Christensen Brian J, Chapple Andrew G, King Brett J
Chief Resident, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
Assistant Professor, Department of Biostatistics, Louisiana State University Health Sciences Center, New Orleans, LA.
J Oral Maxillofac Surg. 2019 Apr;77(4):777-782. doi: 10.1016/j.joms.2018.11.005. Epub 2018 Nov 15.
Surgeons treating facial trauma are faced with a dilemma: Fracture healing requires a tremendous energy expenditure, yet the treatments for mandibular fractures commonly include dietary limitations. Despite this, almost no studies have attempted to quantify the effect of fracture treatments on patient weight. The purposes of this study were to quantify the effect that mandibular fractures and their treatment have on a patient's weight and to identify risk factors associated with an increased change in weight.
A retrospective cohort study was designed. The patients were considered eligible for inclusion if they sustained a mandibular fracture and had at least 1 follow-up visit within 4 weeks after the fracture from August 1, 2012, to April 30, 2015. The study variables were time since presentation, age, gender, open versus closed treatment, and trauma intensive care unit (TICU) stay. The outcome variable of interest was the percentage weight change from baseline. A linear mixed model was used to analyze the data.
A total of 439 patients met the inclusion criteria during the study period. In the final linear mixed model, TICU stay had a significant effect whereas open versus closed treatment did not have a significant effect. The final model predicted a peak weight loss of 4.9% of the initial body weight by day 49. For patients admitted to the TICU, the peak weight loss was 8.8%.
During the course of treatment of mandibular fractures, patients lost an average of almost 5% of their body weight. Closed reduction was not associated with an increased change in weight; however, a stay in the TICU was associated with an increase in weight loss. Further studies will be directed at correlating declining weight with outcomes.
治疗面部创伤的外科医生面临一个两难境地：骨折愈合需要大量能量消耗，但下颌骨骨折的治疗通常包括饮食限制。尽管如此，几乎没有研究试图量化骨折治疗对患者体重的影响。本研究的目的是量化下颌骨骨折及其治疗对患者体重的影响，并确定与体重增加变化相关的风险因素。
设计了一项回顾性队列研究。如果患者发生下颌骨骨折，且在2012年8月1日至2015年4月30日骨折后4周内至少有1次随访，则被认为符合纳入标准。研究变量包括就诊时间、年龄、性别、开放治疗与闭合治疗以及创伤重症监护病房（TICU）住院时间。感兴趣的结果变量是相对于基线的体重变化百分比。使用线性混合模型分析数据。
在研究期间，共有439名患者符合纳入标准。在最终的线性混合模型中，TICU住院时间有显著影响，而开放治疗与闭合治疗没有显著影响。最终模型预测，到第49天时，体重峰值下降为初始体重的4.9%。对于入住TICU的患者，体重峰值下降为8.8%。
在下颌骨骨折治疗过程中，患者平均体重减轻了近5%。闭合复位与体重增加变化无关；然而，入住TICU与体重减轻增加有关。进一步的研究将致力于将体重下降与治疗结果相关联。
