Department of Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
Eur Spine J. 2011 Feb;20(2):195-204. doi: 10.1007/s00586-010-1507-6. Epub 2010 Sep 12.
Considerable controversy exists regarding the optimal management of elderly patients with type II odontoid fractures. There is uncertainty regarding the consequences of non-union. The best treatment remains unclear because of the morbidity associated with prolonged cervical immobilisation versus the risks of surgical intervention. The objective of the study was to evaluate the published literature and determine the current evidence for the management of type II odontoid fractures in elderly. A search of the English language literature from January 1970 to date was performed using Medline and the following keywords: odontoid, fractures, cervical spine and elderly. The search was supplemented by cross-referencing between articles. Case reports and review articles were excluded although some were referred to in the discussion. Studies in patients aged 65 years with a minimum follow-up of 12 months were selected. One-hundred twenty-six articles were reviewed. No class I study was identified. There were two class II studies and the remaining were class III. Significant variability was found in the literature regarding mortality and morbidity rates in patients treated with and without halo vest immobilisation. In recent years several authors have claimed satisfactory results with anterior odontoid screw fixation while others have argued that this may lead to increased complications in this age group. Lately, the posterior cervical (Goel-Harms) construct has also gained popularity amongst surgeons. There is insufficient evidence to establish a standard or guideline for odontoid fracture management in elderly. While most authors agree that cervical immobilisation yields satisfactory results for type I and III fractures in the elderly, the optimal management for type II fractures remain unsolved. A prospective randomised controlled trial is recommended.
关于老年 II 型齿状突骨折的最佳治疗方案存在较大争议。对于不愈合的后果存在不确定性。由于与长期颈椎固定相关的发病率以及手术干预的风险，最佳治疗方法仍不明确。本研究旨在评估已发表的文献，并确定目前治疗老年 II 型齿状突骨折的证据。使用 Medline 和以下关键词搜索了 1970 年 1 月至今日的英文文献：齿状突、骨折、颈椎和老年。通过文章之间的交叉引用进行了补充搜索。排除了病例报告和综述文章，尽管有些文章在讨论中被提及。选择了年龄在 65 岁以上且随访时间至少为 12 个月的患者进行研究。共回顾了 126 篇文章。未发现 I 级研究。有两项 II 级研究，其余为 III 级研究。在接受和不接受 Halo 背心固定治疗的患者的死亡率和发病率方面，文献中存在很大的差异。近年来，一些作者声称前路齿状突螺钉固定可获得满意的结果，而另一些作者则认为这可能会导致该年龄段患者并发症增加。最近，后路颈椎（Goel-Harms）结构也受到了外科医生的欢迎。目前尚无足够的证据为老年齿状突骨折的治疗建立标准或指南。虽然大多数作者认为颈椎固定对老年 I 型和 III 型骨折的效果令人满意，但 II 型骨折的最佳治疗方法仍未解决。建议进行前瞻性随机对照试验。
