Waterman Brian R, Gun Baris, Bader Julia O, Orr Justin D, Belmont Philip J
Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, 5005 N Piedras Street, El Paso, TX 79930.
Department of Graduate Medical Education, William Beaumont Army Medical Center, 5005 N Piedras Street, El Paso, TX 79930.
Mil Med. 2016 Oct;181(10):1308-1313. doi: 10.7205/MILMED-D-15-00571.
To comprehensively quantify established risk factors for the development of lower extremity stress fractures within a contemporary U.S. military cohort.
Using the Defense Medical Epidemiological Database, all U.S. service members diagnosed with tibia/fibula, metatarsal, other bone, femoral neck, and femoral shaft stress fractures were identified based on International Classification of Diseases, 9th Revision, Clinical Modification code from 2009 to 2012. Incidence rates (IRs) and adjusted IRs controlling for sex, race, age, rank, and branch of service were obtained with multivariate Poisson regression analysis.
Between 2009 and 2012, 31,758 lower extremity stress fractures occurred among 5,580,875 person-years, for an unadjusted IR of 5.69 per 1,000 person-years. Tibial/fibular (40%) involvement was the most common. Bimodal age distribution revealed that service members under 20 years old (23.06; 95% confidence interval [CI] 22.52, 23.55) or ≥40 (6.86; 95% CI 6.65, 7.07) had greatest risk. Females were at higher risk for total lower extremity (3.11; 95% CI, 3.03, 3.18). White service members were also more at risk than Black service members (p < 0.0001). The majority of stress fractures (77.5%) occurred in junior enlisted service members, with the Army and Marines most at risk.
This investigation elucidates several nonmodifiable risk factors for stress fractures in the military and may inform screening measures to reduce this significant source of disability.
全面量化当代美国军事队列中下肢应力性骨折发生的既定风险因素。
利用国防医学流行病学数据库，根据2009年至2012年国际疾病分类第九版临床修订版代码，识别所有被诊断为胫腓骨、跖骨、其他骨骼、股骨颈和股骨干应力性骨折的美国现役军人。通过多变量泊松回归分析获得发病率（IRs）以及控制性别、种族、年龄、军衔和军种后的调整发病率。
2009年至2012年期间，在5580875人年中发生了31758例下肢应力性骨折，未调整的发病率为每1000人年5.69例。胫腓骨受累（40%）最为常见。双峰年龄分布显示，20岁以下（23.06；95%置信区间[CI]22.52，23.55）或≥40岁（6.86；95%CI 6.65，7.07）的现役军人风险最高。女性下肢总体风险更高（3.11；95%CI，3.03，3.18）。白人现役军人比黑人现役军人风险也更高（p<0.0001）。大多数应力性骨折（77.5%）发生在初级入伍现役军人中，陆军和海军陆战队风险最高。
本研究阐明了军事应力性骨折的几个不可改变的风险因素，并可能为减少这一重大残疾来源的筛查措施提供依据。
