CORR：肥胖并不会影响儿童骨折后恢复正常活动的时间

肥胖是大部分骨科疾病的危险因素，包括骨折。既往研究认为，肥胖患者往往存在内循环激素和细胞因子的代谢障碍，这些功能障碍最终通过影响骨组织的矿物化而增加骨折风险，影响骨折愈合过程。有学者认为，对肥胖患儿，身体重量的增加导致下肢负荷增加，而下肢骨骼质量相对应的增强，但上肢骨骼因不负重，其矿物化作用减弱，容易出现骨折。但事实上，肥胖对全身各个器官的功能影响存在多方面作用，目前肥胖对骨折，特别是儿童骨折的愈合影响尚不明确，近期来自美国约翰霍普金斯大学医学院的骨科学者就肥胖对儿童骨折后的相关影响进行了回顾性研究分析，以期明确以下疑问：1.儿童患者的肥胖状况是否可以影响骨折愈合从而延长儿童恢复正常活动的时间？2.若患儿出现恢复正常活动的时间延长，其是否和患儿发生骨折时的暴力程度相关？3.肥胖患儿是否合并有更高比例的上肢骨折？

研究的人群来源于约翰霍普金斯医院2010年1月至2011年10月间因骨折就诊的患者，年龄在2-16岁之间，共273例患者符合研究纳入标准（非病理性长骨骨折，最终随访结束时未发生随访丢失），所有研究数据来源于医疗记录中。

将患儿按体重超标程度进行分级：肥胖（61例，23%），超重（38例，14%），正常体重（154例，57%），消瘦（17例，6%）；出现骨折的暴力程度进行分级：高能量损伤，如机动车祸，枪伤，高于10feet处坠落；中等能量损伤，运动损伤等；低能量损伤，平路摔倒等。将低能量和中等能量损伤归类为一组，因这两者的软组织损伤程度较轻。

研究数据显示：超重/肥胖组恢复正常活动的时间为39天，较正常体重组42天少；肥胖儿童骨折遭受轻或中度损伤暴力程度比例较正常体重患儿多，但按损伤类型进行分组比较时未发现恢复活动的时间存在差异；肥胖/超重组患者上肢损伤比例和正常体重组相类似。如表1，2，3，4所示。

表1：按肥胖/超重和正常体重进行分类的不同骨折部位和暴力程度分级比较

表2：按BMI>85%和BMI<85进行分类的不同骨折部位和暴力程度分级比较

表3：按肥胖/超重和正常体重进行分类的不同暴力程度类型进行恢复正常活动时间分组比较

表4：按BMI>85%和BMI<85进行分类不同暴力程度类型进行恢复正常活动时间分组比较

据上述研究结果，研究者认为，肥胖并不会影响儿童骨折后恢复正常活动的时间；肥胖和正常体重患儿上下肢骨折的发生率并无显著差异；不同类型的暴力因素对患儿术后恢复功能运动的时间无显著影响。但因恢复正常活动的时间取决于多因素作用，肥胖最终是否会影响骨折愈合需要远期更多研究证实。

Does obesity affect fracture healing in children?
BACKGROUND
Obesity is a risk factor for various orthopaedic diseases, including fractures. Obesity's influence on circulating hormones and cytokines and bone mineralization ultimately influences the body's osteogenic response and bone mineralization, potentially increasing the risk of fracture and impacting fracture healing.
QUESTIONS/PURPOSES
Does obesity delay fracture recovery in overweight or obese children as measured by the time to release to normal activity? Is this average time for return to activity influenced by the mechanism of the injury? Does obesity's effect on mineralization and loading in overweight or obese children lead to a greater proportion of upper extremity fracture versus lower extremity fracture?
METHODS
We prospectively followed 273 patients with nonpathologic long bone fractures treated from January 2010 to October 2011. Patients were stratified into obese/overweight, normal weight, and underweight groups. All patients were followed until release to regular activities (mean, 41 days; range, 13-100 days).
RESULTS
Release to regular activities occurred sooner in obese/overweight than in normal weight patients: 39 and 42 days, respectively. A greater proportion of obese/overweight patients had low to moderate energy mechanisms of injury than did normal weight patients, but we found no difference between the groups in terms of return to activity when stratified by mechanism. There was also no difference in the proportion of upper extremity injuries between the two groups.
CONCLUSIONS
Obese/overweight children did not have a delay in release to activities compared with children of normal weight.