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 Jun;77(6):1227.e1-1227.e6. doi: 10.1016/j.joms.2019.01.059. Epub 2019 Feb 12.
Fracture healing relies on the body to coordinate an inflammatory and anabolic reaction to re-establish osseous union. Although many factors affect this process or even disrupt it, the role of the body's nutritional reserves is not well understood. The purposes of this study were to describe the weight changes and to identify trends in laboratory values commonly used in nutritional assessment during mandibular fracture treatment.
A prospective cohort study was designed. The study cohort included patients who sustained a mandibular fracture from September 1, 2017, to March 31, 2018. The primary outcome variable was the percentage weight change from baseline. Secondary outcome variables included serum albumin and serum prealbumin levels. Weight change was analyzed using a linear mixed model. Paired Wilcoxon tests were used to compare laboratory values with baseline levels.
Thirty-nine patients met the inclusion criteria with sufficient follow-up data for analysis. The linear mixed model predicted a peak weight loss of 4.1% of the initial body weight by day 34. The serum prealbumin level increased over the study period (P < .001), and the albumin level was increased from baseline at week 3 (P < .05) but not significantly different from baseline after that time.
During the course of treatment for mandibular fractures, patients lost an average of more than 4% of their body weight. However, the study did not show any meaningful change in nutritional laboratory values. Although it is important for patients and surgeons to be able to anticipate a weight loss of about 4 to 5% during mandibular fracture treatment, it is unlikely that this represents a large challenge to the nutritional status of patients.
骨折愈合依赖身体协调炎症反应和合成代谢反应以重建骨愈合。尽管许多因素会影响这一过程甚至使其中断，但身体营养储备的作用尚未得到充分理解。本研究的目的是描述体重变化，并确定下颌骨骨折治疗期间营养评估中常用实验室指标的变化趋势。
设计了一项前瞻性队列研究。研究队列包括2017年9月1日至2018年3月31日期间发生下颌骨骨折的患者。主要结局变量是相对于基线的体重变化百分比。次要结局变量包括血清白蛋白和血清前白蛋白水平。使用线性混合模型分析体重变化。采用配对Wilcoxon检验比较实验室指标与基线水平。
39例患者符合纳入标准并具有足够的随访数据用于分析。线性混合模型预测在第34天时体重峰值下降至初始体重的4.1%。在研究期间血清前白蛋白水平升高（P <.001），白蛋白水平在第3周时较基线升高（P <.05），但此后与基线无显著差异。
在下颌骨骨折治疗过程中，患者平均体重下降超过4%。然而，该研究未显示营养实验室指标有任何有意义的变化。尽管患者和外科医生能够预期下颌骨骨折治疗期间体重会下降约4%至5%很重要，但这对患者的营养状况不太可能构成重大挑战。
