*Department of Neurosurgery, University of Virginia, Charlottesville, VA †Department of Neurological and Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA ‡Department of Health Services, University of Washington, Seattle, WA §Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS ¶Department of Orthopaedic Surgery, University of Washington, Seattle, WA; and ‖Department of Neurosurgery, University of Toronto, Ontario, Canada.
Spine (Phila Pa 1976). 2013 Dec 15;38(26):2240-6. doi: 10.1097/BRS.0000000000000009.
Subgroup analysis of a prospective multicenter study.
Outcome analysis of nonoperatively treated elderly patients with type II odontoid fractures, including assessment of consequence of a fracture nonunion.
Odontoid fractures are among the most common fractures in the elderly, and controversy exists regarding treatment.
Subgroup analysis of a prospective multicenter study of elderly patients (≥65 yr) with type II odontoid fracture. Neck Disability Index and Short-Form 36 (SF-36) version 2 were collected at baseline and 6 and 12 months. Fifty-eight (36.5%) of the 159 patients were treated nonoperatively.
Of the 58 patients initially treated nonoperatively, 8 died within 90 days and were excluded. Of the remaining 50 patients, 11 (22.0%) developed nonunion, with 7 (63.6%) requiring surgery. Four of the 39 (10.3%) patients classified as having "successful union" required surgery due to late fracture displacement. Thus, 15 (30.0%) patients developed primary or secondary nonunion and 11 (22.0%) required surgery. The overall 12-month mortality was 14.0% (nonunion = 2, union = 5; P= 0.6407). For union and nonunion groups, Neck Disability Index and SF-36 version 2 declined significantly at 12 months compared with preinjury values (P< 0.05), except for SF-36 version 2 Physical Functioning (P= 0.1370). There were no significant differences in outcome parameters based on union status at 12 months (P> 0.05); however, it is important to emphasize that the 12-month outcomes for the nonunion patients reflect the status of the patient after delayed surgical treatment in the majority of these cases.
Nonoperative treatment for type II odontoid fracture in the elderly has high rates of nonunion and mortality. Patients with nonunion did not report worse outcomes compared with those who achieved union at 12 months; however, the majority of patients with nonunion required delayed surgical treatment. These findings may prove useful for patients who are not surgical candidates or elect for nonoperative treatment.
前瞻性多中心研究的亚组分析。
分析非手术治疗的老年 II 型齿状突骨折患者的结局，包括评估骨折不愈合的后果。
齿状突骨折是老年人中最常见的骨折之一，对于治疗方法存在争议。
对老年（≥65 岁）II 型齿状突骨折患者的前瞻性多中心研究进行亚组分析。基线、6 个月和 12 个月时采集颈痛残疾指数（NDI）和健康调查简表 36 版本 2（SF-36 v2）。159 例患者中 58 例（36.5%）接受非手术治疗。
最初接受非手术治疗的 58 例患者中，有 8 例在 90 天内死亡而被排除。在其余 50 例患者中，11 例（22.0%）发生了不愈合，其中 7 例（63.6%）需要手术。39 例（10.3%）“愈合成功”的患者中有 4 例因晚期骨折移位需要手术。因此，15 例（30.0%）患者发生原发性或继发性不愈合，11 例（22.0%）需要手术。总的 12 个月死亡率为 14.0%（不愈合=2，愈合=5；P=0.6407）。与损伤前相比，愈合组和不愈合组的 NDI 和 SF-36 v2 在 12 个月时均显著下降（P<0.05），除了 SF-36 v2 生理功能（P=0.1370）。12 个月时根据愈合情况，两组的结局参数无显著差异（P>0.05）；然而，重要的是要强调，大多数不愈合患者的 12 个月结局反映了这些病例中大多数患者延迟手术治疗后的状态。
老年 II 型齿状突骨折的非手术治疗有很高的不愈合率和死亡率。不愈合患者在 12 个月时报告的结局与愈合患者没有差异；然而，大多数不愈合患者需要延迟手术治疗。这些发现可能对不能手术或选择非手术治疗的患者有用。
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