Weinlein John C, Deaderick Stuart, Murphy Robert F
*Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN; and †University of Tennessee School of Medicine, Memphis, TN.
J Orthop Trauma. 2015 Mar;29(3):e91-5. doi: 10.1097/BOT.0000000000000167.
To determine whether morbidity and mortality were increased in morbidly obese patients who had reamed intramedullary nailing of closed femoral shaft fractures compared with similar patients of normal weight.
Retrospective case-control study.
Level I trauma center.
PATIENTS/PARTICIPANTS: All patients with closed femoral shaft fractures treated with reamed intramedullary nailing over a 5-year period were identified. Normal-weight patients (BMI < 25) were compared with overweight (25 ≤ BMI < 30), obese (30 ≤ BMI < 40), and morbidly obese patients (BMI ≥ 40).
Reamed intramedullary nailing.
Occurrence of postoperative complications.
Of 507 patients with 526 femoral shaft fractures (AO/OTA-32), 184 (36.3%) were of normal weight, 170 (33.5%) were overweight, 114 (22.5%) were obese, and 39 (7.7%) were morbidly obese. There were no significant differences in complications when comparing normal-weight patients with overweight and obese patients. Systemic complications occurred in 23% of morbidly obese and 9% of normal-weight patients [odds ratio (OR) = 3.15, P = 0.013]. Morbid obesity increased odds of adult respiratory distress syndrome (OR = 35.38, P = 0.019) and sepsis (OR = 6.49, P = 0.0015). Overall, morbidly obese patients with a femoral fracture had a mortality rate of 10%, but a subset of polytraumatized patients (Injury Severity Score > 17) had a mortality rate of 20%. Morbid obesity significantly increased the odds of mortality (OR = 46.77, P = 0.01). Body mass index was found to be an independent predictor of adult respiratory distress syndrome, sepsis, and death.
Morbid obesity is a significant risk factor for systemic complications in patients with closed femoral shaft fractures, especially in polytraumatized patients. Patients and their families need to be counseled regarding the high risk of morbidity and mortality.
Prognostic level II. See Instructions for Authors for a complete description of levels of evidence.
确定与体重正常的类似患者相比，接受闭合性股骨干骨折扩髓髓内钉固定术的病态肥胖患者的发病率和死亡率是否增加。
回顾性病例对照研究。
一级创伤中心。
患者/参与者：确定了在5年期间接受扩髓髓内钉固定术治疗的所有闭合性股骨干骨折患者。将体重正常的患者（BMI<25）与超重患者（25≤BMI<30）、肥胖患者（30≤BMI<40）和病态肥胖患者（BMI≥40）进行比较。
扩髓髓内钉固定术。
术后并发症的发生情况。
在507例有526个股骨干骨折（AO/OTA-32）的患者中，184例（36.3%）体重正常，170例（33.5%）超重，114例（22.5%）肥胖，39例（7.7%）病态肥胖。将体重正常的患者与超重和肥胖患者进行比较时，并发症无显著差异。23%的病态肥胖患者和9%的体重正常患者发生全身并发症[比值比（OR）=3.15，P=0.013]。病态肥胖增加了成人呼吸窘迫综合征（OR=35.38，P=0.019）和脓毒症（OR=6.49，P=0.0015）的发生几率。总体而言，股骨干骨折的病态肥胖患者死亡率为10%，但一部分多发伤患者（损伤严重度评分>17）死亡率为20%。病态肥胖显著增加了死亡几率（OR=46.77，P=0.01）。发现体重指数是成人呼吸窘迫综合征、脓毒症和死亡的独立预测因素。
病态肥胖是闭合性股骨干骨折患者发生全身并发症的重要危险因素，尤其是在多发伤患者中。需要向患者及其家属咨询发病和死亡的高风险情况。
预后II级。有关证据级别的完整描述，请参阅《作者须知》。
