Kessler Jeffrey I, Jacobs John C, Cannamela Peter C, Shea Kevin G, Weiss Jennifer M
Kaiser Permanente Southern California, Los Angeles, CA.
University of Utah School of Medicine, Salt Lake City, UT.
J Pediatr Orthop. 2018 May/Jun;38(5):e296-e299. doi: 10.1097/BPO.0000000000001158.
Osteochondritis dissecans (OCD) is a joint disorder of the subchondral bone and articular cartilage whose association with obesity in children is not clearly known. The purpose of this study was to assess the magnitude of the association between childhood obesity and the occurrence of OCD of the knee, ankle, and elbow in children.
A retrospective chart review of an integrated health system was performed on OCD patients aged 2 to 19 from 2007 to 2011, with over 1 million patients in this cohort. Lesion location, laterality, and all patient demographics were recorded. The body mass index (BMI) for each patient in the cohort was used to stratify patients into 5 weight classes (underweight, normal weight, overweight, moderately obese, and extremely obese) based on BMI-for-age. The associations between the 5 weight classes and OCD of the ankle, knee, and elbow were assessed using multiple logistic regression models to estimate odds ratios (OR) and 95% confidence intervals using multivariate analysis to adjust for patient demographic variables.
In total, 269 patients fit the inclusion criteria. Mean BMI, both absolute and percentile, was significantly higher for patients with OCD of the knee, elbow, and ankle than patients without OCD. In the multivariate analysis, extremely obese patients were found to have an increased OR of OCD for all patients, with an 86% increased risk of any OCD compared with normal weight patients. In addition, assessment by different types of OCD revealed that extremely obese patients had an increased OR of OCD of the elbow and ankle individually, with a 3.1 times increased OCD elbow risk and 3.0 times increased risk of ankle OCD in extremely obese patients. Although extremely obese patients did not have a statistically significant increased risk of knee OCD, moderately obese patients did have a 1.8 times increased risk of knee OCD as compared with normal weight children. There were no significantly different risks of any type of OCD seen in overweight or underweight patients as compared with normal weight patients.
In this population-based cohort study, extreme obesity is strongly associated with an increased risk of OCD overall and OCD of the elbow and ankle specifically. In addition, moderate obesity is associated with an increased risk of knee OCD. All types of OCD were also found to have a significantly greater average BMI when compared with patients without OCD.
Level IV-descriptive epidemiology study.
剥脱性骨软骨炎（OCD）是一种软骨下骨和关节软骨的关节疾病，其与儿童肥胖之间的关联尚不清楚。本研究的目的是评估儿童肥胖与儿童膝关节、踝关节和肘关节OCD发生之间的关联程度。
对2007年至2011年年龄在2至19岁的OCD患者进行综合卫生系统的回顾性病历审查，该队列中有超过100万患者。记录病变位置、侧别和所有患者的人口统计学数据。根据年龄别BMI将队列中每位患者的体重指数（BMI）用于将患者分为5个体重类别（体重过轻、正常体重、超重、中度肥胖和极度肥胖）。使用多元逻辑回归模型评估5个体重类别与踝关节、膝关节和肘关节OCD之间的关联，以估计比值比（OR）和95%置信区间，并使用多变量分析调整患者人口统计学变量。
共有269名患者符合纳入标准。膝关节、肘关节和踝关节OCD患者的平均BMI（绝对值和百分位数）均显著高于无OCD患者。在多变量分析中，发现极度肥胖患者在所有患者中OCD的OR增加，与正常体重患者相比，任何OCD的风险增加86%。此外，按不同类型的OCD评估显示，极度肥胖患者单独发生肘关节和踝关节OCD的OR增加，极度肥胖患者肘关节OCD风险增加3.1倍，踝关节OCD风险增加3.0倍。虽然极度肥胖患者膝关节OCD风险没有统计学上的显著增加，但中度肥胖患者与正常体重儿童相比，膝关节OCD风险增加1.8倍。与正常体重患者相比，超重或体重过轻患者在任何类型OCD方面的风险没有显著差异。
在这项基于人群的队列研究中，极度肥胖与总体OCD风险增加以及特别是肘关节和踝关节OCD风险增加密切相关。此外，中度肥胖与膝关节OCD风险增加有关。与无OCD患者相比，所有类型的OCD患者平均BMI也显著更高。
IV级——描述性流行病学研究。
