戒烟干预对急性骨折手术的影响：随机对照研究
2010/08/11
背景：吸烟是一个重大的健康和经济问题，并且已明确其对外科手术的预后具有负面影响。早前的试验已经对择期手术前进行戒烟干预的益处进行了研究。本试验旨在评价急诊住院，进行为期6周的戒烟计划是否能减少急诊骨折手术的并发症。
方法：在一项多中心、单盲、随机、对照临床试验中，共105名上肢或下肢骨折的吸烟者入选本研究。这些患者需进行急诊手术治疗。将这些患者随机分为干预组（n = 50）和对照组（n = 55）。干预组患者给予为期6周的标准戒烟干预。术后第2～3周、4周和6～12周进行随访。
结果：在对照组患者中，出现至少一种并发症的患者显著多于干预组（分别为38%和20%；P= 0.048）。对照组患者更易出现2个或更多并发症。伤口表面感染是两治疗组最为常见的并发症，该并发症的发生率在对照组和干预组分别为20%和8%，但无显著差异。二级分析显示，对照组患者出现1个并发症的优势比是干预组的2.51倍（95%CI；0.96～6.9倍），但无显著差异。
结论：我们结果显示，骨折术后前6周进行的戒烟干预措施可减少术后并发症风险。
证据水平：治疗水平I级。
（刘国梁 审校）
J Bone Joint Surg Am. 2010 Jun;92(6):1335-1342.
Effect of smoking cessation intervention on results of acute fracture surgery: a randomized controlled trial.
Nåsell H, Adami J, Samnegård E, Tønnesen H, Ponzer S.
Section of Orthopaedics, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, S-118 83 Stockholm, Sweden. nasell@sodersjukhuset.se.
Abstract
BACKGROUND: Tobacco smoking is a major health and economic concern and is also known to have a significant negative effect on surgical outcomes. The benefits of a smoking cessation intervention prior to elective orthopaedic surgery have been evaluated previously. Our aim was to assess whether a smoking cessation program, initiated during the acute hospitalization period and carried out for six weeks, could reduce the number of complications following emergency surgical treatment of fractures.
METHODS: In a multicenter, single-blinded, randomized, controlled clinical trial, 105 smokers with a fracture of the lower or upper extremity that needed acute surgical treatment were randomized to an intervention group (n = 50) or a control group (n = 55). The intervention group was offered a standardized smoking cessation program for six weeks, and all patients were followed at two to three weeks, four weeks, and six to twelve weeks.
RESULTS: The proportion of patients with at least one postoperative complication was significantly larger in the control group than it was in the intervention group (38% and 20%, respectively; p = 0.048). The development of two or more postoperative complications was also more common among the controls (p = 0.039). The rates of superficial wound infection, the most frequently recorded complication in both groups, were 20% and 8%, but this difference was not significant. A secondary analysis showed that the odds of having a complication were 2.51 times (95% confidence interval, 0.96 to 6.9 times) higher in the control group than in the intervention group, but this difference was not significant.
CONCLUSIONS: Our results indicate that a smoking cessation intervention program during the first six weeks after acute fracture surgery decreases the risk of postoperative complications.
LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.
J Bone Joint Surg Am. 2010 Jun;92(6):1335-42.
方法：在一项多中心、单盲、随机、对照临床试验中，共105名上肢或下肢骨折的吸烟者入选本研究。这些患者需进行急诊手术治疗。将这些患者随机分为干预组（n = 50）和对照组（n = 55）。干预组患者给予为期6周的标准戒烟干预。术后第2～3周、4周和6～12周进行随访。
结果：在对照组患者中，出现至少一种并发症的患者显著多于干预组（分别为38%和20%；P= 0.048）。对照组患者更易出现2个或更多并发症。伤口表面感染是两治疗组最为常见的并发症，该并发症的发生率在对照组和干预组分别为20%和8%，但无显著差异。二级分析显示，对照组患者出现1个并发症的优势比是干预组的2.51倍（95%CI；0.96～6.9倍），但无显著差异。
结论：我们结果显示，骨折术后前6周进行的戒烟干预措施可减少术后并发症风险。
证据水平：治疗水平I级。
（刘国梁 审校）
J Bone Joint Surg Am. 2010 Jun;92(6):1335-1342.
Effect of smoking cessation intervention on results of acute fracture surgery: a randomized controlled trial.
Nåsell H, Adami J, Samnegård E, Tønnesen H, Ponzer S.
Section of Orthopaedics, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, S-118 83 Stockholm, Sweden. nasell@sodersjukhuset.se.
Abstract
BACKGROUND: Tobacco smoking is a major health and economic concern and is also known to have a significant negative effect on surgical outcomes. The benefits of a smoking cessation intervention prior to elective orthopaedic surgery have been evaluated previously. Our aim was to assess whether a smoking cessation program, initiated during the acute hospitalization period and carried out for six weeks, could reduce the number of complications following emergency surgical treatment of fractures.
METHODS: In a multicenter, single-blinded, randomized, controlled clinical trial, 105 smokers with a fracture of the lower or upper extremity that needed acute surgical treatment were randomized to an intervention group (n = 50) or a control group (n = 55). The intervention group was offered a standardized smoking cessation program for six weeks, and all patients were followed at two to three weeks, four weeks, and six to twelve weeks.
RESULTS: The proportion of patients with at least one postoperative complication was significantly larger in the control group than it was in the intervention group (38% and 20%, respectively; p = 0.048). The development of two or more postoperative complications was also more common among the controls (p = 0.039). The rates of superficial wound infection, the most frequently recorded complication in both groups, were 20% and 8%, but this difference was not significant. A secondary analysis showed that the odds of having a complication were 2.51 times (95% confidence interval, 0.96 to 6.9 times) higher in the control group than in the intervention group, but this difference was not significant.
CONCLUSIONS: Our results indicate that a smoking cessation intervention program during the first six weeks after acute fracture surgery decreases the risk of postoperative complications.
LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.
J Bone Joint Surg Am. 2010 Jun;92(6):1335-42.
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