Archives of Craniofacial Surgery Arch Craniofac Surg Vol.13 No.1, 36-40 http://dx.doi.org/10.7181/acfs.2012.13.1.36 안면골골절의발생인자에대한통계학적분석 서용훈 김영준 Original Article 인제대학교의과대학상계백병원성형외과학교실 Statistical Analysis of Factors Associated with Facial Bone Fractures Yong Hoon Suh, Young Joon Kim Department of Plastic and Reconstructive Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea Purpose: Statistical analysis of facial bone fractures has been performed in various papers. However, reports on risk factors for facial bone fractures are rare. In order to prevent facial bone fractures, it is important to determine the risk factors for their occurrence. This study seeks to perform a statistical analysis on and identify the risk factors associated with facial bone fractures. Methods: A retrospective study was performed to assess facial bone fractures in patients presenting from October 2009 to January 2011 through a chart review. The data collected included age, gender, etiology, and alcohol consumption. Data was analyzed using multinomial logistic regression analysis. The significance level was set at p<0.05 and SAS ver. 9.2 was used. Results: A total of 489 patients were analyzed. The patients age ranged from 2 to 85 years (mean age, 31.8±15.4 years). The ratio of men to women was 5.0:1. The predominant group was age below 19 years old (30.9%). The main causes of facial bone fractures were assaults (37.8%), falls (27.2%), and sport accidents (19.5%). On multinomial logistic regression analysis, age, especially in the teen group was associated with assaults (p<0.05) resulting in facial bone fractures. Alcohol consumption was significantly associated with assaults and falls (p<0.05) leading to facial bone fractures. Conclusion: Facial bone fracture is a challenging problem, because of its high incidence and financial cost. The findings of this study indicate that more effective policies aimed at reducing alcohol intake and teenage violence are needed. Keywords: Facial bone fracture 서 론 안면골골절은성형외과영역에서흔히접할수있는질환이고외모변형과기능장애를일으킬수있으며심할경우생명을위협할수있다. 1,2 또한적절한치료후에도물리적장애뿐아니라외상후스트레스장애등의정신적후 Correspondence: Young Joon Kim Department of Plastic and Reconstructive Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul 139-707, Korea Tel: +82-2-950-1048 / Fax: +82-2-932-6373 / E-mail: S2639@paik.ac.kr Received January 16, 2012 / Revised February 27, 2012 Accepted February 28, 2012 유증을남기기도한다. 1 3 따라서안면골골절의치료외에도발생을예방하는데관심을두어야한다. 안면골골절과관련하여발표된여러논문에서안면골골절의원인으로교통사고, 폭력사고, 운동사고, 낙상사고등이제시되었다. 1,4 하지만안면골골절의원인들과이에관련된위험인자에대한분석은드물다. 본연구에서는안면골골절의원인들과이에영향을미치는인자들중성별, 나이, 음주여부와의연관성을통계학적분석을통해파악하여안면골골절예방을위한방안마련에도움을주고자하였다. 36 Copyright 2012 The Korean Cleft Palate-Craniofacial Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ISSN 2287-1152
Yong Hoon Suh, et al. Statistical analysis of facial bone fractures 재료및방법 2009년 10월부터 2011년 1월까지본원성형외과에내원하여치료받은모든안면골골절환자를대상으로성별, 나이, 발생원인, 수상당시음주여부를조사하였다. 조사방법은의무기록을이용하여후향적으로진행하였고전체 502명의안면골골절환자중자료가불충분한환자를제외한 489명을대상으로하였다. 자료분석은기본적인통계조사와발생원인과성별, 나이, 음주와의관련성을보기위해다중회귀분석, 카이제곱을이용하였고유의수준은 p value 0.05 미만으로하였다. 통계분석은 SAS ver. 9.2 (SAS Institute Inc., Cary, NC, USA) 프로그램을이용하였다. 결과 전체 489명중남자 407명, 여자 82명으로남녀성비는 5.0:1이었고평균나이는 31.8세였으며 2세에서 85세까지분포하였다. 나이별로 10대이하가 30.9%, 20대 20.8%, 30대 16.6%, 40대 13.9% 이었다 (Table I). 원인별로는폭력사고가 37.8%, 낙상사고가 27.2%, 운동사고 19.5%, 교통사고 15.5% 순이었다 (Table II). 발생원인을나이별로보면폭력사고나운동사고는 10 대의비중이높았고낙상사고나교통사고는 50대이상의비율이높았다 (Fig. 1). 발생원인을성별에따라분류하면남자의비율이모든경우에서높게나타났다 (Fig. 2). 원인 과음주와의비교에서는전체음주비율은 39.7% 로나타났으며폭력사고 (61.6%) 와낙상사고 (49.6%) 에서음주비율이운동사고 (1.1%) 나교통사고 (17.1%) 에서보다상대적으로높게나타났다 (Fig. 3). 다중회귀분석을이용하여안면골골절의원인들간성별, 나이, 음주여부의차이를비교하였다. 안면골골절의원인으로폭력사고, 낙상사고, 운동사고, 교통사고가제시되었고그중빈도가높게나타난폭력사고, 낙상사고, 운동사고를검정대상으로하고빈도가가장낮은교통사고를기준값으로하였다. 다중회귀분석결과폭력사고는 10대이하, 음주와유의하게관련성이높았고낙상사고는음주와관련성이높았다 (Table III). 안면골골절원인중가장많은빈도를차치하는폭력사고와나이, 음주와의관련성을세분화하여보기위해나이별로음주여부에따라분류하였다. 폭력사고는 10세미만에서는없었고 10대 58명, 20대 53명, 30대 32명, 40대 22명, 50 대이상 20명이었다. 각나이대별로폭력군과비폭력군사이의음주비율의차이를비교하였는데 10대의경우폭력군에서음주비율이 12.1%, 비폭력군에서음주비율은 4% 로 Table I. Age Distribution of Facial Bone Fractures Age Number (%) <20 151 (30.9) 20-29 102 (20.8) 30-39 81 (16.6) 40-49 68 (13.9) 49< 87 (17.8) Fig. 1. Distribution of fractures according to age and cause. Table II. Cause of Facial Bone Fractures Cause Number (%) Assaults 185 (37.8) Falls 133 (27.2) Sports 95 (19.5) Traffic accident 76 (15.5) Fig. 2. Distribution of fractures according to gender and cause. 37
Vol. 13, No. 1, 2012 Archives of Craniofacial Surgery Table III. Multinomial Logistic Regression Gender Assaults Falls Sports Odds ratio p-value* Odds ratio p-value* Odds ratio p-value* Male 1.132 0.7552 0.896 0.7720 2.011 0.1155 Female 1.000 1.000 1.000 Age <20 1.000 1.000 1.000 20-29 0.249 0.0037 0.388 0.0663 0.526 0.1761 30-39 0.172 0.0013 0.636 0.4061 0.729 0.5546 40-49 0.245 0.0117 1.358 0.5660 0.407 0.1254 49< 0.069 <0.0001 0.487 0.0933 0.054 <0.0001 Alcohol consumption Yes 15.721 <0.0001 5.688 <0.0001 0.057 0.0075 No 1.000 1.000 1.000 Reference category: traffic accident. *p-values are for multinomial logistic regression analysis (ref=traffic accident). Table IV. Association of Alcohol-related Fractures with Age and Gender Fig. 3. Distribution of fractures according to alcohol consumption and cause. Age (yr) IPV group Non-IPV group* Alcohol No alcohol Alcohol No alcohol 0-9 0 0 0 16 p-value 10-19 7 51 3 75 0.097 20-29 49 4 12 37 0 30-39 28 4 23 26 0 40-49 16 6 19 27 0.02 49< 14 6 23 44 0.009 IPV, interpersonal violence. *Non-IPV group: falls, sports, traffic accident. 나타났고서로유의한차이를보이지않았다. 하지만 20대에서는폭력군, 비폭력군간음주비율이각각 92.5%, 24.5% 였고유의한차이를보였다 (p<0.05). 30대, 40대, 50대이상에서도폭력군의음주비율이비폭력군에비해유의하게높게나타났다 (pearson s chi squred test, p<0.05) (Table IV). 고찰 음주와폭력사고의연관성은여러논문에서발표되었다. Kai 등은폭력군과비폭력군사이의비교를통해음주가폭력사고의주요한기여인자라고보고하였다. 음주에의해폭력사고가증가하는이유는위험을포착하는인지력저하, 이성적판단력어려움, 위험을피하거나자기를방어하는능력저하등이제시되고있다. 5,6 음주와낙상사고 의연관성도발표되었는데 Johnston과 McGovern 7 은알코올수치가증가할수록낙상사고에의한안면부수상빈도가증가하고수상정도도심해진다고보고하였고그이유로알코올에의해보호반사저하를제시하였다. 본연구에서음주는폭력사고, 낙상사고와연관이있는것으로나타났고이전의연구와일치하는결과였다. 따라서안면골골절의다수를차지하는폭력사고와낙상사고를줄이기위해음주를줄이기위한방안을마련하는것이필요하다. 전체안면골골절환자중 10세미만의경우 19명으로 3.9% 를차지하였다. 10세미만의소아에서안면골골절의빈도가낮게나타나는이유는첫째, 두개골에비해안면골이작다. 둘째, 안면골의굴곡이심하지않아돌출이적다. 셋째, 상악동이미성숙하여비교적단단하다. 넷째, 안면골중치아가상당부분을차지한다. 다섯째, 골절선이유합이 38
Yong Hoon Suh, et al. Statistical analysis of facial bone fractures 이뤄지지않아유연하다. 여섯째, 지방층이두꺼워충격을완화해준다. 일곱째, 부모로부터보호를받는다. 등이제시되고있다. 8 하지만청소년기에들어서면안면골골절의빈도는증가하고성인의빈도와비슷하게나타난다. 9 안면골골절환자중 10대, 20대환자가다수를차지하는이유는위험한운동에빈번하게참여하고부주의하게운전하는경향이있으며폭력사고가많기때문이다. 1 본연구에서도 10대가 27.0%, 20대가 20.8% 로다수를차지하였다. 하지만 10대는폭력사고와유의한관련성은있는것으로나타났지만폭력군과비폭력군간음주비율에있어유의한차이는보이지않았다. 이는청소년의음주를법으로금지하고있는우리나라의특성때문으로생각된다. Fasola 등 10 은나이가증가함에따라낙상사고가증가한다고보고하였는데본연구에서는시행한다중회귀분석결과고령과낙상사고는유의한관련이없는것으로나타났다. 하지만이는기준값으로사용한교통사고에서 50대이상의비율이높기때문이다. 실제로낙상사고에서 50대이상의비율은 26.3% 로폭력사고 10.8%, 폭력사고 4.2% 보다높았으나교통사고에서의 36.8% 를기준으로유의한차이가없는것으로나타났다. 다중회귀분석에서각각의원인들간성별발생의빈도에있어유의한차이는나타나지않았다. 본연구에서남녀성비는 5.0:1로남자가우세하였고각원인에서남녀성비도남자가다수를차지하였다. 기존의연구결과에서도본연구에서와마찬가지로남자의비율이높게나타났다. 1,4 남성에서안면부수상비율이높은이유로육체적인운동에대한높은참여, 활동적인사회생활, 높은음주비율이제시되고있다. 11 Gassner 등 12 은여성이사회적활동에널리참여하는호주에서남녀성비는 2.1:1로보고하였고 Al Ahmed 등 13 은남성이주로사회활동을하고여성들이거의운전을하지않는아랍에미레이트에서남녀성비를 11:1로보고하였다. 점차여성의사회경제적활동이늘어가고있는우리나라도여성의안면골골절증가에대한대비가필요할것이다. 이전의여러논문에서안면골골절에대한일반적인데이터만을제시하고이에대한분석을시행하였다. 하지만안면골골절의원인과이와관련된요인에대한통계학적분석은드물다. 각원인들과관련된연관요인의차이를조사하면각각의안면골골절원인과관련된특징을발견하고개별적인예방방안마련에도움을줄수있다. 하지만 다중회귀분석은임의의기준값을기준으로해석을하기 때문에결과해석에신중해야한다. 보편적인기준값을선 택하는것이우선이고힘든경우라면분석시기준값자체 에대한고려가필요하다. 본연구에서는후향적연구의특 성상공통적으로비교가능한자료수집에제한이있어성 별, 나이, 음주여부만을비교할수있었다. 전향적연구를 통해더많은변수를포함할수있다면다양한연관요인 파악에도움을줄수있을것이다. 결 론 안면부골절은성형외과에서흔히접하는질환이고적 절한치료에도신체적, 정신적후유증을남길수있어예방 이중요하다. 예방책마련을도움을주기위해안면골골절 원인과연관요인에대해조사하였고폭력사고와 10 대, 음 주가관련이있는것으로나타났으며낙상사고는음주와 관련이있는것으로나타났다. 특히폭력사고의경우 20 대 이상에서는음주를줄이기위한방안이필요하고 10 대의 경우음주외의연관요인파악이필요하다. REFERENCES 1. Lee JH, Mun GH, Bang SI: A clinical & statistical analysis of the facial bone fractures: 7 years survey. J Korean Soc Plast Reconstr Surg 25: 1046, 1998 2. Shin SW, Kyeong HS, Ha DH, Kim DI: A study on the clinical and statistical analysis of the zygoma fracture. J Korean Cleft Palate Craniofac Assoc 3: 147, 2002 3. Levine E, Degutis L, Pruzinsky T, Shin J, Persing JA: Quality of life and facial trauma: psychological and body image effects. Ann Plast Surg 54: 502, 2005 4. Kim BK, Yang SJ, Koh YS, Bang YH, Park CS: A clinical survey of the facial bone fractures. J Korean Soc Plast Reconstr Surg 8: 305, 1981 5. Lee KH: Interpersonal violence and facial fractures. J Oral Maxillofac Surg 67: 1878, 2009 6. Borges G, Cherpitel CJ, Rosovsky H: Male drinking and violence related injury in the emergency room. Addiction 93: 103, 1998 7. Johnston JJ, McGovern SJ: Alcohol related falls: an interesting pattern of injuries. Emerg Med J 21: 185, 2004 8. Yarington CT Jr: Maxillofacial trauma in children. Otolaryngol Clin North Am 10: 25, 1977 9. Munante Cardenas JL, Olate S, Asprino L, de Albergaria Barbosa JR, de Moraes M, Moreira RW: Pattern and treatment of facial trauma in pediatric and adolescent patients. J Craniofac Surg 22: 1251, 2011 39
Vol. 13, No. 1, 2012 Archives of Craniofacial Surgery 10. Fasola AO, Obiechina AE, Arotiba JT: Incidence and pattern of maxillofacial fractures in the elderly. Int J Oral Maxillofac Surg 32: 206, 2003 11. Gomes PP, Passeri LA, Barbosa JR: A 5 year retrospective study of zygomatico orbital complex and zygomatic arch fractures in Sao Paulo State, Brazil. J Oral Maxillofac Surg 64: 63, 2006 12. Gassner R, Tuli T, Hachl O, Rudisch A, Ulmer H: Cranio maxillofacial trauma: a 10 year review of 9,543 cases with 21,067 injuries. J Craniomaxillofac Surg 31: 51, 2003 13. Al Ahmed HE, Jaber MA, Abu Fanas SH, Karas M: The pattern of maxillofacial fractures in Sharjah, United Arab Emirates: a review of 230 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 98: 166, 2004 40