Department of Trauma Surgery and Sports Traumatology, Academic Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria.
Eur Spine J. 2011 Nov;20(11):1915-20. doi: 10.1007/s00586-011-1890-7. Epub 2011 Jul 5.
Anterior screw fixation of Type II odontoid fractures has been recommended. Only few publications analyse the mechanism of failure in geriatric patients. We reviewed 18 male and 15 female patients aged 65 and above for parameters that influence the development of postoperative loss of correction, delayed union or non-union. Patients were stratified in two groups: 21 cases in Group A (union) and 12 patients in Group B (loss of correction, delayed union, non-union, revision surgery). Statistically significant correlation (p < 0.05) could be detected between failure to heal and: (1) degenerative changes in the atlanto-odontoid joint, (2) severity of osteoporosis in the odontoid process, (3) posterior oblique fracture type, (4) suboptimal fracture reduction, (5) suboptimal position of implant following demanding intraoperative conditions, (6) quality of fracture compression and (7) severity of fracture comminution. The overall morbidity and mortality rates were 29.0 and 8.6%, respectively. Our results indicate that these factors should be addressed regarding the selection of the operative treatment method in the geriatric patient.
已推荐使用前路螺钉固定 II 型齿状突骨折。只有少数出版物分析了老年患者失败的机制。我们回顾了 18 名年龄在 65 岁及以上的男性和 15 名女性患者，分析了影响术后矫正丢失、延迟愈合或不愈合的参数。患者分为两组：A 组（愈合）21 例，B 组（矫正丢失、延迟愈合、不愈合、翻修手术）12 例。未能愈合与以下因素之间存在显著相关性（p<0.05）：（1）寰枢关节退行性改变，（2）齿状突骨质疏松严重程度，（3）后斜骨折类型，（4）骨折复位不理想，（5）在术中条件苛刻的情况下，植入物位置不理想，（6）骨折压缩质量，（7）骨折粉碎程度。总体发病率和死亡率分别为 29.0%和 8.6%。我们的结果表明，在选择老年患者的手术治疗方法时，应考虑这些因素。
