Stavem Knut, Naumann Markus G, Sigurdsen Ulf, Utvåg Stein Erik
Professor, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Pulmonary Medicine, Medical Division, Akershus University Hospital, Lørenskog, Norway; Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.
Surgeon, Department of Orthopaedics, østfold Hospital, Grålum, Norway.
J Foot Ankle Surg. 2017 Mar-Apr;56(2):314-318. doi: 10.1053/j.jfas.2016.10.008. Epub 2016 Dec 29.
The present retrospective cohort study assessed the association of body mass index (BMI) with the pattern of ankle fractures using 2 classifications systems. Of the 1011 consecutive patients who underwent surgery for ankle fractures in 2 hospitals from January 2009 to December 2011, 837 had a classifiable fracture according to 1 of 2 classification systems and complete information available for covariates. The association of BMI, adjusted for age, sex, corticosteroid use, diabetes, and smoking status with having a more proximal fibula fracture (Weber class A to C) and an increasing number of malleoli involved (uni-, bi-, or trimalleolar) was assessed using multivariable ordered logistic regression analysis. The mean age of the patients was 50.9 ± 16.9 years, and 461 (55%) were female. On multivariable analysis, BMI and male sex were associated with having a more proximal fibula fracture using the Weber classification, with an odds ratio (OR) of 1.07 (95% confidence interval [CI] 1.04 to 1.11; p < .001) per 1 kg/m increase and OR of 2.96 (95% CI 2.13 to 4.11; p < .001) compared with female sex, respectively. Age was not associated with this fracture classification. In an analysis of uni-, bi-, and trimalleolar fractures, age per 10 years showed higher odds (OR 1.24, 95% CI 1.14 to 1.36; p < .001) and male sex lower odds compared with female sex (OR 0.36, 95% CI 0.27 to 0.48; p < .001) of having trimalleolar fractures than uni- or bimalleolar fractures. An increasing BMI did not seem to be a risk factor, although an inverse U-shaped relationship was seen between quintiles of BMI and the OR of having trimalleolar versus uni- or bimalleolar fractures. Corticosteroid use, diabetes, and smoking status were not significantly associated with the pattern of the ankle fractures using either classification system. In conclusion, an increasing BMI and male sex were risk factors for proximal fibula fractures, and female sex and age were risk factors for bi- and trimalleolar fractures.
本回顾性队列研究使用两种分类系统评估了体重指数（BMI）与踝关节骨折类型之间的关联。在2009年1月至2011年12月期间于两家医院连续接受踝关节骨折手术的1011例患者中，837例根据两种分类系统之一有可分类的骨折，且有协变量的完整信息。使用多变量有序逻辑回归分析评估了校正年龄、性别、皮质类固醇使用情况、糖尿病和吸烟状况后的BMI与腓骨近端骨折（Weber A至C级）以及涉及的踝关节数量增加（单踝、双踝或三踝）之间的关联。患者的平均年龄为50.9±16.9岁，461例（55%）为女性。多变量分析显示，使用Weber分类法时，BMI和男性与腓骨近端骨折相关，每增加1kg/m²，优势比（OR）为1.07（95%置信区间[CI]1.04至1.11；p<.001），与女性相比，OR为2.96（95%CI 2.13至4.11；p<.001）。年龄与这种骨折分类无关。在对单踝、双踝和三踝骨折的分析中，每10岁的年龄显示三踝骨折比单踝或双踝骨折的优势更高（OR 1.24，95%CI 1.14至1.36；p<.001），男性与女性相比优势更低（OR 0.36，95%CI 0.27至0.48；p<.001）。尽管BMI五分位数与三踝骨折相对于单踝或双踝骨折的OR之间呈倒U形关系，但BMI增加似乎不是一个危险因素。使用两种分类系统中的任何一种，皮质类固醇使用情况、糖尿病和吸烟状况与踝关节骨折类型均无显著关联。总之，BMI增加和男性是腓骨近端骨折的危险因素，女性和年龄是双踝和三踝骨折的危险因素。
