Johnson Joey P, Kleiner Justin, Klinge Stephen A, McClure Philip K, Hayda Roman A, Born Christopher T
Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI.
Warren Alpert Medical School, Brown University, Providence, RI.
J Orthop Trauma. 2018 Feb;32(2):82-87. doi: 10.1097/BOT.0000000000001027.
With rising rates of obesity in the United States, the burden of knee dislocations in this population remains unknown. This national epidemiologic study was designed to analyze the association of obesity with closed knee dislocation and vascular complications.
Retrospective cohort study.
The deidentified Nationwide Inpatient Sample database was used to access the US inpatient data from 2000 to 2012.
PATIENTS/PARTICIPANTS: Patients with noncongenital closed knee dislocations were included. Examined variables included patient age, sex, vascular injury, and obesity status.
Outcome measures included hospital length of stay, amputation, and inpatient hospitalization charge.
From 2000 to 2012, a total of 19,087 knee dislocations were identified, including 2265 in overweight/obese patients (11.9%). The annual incidence of knee dislocations reported in patients diagnosed as either obese or morbidly obese increased over the 13-year period (P < 0.0001). The overall average rate of vascular injury requiring intervention was 5.63%, whereas 7.2% of obese patients and 11.3% of morbidly obese patients with knee dislocations (P < 0.0001) sustained a vascular injury requiring intervention. The average length of stay and amputation rate for obese and morbidly obese patients who sustained a knee dislocation was not statistically different from nonobese patients when vascular injury was controlled. When patients with a vascular injury were excluded, obese and morbidly obese patients who sustained a knee dislocation had higher average cost of hospital stay than nonobese patients (P = 0.0262).
This study demonstrates significant increases in costs of stay with obese patients sustaining knee dislocations when compared with normal weight knee dislocation patients. Vascular injuries were found to be far more common in obese and morbidly obese patient groups than nonobese patients. Providers should be on high alert when managing knee dislocations in obese patients because a significant number require prompt vascular intervention.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
随着美国肥胖率的上升，该人群中膝关节脱位的负担仍不明确。这项全国性的流行病学研究旨在分析肥胖与闭合性膝关节脱位及血管并发症之间的关联。
回顾性队列研究。
使用经过去识别化处理的全国住院患者样本数据库来获取2000年至2012年的美国住院患者数据。
患者/参与者：纳入非先天性闭合性膝关节脱位患者。检查的变量包括患者年龄、性别、血管损伤和肥胖状况。
结局指标包括住院时间、截肢情况和住院费用。
2000年至2012年，共识别出19087例膝关节脱位，其中超重/肥胖患者2265例（11.9%）。在这13年期间，被诊断为肥胖或病态肥胖的患者中报告的膝关节脱位年发病率有所增加（P < 0.0001）。需要干预的血管损伤总体平均发生率为5.63%，而膝关节脱位的肥胖患者中有7.2%、病态肥胖患者中有11.3%发生了需要干预的血管损伤（P < 0.0001）。当控制血管损伤因素时，肥胖和病态肥胖的膝关节脱位患者的平均住院时间和截肢率与非肥胖患者相比无统计学差异。排除有血管损伤的患者后，肥胖和病态肥胖的膝关节脱位患者的平均住院费用高于非肥胖患者（P = 0.0262）。
本研究表明，与正常体重的膝关节脱位患者相比，肥胖患者发生膝关节脱位时的住院费用显著增加。发现血管损伤在肥胖和病态肥胖患者组中比非肥胖患者更为常见。在处理肥胖患者的膝关节脱位时，医护人员应高度警惕，因为相当一部分患者需要及时进行血管干预。
预后水平III。有关证据水平的完整描述，请参阅作者指南。
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