Bajada S, Ved A, Dudhniwala A G, Ahuja S
University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, Cardiff, UK.
Bone Joint J. 2017 Jan;99-B(1):116-121. doi: 10.1302/0301-620X.99B1.37989.
Rates of mortality as high as 25% to 30% have been described following fractures of the odontoid in the elderly population. The aim of this study was to examine whether easily identifiable variables present on admission are associated with mortality.
A consecutive series of 83 elderly patients with a fracture of the odontoid following a low-impact injury was identified retrospectively. Data that were collected included demographics, past medical history and the results of blood tests on admission. Radiological investigations were used to assess the Anderson and D'Alonzo classification and displacement of the fracture. The mean age was 82.9 years (65 to 101). Most patients (66; 79.5%) had a type 2 fracture. An associated neurological deficit was present in 11 (13.3%). All were treated conservatively; 80 (96.4%) with a hard collar and three (3.6%) with halo vest immobilisation.
The rate of mortality was 16% (13 patients) at 30 days and 24% (20 patients) at one year after injury. A low serum level of haemoglobin and the presence of a neurological deficit on admission were independent predicators of mortality at 30 days on binary logistic regression analysis. A, low level of haemoglobin, admission from an institution, a neurological deficit and type 3 fractures were independent predictors of mortality at one year.
We suggest that these easily identifiable predictors present on admission can be used to identify patients at high risk and guide management by a multidisciplinary team. Cite this article: Bone Joint J 2017;99-B:116-21.
据描述，老年人群齿状突骨折后的死亡率高达25%至30%。本研究的目的是检查入院时易于识别的变量是否与死亡率相关。
回顾性确定了一系列连续的83例因低冲击力损伤导致齿状突骨折的老年患者。收集的数据包括人口统计学资料、既往病史及入院时的血液检查结果。采用放射学检查评估安德森和达隆佐分类以及骨折移位情况。平均年龄为82.9岁（65至101岁）。大多数患者（66例；79.5%）为2型骨折。11例（13.3%）伴有神经功能缺损。所有患者均接受保守治疗；80例（96.4%）使用硬颈托，3例（3.6%）使用头环背心固定。
伤后30天死亡率为16%（13例患者），伤后1年死亡率为24%（20例患者）。二元逻辑回归分析显示，入院时血清血红蛋白水平低和存在神经功能缺损是30天死亡率的独立预测因素。血红蛋白水平低、从机构入院、神经功能缺损和3型骨折是1年死亡率的独立预测因素。
我们认为，这些入院时易于识别的预测因素可用于识别高危患者，并指导多学科团队的管理。引用本文：《骨与关节杂志》2017年；99-B：116 - 21。
