26例接受后路融合治疗的老年齿状突骨折患者的功能预后、发病率、死亡率及骨折愈合情况

Functional outcomes, morbidity, mortality, and fracture healing in 26 consecutive geriatric odontoid fracture patients treated with posterior fusion.

作者信息

Molinari Robert William, Dahl Jason, Gruhn William L, Molinari William J

机构信息

Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY 14642, USA.

出版信息

J Spinal Disord Tech. 2013 May;26(3):119-26. doi: 10.1097/BSD.0b013e31823e99e4.

DOI:10.1097/BSD.0b013e31823e99e4

PMID:22143048

Abstract

STUDY DESIGN

Retrospective review.

OBJECTIVE

To evaluate functional outcomes, fracture healing, complications, and mortality associated with posterior fusion surgery (PSF) for the management of geriatric type II odontoid fractures.

SUMMARY OF BACKGROUND DATA

Outcomes of C1-2 fusion for geriatric odontoid fractures are not well defined.

METHODS

Twenty-six consecutive elderly patients with type II odontoid fractures were treated by the same spinal surgeon at a Level-1 trauma center during an 8-year period. All patients had ≥50% odontoid displacement and were treated with PSF including C1-2 (PSF group; average age, 79 y). Chart reviews were performed evaluating patient comorbidities, treatment complications, and mortality rates. At ultimate follow-up, patients had open mouth, flexion, and extension radiographs to assess fracture stability and healing. In addition, functional outcomes were assessed using Neck Disability Index (NDI), analog pain, and satisfaction questionnaire scores and compared with a group of 40 aged-matched control patients (control group; average age, 79.8 y).

RESULTS

The mortality rate was 19.2%, and major complications occurred in 27% of patients. At an average 13-month follow-up (range, 3-48 mo), the fracture-healing rate was only 33%. However, no patient had mobile odontoid nonunion or instability of the C1-2 articulation. NDI scores averaged 18.1 points indicating only mild residual disability. Pain scores were low averaging only 1.8 points. NDI and pain scores did not differ significantly from aged-matched controls (P = 0.16). Treatment satisfaction scores were high. Odontoid nonunion was not associated with significantly higher levels of disability or neck pain and did not affect scores for patient satisfaction.

CONCLUSIONS

PSF for geriatric odontoid fractures is associated with moderately high levels of morbidity and mortality. Posttreatment neck pain and disability is low and does not differ significantly from aged-matched cohorts. Odontoid fracture healing after surgical stabilization does not correlate with improved functional outcomes.

摘要

研究设计

回顾性研究。

目的

评估老年II型齿状突骨折后路融合手术（PSF）的功能结局、骨折愈合情况、并发症及死亡率。

背景资料总结

老年齿状突骨折C1-2融合的结局尚不明确。

方法

在8年期间，一名脊柱外科医生在一级创伤中心连续治疗了26例老年II型齿状突骨折患者。所有患者齿状突移位≥50%，并接受了包括C1-2的PSF治疗（PSF组；平均年龄79岁）。进行病历回顾以评估患者的合并症、治疗并发症及死亡率。在最终随访时，患者拍摄张口位、屈曲位和伸展位X线片以评估骨折稳定性和愈合情况。此外，使用颈部功能障碍指数（NDI）、模拟疼痛评分和满意度问卷评分评估功能结局，并与40例年龄匹配的对照患者组（对照组；平均年龄79.8岁）进行比较。

结果

死亡率为19.2%，27%的患者发生了主要并发症。平均随访13个月（范围3-48个月）时，骨折愈合率仅为33%。然而，没有患者出现活动的齿状突不愈合或C1-2关节不稳定。NDI评分平均为18.1分，表明仅存在轻度残留残疾。疼痛评分较低，平均仅为1.8分。NDI和疼痛评分与年龄匹配的对照组无显著差异（P = 0.16）。治疗满意度评分较高。齿状突不愈合与残疾或颈部疼痛水平显著升高无关，也不影响患者满意度评分。