Koerner John D, Patel Neeraj M, Yoon Richard S, Gage Mark J, Donegan Derek J, Liporace Frank A
Division of Spine Surgery, Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA.
Injury. 2014 Jul;45(7):1095-8. doi: 10.1016/j.injury.2014.02.010. Epub 2014 Feb 26.
Intramedullary nailing (IMN) of obese patients with femoral fractures can be difficult due to soft tissue considerations and overall body habitus. Complications including malrotation can occur and have significant impact on postoperative function. The purpose of this study was to evaluate femoral rotation after intramedullary nailing of obese and non-obese patients to see if there was a difference in rotation, complications and any risk factors for malrotation.
Between 2000 and 2009, 417 consecutive patients with femur fractures treated with IM nail at Level I trauma and tertiary referral center. Of these, 335 with postoperative computed tomography (CT) scanogram of the bilateral lower extremities were included in this study. Baseline demographic, perioperative and postoperative femoral version calculations were included in the dataset. Statistical analysis included chi-squared test for categorical data, t-test for continuous data, and univariate and multivariate regression analysis. Significance was set at p<0.05.
Of the 417 patients with femur fractures between 2000 and 2009, 335 met criteria for this study. There were 111 patients with a BMI <25, 129 with BMI 25-29.9, and 95 patients with a BMI >30. When BMI was categorised into 3 groups (<25, 25-29.9, or 30+), none of these groups were predictive of version in univariate or multivariate regressions. Among only obese patients (BMI 30+), BMI of 35+ was not a significant predictor of version when compared to BMI 30-34.9. There were no significant differences in femoral version based on entry point (antegrade vs. retrograde) in any BMI category. There were also no significant difference between groups of patients with a DFV of >15̊ (p=0.212).
Based on this study, BMI did not have an effect on postoperative difference in femoral version. In fact, in our multivariate regression analysis, BMI of over 30 was actually predictive of significantly lower difference in femoral version. While other studies have documented the intraoperative difficulties encountered with obese patients with femur fractures, the outcome of femoral rotation is not affected by an increasing BMI.
由于软组织因素和整体身体状况，肥胖患者股骨骨折的髓内钉固定（IMN）可能具有挑战性。包括旋转不良在内的并发症可能会发生，并对术后功能产生重大影响。本研究的目的是评估肥胖和非肥胖患者髓内钉固定术后的股骨旋转情况，以观察旋转、并发症以及旋转不良的任何危险因素是否存在差异。
2000年至2009年间，在一级创伤和三级转诊中心，417例连续的股骨骨折患者接受了髓内钉治疗。其中，335例术后进行了双下肢计算机断层扫描（CT）扫描图的患者纳入本研究。数据集包括基线人口统计学、围手术期和术后股骨扭转角计算。统计分析包括分类数据的卡方检验、连续数据的t检验以及单变量和多变量回归分析。显著性设定为p<0.05。
2000年至2009年间的417例股骨骨折患者中，335例符合本研究标准。体重指数（BMI）<25的患者有111例，BMI为25-29.9的患者有129例，BMI>30的患者有95例。当将BMI分为3组（<25、25-29.9或30+）时，这些组在单变量或多变量回归中均不能预测扭转角。仅在肥胖患者（BMI 30+）中，与BMI 30-34.9相比，BMI 35+不是扭转角的显著预测因素。在任何BMI类别中，基于入钉点（顺行与逆行）的股骨扭转角均无显著差异。双平面股骨扭转角（DFV）>15°的患者组之间也无显著差异（p=0.212）。
基于本研究，BMI对术后股骨扭转角差异无影响。事实上，在我们的多变量回归分析中，BMI超过30实际上预示着股骨扭转角差异显著更低。虽然其他研究记录了肥胖股骨骨折患者术中遇到的困难，但股骨旋转的结果不受BMI增加的影响。
