Departments of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
Spine (Phila Pa 1976). 2010 Oct 1;35(21 Suppl):S219-27. doi: 10.1097/BRS.0b013e3181f32716.
Clinically based systematic review.
To define optimal clinical care for elderly patients with Type II and III odontoid fractures using a systematic review with expert opinion.
Numerous manuscripts have been written about treatment strategies of odontoid fractures in the elderly. However, these articles are of low quality and optimal treatment algorithms do not exist.
Focused questions on the treatment of elderly patients with Type II and III odontoid fractures were refined by a panel of spine traumologists surgeons, consisting of fellowship trained neurologic and orthopedic surgeons. MeSH keywords were searched through MEDLINE, EMBASE, and the Cochrane Database of Systematic reviews, and pertinent abstracts and manuscripts obtained. The quality of literature was rated as high, moderate, low, or very low. Using the GRADE evidence-based review system, the proposed questions were answered using the literature review and expert opinion. These treatment recommendations were then rated as either strong or weak based on the quality of evidence and clinical expertise.
The literature searches revealed low and very low quality evidence with no prospective or randomized studies. The MEDLINE search engine returned 1759 articles, which were further limited to "all aged (65 and over)," human subjects and the English language. The subsequent search resulted in a return of 377 manuscripts. These abstracts where then reviewed in detail and 117 manuscripts were selected, which were obtained and supplemented with additional manuscripts to form an evidentiary table.
Odontoid fractures have a significant morbidity in the elderly (>65 years) population. Type II fractures in this population are recommended to be treated operatively with a weak recommendation, and if treated nonoperatively using a hard collar immobilization device. Type III odontoid fractures in the elderly optimal treatment with a strong recommendation is immobilization in a hard collar.
基于临床的系统评价。
通过系统评价和专家意见，为 II 型和 III 型齿状突骨折的老年患者确定最佳临床治疗方案。
已经有许多关于老年人齿状突骨折治疗策略的文献。然而，这些文章的质量较低，并且不存在最佳的治疗方案。
由一组脊柱创伤外科医生组成的专家小组，对 II 型和 III 型齿状突骨折老年患者的治疗问题进行了重点研究。这些医生包括神经外科和骨科的研究员。通过 MEDLINE、EMBASE 和 Cochrane 系统评价数据库搜索了 MeSH 关键词，并获得了相关的摘要和文章。对文献的质量进行了评价，分为高、中、低和极低质量。使用 GRADE 循证评价系统，根据文献综述和专家意见回答了提出的问题。然后根据证据质量和临床专业知识，将这些治疗建议评为强或弱。
文献检索结果显示，低质量和极低质量证据，没有前瞻性或随机研究。MEDLINE 搜索引擎返回了 1759 篇文章，然后将其进一步限制为“所有年龄（65 岁及以上）”、人类研究对象和英语。随后的搜索结果返回了 377 篇手稿。然后详细审查了这些摘要，并选择了 117 篇手稿，获得并补充了其他手稿，形成了一个证据表。
齿状突骨折在老年人（>65 岁）中发病率较高。对于该人群中的 II 型骨折，建议采用手术治疗，推荐级别较弱，如果采用硬领固定装置进行非手术治疗。对于老年 III 型齿状突骨折，采用硬领固定的最佳治疗方法是采用强推荐。
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