Stanford University School of Medicine, Stanford, California.
Division of Otolaryngology-Head and Neck Surgery, University of Montreal, Montreal, Quebec, Canada.
JAMA Facial Plast Surg. 2018 Dec 1;20(6):460-467. doi: 10.1001/jamafacial.2018.0336.
Initial treatment of nasal fractures can result in long-standing cosmetic or functional defects, but the risk factors for subsequent septorhinoplasty have not been explored.
To assess the risk factors for septorhinoplasty after the initial treatment of isolated nasal fracture.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective population-based analysis of US patients diagnosed with nasal fracture between January 1, 2007, and December 31, 2015, used insurance claims data from the Commercial and Medicare Supplemental categories of the Truven Health MarketScan database. Of the 340 715 patients diagnosed with nasal fracture, 78 474 were included in the final study cohort, excluding those who did not meet enrollment criteria or were diagnosed with concomitant facial fracture. Patients were classified into 1 of 4 groups according to the type and timing of treatment.
Septorhinoplasty between 6 and 24 months after nasal fracture diagnosis. Explanatory variables included initial fracture treatment, demographics, comorbidities, and diagnoses associated with a preexisting nasal obstruction or defect.
Most of the 78 474 patients were under 65 years of age (66 770 [85.1%]) and male (41 997 [53.5%]) and lived in an urban area (67 938 [86.6%]). Among patients with no preexisting diagnosis of nasal obstruction or defect, open treatment within 3 weeks (adjusted odds ratio [aOR], 1.76; 95% CI, 1.33-2.32) of nasal fracture and between 3 weeks and 6 months (aOR, 1.52; 95% CI, 1.14-2.04) after fracture were associated with increased risk of subsequent septorhinoplasty. In patients with a diagnosis of preexisting nasal obstruction or defect, observation (aOR, 3.56; 95% CI, 2.80-4.53), closed reduction treatment (aOR, 3.10; 95% CI, 1.93-4.96), and open treatment within 3 weeks (aOR, 2.02; 95% CI, 1.48-2.77) of fracture were all associated with increased risk of subsequent septorhinoplasty, with observation having the highest risk. Patients were also more likely to undergo subsequent septorhinoplasty if they were younger than 65 years, with the greatest risk seen in patients 18 to 34 years of age (aOR, 6.02; 95% CI, 4.26-8.50), lived in an urban area (aOR, 1.21; 95% CI, 1.01-1.44), or had a history of anxiety (aOR, 1.45; 95% CI, 1.18-1.78), but less likely if they were male (aOR, 0.82; 95% CI, 0.73-0.91).
This study suggests that a preexisting diagnosis of nasal obstruction or defect and other aspects of a patient's history are factors to consider when assessing the likelihood of surgical revision of initial treatment of nasal fracture.
NA.
鼻骨骨折的初始治疗可能导致长期的美容或功能缺陷，但尚未探讨随后鼻中隔成形术的风险因素。
评估初次治疗孤立性鼻骨骨折后鼻中隔成形术的风险因素。
设计、地点和参与者：本研究对 2007 年 1 月 1 日至 2015 年 12 月 31 日期间美国患者的商业和补充医疗保险索赔数据进行了回顾性人群分析，使用 Truven Health MarketScan 数据库，纳入了 340715 例被诊断为鼻骨折的患者。最终研究队列排除了不符合入组标准或同时诊断为面部骨折的患者，其中 78474 例患者符合条件。根据治疗类型和时间，患者被分为 4 组之一。
鼻骨折诊断后 6 至 24 个月行鼻中隔成形术。解释变量包括初始骨折治疗、人口统计学、合并症以及与先前存在的鼻阻塞或缺陷相关的诊断。
大多数 78474 例患者年龄在 65 岁以下（66770 [85.1%]），男性（41997 [53.5%]），居住在城市地区（67938 [86.6%]）。在没有先前诊断为鼻阻塞或缺陷的患者中，骨折后 3 周内（校正优势比[OR]，1.76；95%置信区间[CI]，1.33-2.32）和 3 周到 6 个月（校正 OR，1.52；95% CI，1.14-2.04）行开放性治疗与随后行鼻中隔成形术的风险增加相关。在有先前诊断为鼻阻塞或缺陷的患者中，观察（校正 OR，3.56；95% CI，2.80-4.53）、闭合复位治疗（校正 OR，3.10；95% CI，1.93-4.96）和骨折后 3 周内行开放性治疗（校正 OR，2.02；95% CI，1.48-2.77）均与随后行鼻中隔成形术的风险增加相关，观察具有最高风险。如果患者年龄小于 65 岁，他们也更有可能接受随后的鼻中隔成形术，其中 18 至 34 岁的患者风险最大（校正 OR，6.02；95% CI，4.26-8.50），居住在城市地区（校正 OR，1.21；95% CI，1.01-1.44），或有焦虑史（校正 OR，1.45；95% CI，1.18-1.78），但如果是男性，风险较低（校正 OR，0.82；95% CI，0.73-0.91）。
本研究表明，先前存在的鼻阻塞或缺陷诊断以及患者病史的其他方面是评估初次治疗鼻骨骨折手术修复可能性时需要考虑的因素。
NA。
