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為了讓學習效果最大化，我們特別從講師近年的出版作品中，找到最適合初學者閱讀與學習的學術論文，提供給同學做指定閱讀。這篇吳昭慶醫師團隊登在 Journal of Neurosurgery: Spine 的作品，正具有「統計簡單、概念直覺、頂尖期刊」的特性。
新思惟國際，尊重各種形式的智慧財。所以，我們取得昭慶同意後，拿到論文的 MS-Word 版本原稿重新編輯，也委請設計師，用不同的風格，重新排版過。版權由「新思惟國際」回贈給吳昭慶醫師，並均能獨立使用。
這篇指定論文，將作為工作坊的教材，在課前提醒您閱讀。建議用以下的角度出發，並邊做筆記：
- 我需要多深的知識儲備與「臨床感」，才能看到這個機會？
- 如果機會來臨，我有沒有這樣的能力能掌握這些資料，寫出論文？
- 我有沒有能力做出裡頭的圖表？
- 我能不能寫出這樣的論文？如果目前不行，我在能力與經驗上還缺什麼？
歡迎您記錄所有問題，並在課程當天的任何空檔，詢問原作者。這個學習過程，非常有效且值得。你將會體驗到更多在學術界發表的重要面向。
提供 revision letter 供參考
更重要的，課程當天，我們將提供本篇文章的 revision letter，給各位參考。看看一開始被判定為「可以考慮」的 major revision 後，吳昭慶醫師團隊是怎麼修改、怎麼應對、怎麼捍衛自己的論點、怎麼讓 reviewer 爽快按下 accept 鍵！
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論文故事
因為姿勢不良或其他原因造成的頸椎退化，使得椎間盤突出並壓迫到神經。傳統的手術，是針對椎間盤減壓，之後將上下節頸椎融合起來，可有效減輕症狀，不過該節頸椎活動度就會被限制。這種傳統手術，在抽菸的患者，會因為骨頭融合不佳，而有較差的預後。
後來，人工椎間盤問世，在椎間盤減壓之後，可置入並取代椎間盤的功能，手術後仍能保有一定程度的活動度，是近年常見的手術。不過，抽菸會不會對人工椎間盤置放的手術造成負面影響呢？這是吳昭慶醫師團隊想知道的。
研究收入 109 位患者，89 位無抽菸組、20 位有抽菸組，抽菸組的患者稍微較年輕，男性也較多。平均追蹤 3.5 年後，整體臨床預後，兩組的臨床結果差不多，抽菸組的術後活動度稍微比較好。
整體來說，人工椎間盤手術，在抽菸患者的預後並不會比較差，對於抽菸族群，是個合理的選項。
原刊登版本
Tu TH, Kuo CH, Huang WC, Fay LY, Cheng H, Wu JC. Effects of smoking on cervical disc arthroplasty. J Neurosurg Spine. 2019 Feb 1;30(2):168-174. doi: 10.3171/2018.7.SPINE18634.
原文摘要
Objective: Cigarette smoking can adversely affect bone fusion in patients who undergo anterior cervical discectomy and fusion. However, there is a paucity of data on smoking among patients who have undergone cervical disc arthroplasty (CDA). The present study aimed to compare the clinical and radiological outcomes of smokers to those of nonsmokers following CDA.
Methods: The authors retrospectively reviewed the records of consecutive patients who had undergone 1- or 2-level CDA for cervical disc herniation or spondylosis and had a minimum 2-year follow-up. All patients were grouped into a smoking group, which consisted of those who had consumed cigarettes within 6 months prior to the CDA surgery, or a nonsmoking group, which consisted of those who had not consumed cigarettes at all or within 6 months of the CDA. Clinical outcomes were evaluated according to the visual analog scale for neck and arm pain, Neck Disability Index, Japanese Orthopaedic Association Scale, and Nurick Scale at each time point of evaluation. Radiological outcomes were assessed using radiographs and CT for multiple parameters, including segmental range of motion (ROM), neutral lordotic curve, and presence of heterotopic ossification (HO).
Results: A total of 109 patients completed at least 2 years of follow-up and were analyzed (mean follow-up 42.3 months). There were 89 patients in the nonsmoking group and 20 in the smoking group. The latter group was younger and predominantly male (both p < 0.05) compared to the nonsmoking group. The two groups had similar improvements in all clinical outcomes after CDA compared to preoperatively. Radiological evaluations were also very similar between the two groups, except for two factors. The smoking group had well-preserved segmental ROM after CDA at an average of 8.1° (both pre- and postoperation). However, while the nonsmoking group remained mobile, segmental ROM decreased significantly (8.2° to 6.9°, p < 0.05) after CDA. There was a trend toward more HO development in the nonsmoking group than in the smoking group, but the difference was without significance (59.6% vs 50.0%, p = 0.43).
Conclusions: During an average 3.5 years of follow-up after 1- and 2-level CDA, cigarette smokers and nonsmokers had similar improvements in clinical outcomes. Moreover, segmental mobility was slightly better preserved in smokers. Since smoking status did not negatively impact outcomes, CDA may be a reasonable option for selected patients who have smoked.
Abbreviations: ACDF = anterior cervical discectomy and fusion; ASD = adjacent-segment degeneration; CDA = cervical disc arthroplasty; FDA = Food and Drug Administration; HO = heterotopic ossification; JOA = Japanese Orthopaedic Association; NDI = Neck Disability Index; ROM = range of motion; VAS = visual analog scale.
Keywords: cervical disc arthroplasty; anterior cervical discectomy and fusion; heterotopic ossification; cigarette; smoke.
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