus tendon repairs were included. The healing rate was 77% in smokers and 90% in nonsmokers. Smoking was the independent predictor of a poorer 2-year VAS (P < .001) and ASES (P < .001) scores. Significant improvement in clinical outcomes was observed between preoperation and the 2-year follow-up, regardless of the integrity of the repair or smoking status (P < .001). When the repaired tendon was intact, nonsmokers had a greater chance of achieving MCID in 2-year VAS and ASES scores than smokers. Ninety-nine percent of nonsmokers, compared with 82% of smokers, achieved MCID in VAS at the 2-year follow-up (P = .023). The corresponding figures for ASES were 98% and 71%, respectively (P = .004).

Conclusions

In this study, smoking was associated with poorer clinical outcomes, including a greater 2-year VAS pain score and a lower 2-year ASES score, when compared with nonsmokers, even in cases in which there was no full-thickness retear of the repaired supraspinatus tendon.