Center for Advanced Neurosurgery, University of Louisville, Louisville, KY 40202, USA.
Spine (Phila Pa 1976). 2012 May 1;37(10):854-9. doi: 10.1097/BRS.0b013e3182377486.
Propensity score matched retrospective cohort study.
To report early complication rates and associated risk factors in patients with C2 fractures who underwent fusion or halo immobilization.
There is limited data on the impact of age, injury severity score, and medical comorbidities on overall complication rates from surgical fixation versus halo-vest immobilization of C2 fractures.
The Nationwide Inpatient Sample database from 2002 to 2008 was queried to identify cohorts of adult patients (age ≥ 18 years) with C2 fractures without spinal cord injury who were treated with either fusion or halo-vest immobilization. Complication rates, hospital length of stay, and costs were compared in a propensity score matched sample. Multivariate analysis was used to identify predictors of in-hospital complications.
A total of 3758 patients (1627 fusion and 2131 halo) were identified. Fusion was associated with greater overall complication rates (20.2% vs. 10.1%, P < 0.0001), increased length of stay (8.9 d vs. 6.4 d, P < 0.0001), higher charges ($80,000 vs. $41,000, P < 0.0001), but a lower rate of nonroutine discharge (52.6% vs. 62.6%, P < 0.0001). There was no difference in mortality between the fusion group (2.75%) and the halo group (3.33%). Age, injury score, and comorbidity increased complication rates by a similar degree (odds ratio) in both cohorts. Patients aged 80 years and older were 3.5 times more likely to have a complication than those younger than 60 years.
Fusion patients had greater overall complication rates, increased length of stay, and greater resource utilization but were discharged home in a greater proportion. Both fusion and halo were associated with significant (more than 3-fold) increase in complication rates in elderly patients aged 80 years or older. Given the similar mortality rate between the fusion group and the halo group and the higher cost and complication rate in the fusion group, our study supports the use of halo-vest immobilization in patients where operative therapy is contraindicated.
倾向评分匹配回顾性队列研究。
报告接受融合或 halo 固定治疗的 C2 骨折患者的早期并发症发生率和相关危险因素。
关于年龄、损伤严重程度评分和合并症对 C2 骨折手术固定与 halo-vest 固定的整体并发症发生率的影响，数据有限。
从 2002 年至 2008 年的全国住院患者样本数据库中检索到无脊髓损伤的 C2 骨折成年患者（年龄≥18 岁）的队列，他们接受融合或 halo-vest 固定治疗。在倾向评分匹配样本中比较并发症发生率、住院时间和费用。采用多变量分析确定院内并发症的预测因素。
共纳入 3758 例患者（融合组 1627 例， halo 组 2131 例）。融合组总体并发症发生率较高（20.2%比 10.1%，P<0.0001），住院时间较长（8.9 d 比 6.4 d，P<0.0001），费用较高（80000 美元比 41000 美元，P<0.0001），但非常规出院率较低（52.6%比 62.6%，P<0.0001）。融合组死亡率（2.75%）与 halo 组（3.33%）无差异。年龄、损伤评分和合并症在两个队列中以相似程度（比值比）增加并发症发生率。80 岁及以上的患者发生并发症的可能性是 60 岁以下患者的 3.5 倍。
融合组患者总体并发症发生率较高、住院时间较长、资源利用率较高，但出院回家的比例较大。融合和 halo 固定都与 80 岁及以上老年患者并发症发生率显著增加（3 倍以上）有关。鉴于融合组和 halo 组的死亡率相似，以及融合组的成本和并发症发生率较高，我们的研究支持在手术治疗禁忌的情况下使用 halo-vest 固定。
