CAJ | 학술논문

目的：探讨导致肱骨干骨折延迟愈合及不愈合的相关因素。方法：回顾性分析93例肱骨干骨折患者的病例资料，其中31例肱骨干骨折延迟愈合及不愈合患者纳入观察组，62例肱骨干骨折骨性愈合患者纳入对照组。比较2组患者的骨折粉碎、骨折端软组织损伤、骨折复位、固定不稳、感染及不合理功能活动情况。结果：观察组中23例为严重粉碎性骨折患者，对照组中26例为严重粉碎性骨折患者；观察组中严重粉碎性骨折患者的比例大于对照组（χ2=8.627，p =0.003）；其相对危险度是对照组的3.981倍。观察组中固定不稳25例，对照组中固定不稳13例；观察组中固定不稳患者的比例大于对照组（χ2=30.459，p =0.000）；其相对危险度是对照组的15.705倍。观察组中不合理功能活动患者26例，对照组中12例；观察组中不合理功能活动患者的比例大于对照组（χ2=35.598，p =0.000）；其相对危险度是对照组的21.667倍。观察组在骨折端软组织损伤情况、骨折复位和感染三方面与对照组相比，组间差异均无统计学意义（χ2=1.902，p =0.168；χ2=0.939，p =0.332；χ2=0.661，p =0.416）。结论：肱骨干骨折后发生延迟愈合及不愈合主要与不合理的功能活动、固定不稳及严重粉碎性骨折有关联，但骨折延迟愈合及不愈合的发生绝不是单一因素作用的结果，而是混杂了多种因素的交叉作用结果。对于各因素间有无交互效应及其相关性，我们将继续收集资料做进一步分析研究。
목적：탐토도치굉골간골절연지유합급불유합적상관인소。방법：회고성분석93례굉골간골절환자적병례자료，기중31례굉골간골절연지유합급불유합환자납입관찰조，62례굉골간골절골성유합환자납입대조조。비교2조환자적골절분쇄、골절단연조직손상、골절복위、고정불은、감염급불합리공능활동정황。결과：관찰조중23례위엄중분쇄성골절환자，대조조중26례위엄중분쇄성골절환자；관찰조중엄중분쇄성골절환자적비례대우대조조（χ2=8.627，p =0.003）；기상대위험도시대조조적3.981배。관찰조중고정불은25례，대조조중고정불은13례；관찰조중고정불은환자적비례대우대조조（χ2=30.459，p =0.000）；기상대위험도시대조조적15.705배。관찰조중불합리공능활동환자26례，대조조중12례；관찰조중불합리공능활동환자적비례대우대조조（χ2=35.598，p =0.000）；기상대위험도시대조조적21.667배。관찰조재골절단연조직손상정황、골절복위화감염삼방면여대조조상비，조간차이균무통계학의의（χ2=1.902，p =0.168；χ2=0.939，p =0.332；χ2=0.661，p =0.416）。결론：굉골간골절후발생연지유합급불유합주요여불합리적공능활동、고정불은급엄중분쇄성골절유관련，단골절연지유합급불유합적발생절불시단일인소작용적결과，이시혼잡료다충인소적교차작용결과。대우각인소간유무교호효응급기상관성，아문장계속수집자료주진일보분석연구。
Objective:To explore the relevant factors of humeral shaft fracture delayed union and disunion. Methods:The medical re-cords of 93 patients with humeral shaft fracture were analyzed retrospectively. Thirty-one patients with humeral shaft fracture delayed union and disunion were recruited into the observation group,while 62 patients with humeral shaft fracture bone union were recruited into the con-trol group. Then the two groups were compared with each other in degree of fracture comminution,soft tissue injury around broken ends of fractured bone,fracture reduction,fixation instability,infection and unreasonable functional activities. Results:Twenty-three patients were diagnosed as severe comminuted fracture in observation group,while 26 patients were diagnosed as severe comminuted fracture in control group. The proportion of patients with severe comminuted fracture was larger in observation group compared to control group(χ2 = 8. 627, p = 0. 003),and the relative risk of severe comminuted fracture of observation group was 3. 981 times of that of control group. There were 25 patients with fixation instability in observation group,while 13 patients in control group. The proportion of patients with fixation instability was larger in observation group compared to control group(χ2 = 30. 459,p = 0. 000),and the relative risk of observation group was 15. 705 times of that of control group. There were 26 patients with unreasonable functional activities in observation group,while 12 patients in control group. The proportion of patients with unreasonable functional activities was larger in observation group compared to control group(χ2 =35. 598,p = 0. 000),and the relative risk of observation group was 21. 667 times of that of control group. There was no statistical difference in degree of soft tissue injury around broken ends of fractured bone,fracture reduction and infection between the 2 groups(χ2 = 1. 902,p =0. 168;χ2 = 0. 939,p = 0. 332;χ2 = 0. 661,p = 0. 416). Conclusion:The humeral shaft fracture delayed union and disunion are mainly as-sociated with unreasonable functional activities,fixation instability and severe comminuted fractures. However,multiple factors but not single factor lead to humeral shaft fracture delayed union and disunion. Further study is needed to make clear whether there are any interaction effects and correlations between various factors.