Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan.
Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan2Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan.
JAMA Facial Plast Surg. 2016 Dec 1;18(6):441-448. doi: 10.1001/jamafacial.2016.0714.
There are well-described racial, sex, and age differences related to osteoporosis and hip and/or extremity fractures. Nonetheless, there has been virtually no inquiry evaluating whether these findings carry over to facial fracture.
To characterize the incidence of facial fractures by patient demographics and injury mechanism, focusing on whether differences are noted with race, sex, and advancing age.
Retrospective analysis of the National Electronic Injury Surveillance System (NEISS) was performed in October and November 2015, specifically evaluating adult emergency department (ED) visits from 2012 to 2014 related to facial trauma. Entries were organized by age groups (both individual decades as well as younger adults [18-59 years] vs older adults [60-89 years]), sex, and race (white, black, Asian, other/unspecified). Incidence of facial fractures and mechanism of injury were also evaluated.
There were 33 825 NEISS entries correlating to 1 401 196 ED (range, 1 136 048-1 666 344) visits for adult facial injury, with 14.4% involving fracture. A greater proportion of facial injuries among younger men (<60 years) were fractures relative to younger women (15.5% vs 12.5%; difference of the mean [DOM], 3.0%; 95% CI, 2.8%-3.1%; P < .001); however, on comparison by sex in elderly populations (≥ 60 years), women had an increased fracture predilection (15.0% vs 14.0%; DOM, 1.0%; 95% CI, 0.8%-1.2%; P < .001). Also, older women had a significantly greater risk of fracture relative to those younger than 60 years (15.0% vs 12.5%; DOM, 2.5%; 95% CI, 2.4%-2.7%; P < .001), a comparison that was significant among whites and Asians. Black women had a significantly decreased risk of fracture in the older aged population. (8.4% vs 9.1%; DOM, 0.7%; 95% CI, 0.2%- 1.3%; P = .001). Both on individual comparisons of younger and older cohorts, white and Asian individuals of either sex had significantly greater rates of facial fracture injury than blacks. Among younger cohorts in either sex, injuries sustained during participation in recreational activities were a significant factor, replaced largely by injuries due to housing structural elements and falls among older cohorts.
There is an increase in the risk of facial fracture among postmenopausal women sustaining facial injuries, with these results significant among whites and Asians. In contrast, a decreased risk was noted on comparison of younger and older black women. Mechanism of injuries also varied significantly by age, race, and sex.
已有大量文献描述了与骨质疏松症、髋部和/或四肢骨折相关的种族、性别和年龄差异。尽管如此，几乎没有研究评估这些发现是否适用于面部骨折。
通过患者人口统计学和损伤机制来描述面部骨折的发生率，重点关注种族、性别和年龄增长是否会导致差异。
2015 年 10 月和 11 月对国家电子伤害监测系统（NEISS）进行了回顾性分析，专门评估了 2012 年至 2014 年与面部创伤相关的成年人急诊室（ED）就诊情况。根据年龄组（单个十年以及年轻成年人[18-59 岁]与老年成年人[60-89 岁]）、性别和种族（白人、黑人、亚洲人、其他/未特指）对条目进行了分类。还评估了面部骨折的发生率和损伤机制。
NEISS 中有 33825 条记录与 1401196 例 ED（范围 1136048-1666344）就诊相关，涉及 14.4%的成人面部损伤为骨折。在年轻男性（<60 岁）中，与年轻女性相比，更多的面部损伤是骨折（15.5%比 12.5%；平均差值[DOM]，3.0%；95%置信区间[CI]，2.8%-3.1%；P<0.001）；然而，在老年人群（≥60 岁）中按性别比较时，女性骨折的倾向更高（15.0%比 14.0%；DOM，1.0%；95%CI，0.8%-1.2%；P<0.001）。此外，与 60 岁以下的人相比，老年女性骨折的风险显著增加（15.0%比 12.5%；DOM，2.5%；95%CI，2.4%-2.7%；P<0.001），这种比较在白人和亚洲人中具有统计学意义。黑人女性在老年人群中骨折的风险显著降低（8.4%比 9.1%；DOM，0.7%；95%CI，0.2%-1.3%；P=0.001）。在年轻和老年队列的个体比较中，无论性别如何，白人及亚洲人的面部骨折损伤率都明显高于黑人。在年轻人群中，无论是男性还是女性，因参与娱乐活动而导致的损伤都是一个重要因素，而在老年人群中，主要由住房结构元素和跌倒导致的损伤取代了这一因素。
绝经后女性面部受伤的风险增加，白人及亚洲人的结果具有统计学意义。相比之下，年轻和老年黑人女性之间的比较显示风险降低。损伤机制也因年龄、种族和性别而有显著差异。
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