Pola Enrico, Pambianco Virginia, Colangelo Debora, Formica Virginia M, Autore Giovanni, Nasto Luigi A
Enrico Pola, Virginia Pambianco, Debora Colangelo, Virginia M Formica, Giovanni Autore, Spinal Unit, Department of Orthopaedics and Traumatology, "A. Gemelli" University Hospital, Catholic University of Rome, 00168 Rome, Italy.
World J Orthop. 2017 Jan 18;8(1):82-86. doi: 10.5312/wjo.v8.i1.82.
Odontoid fractures account for 5% to 15% of all cervical spine injuries and 1% to 2% of all spine fractures. Type II fractures are the most common fracture pattern in elderly patients. Treatment (rigid and non-rigid immobilization, anterior screw fixation of the odontoid and posterior C1-C2 fusion) remains controversial and represents a unique challenge for the treating surgeon. The aims of treatment in the elderly is to quickly restore pre-injury function while decreasing morbidity and mortality associated with inactivity, immobilization with rigid collar and prolonged hospitalization. Conservative treatment of type II odontoid fractures is associated with relatively high rates of non-union and in a few cases delayed instability. Options for treatment of symptomatic non-unions include surgical fixation or prolonged rigid immobilization. In this report we present the case of a 73-year-old woman with post-traumatic odontoid non-union successfully treated with Teriparatide systemic anabolic therapy. Complete fusion and resolution of the symptoms was achieved 12 wk after the onset of the treatment. Several animal and clinical studies have confirmed the potential role of Teriparatide in enhancing fracture healing. Our case suggests that Teriparatide may have a role in improving fusion rates of C2 fractures in elderly patients.
齿突骨折占所有颈椎损伤的5%至15%，占所有脊柱骨折的1%至2%。Ⅱ型骨折是老年患者中最常见的骨折类型。治疗方法（刚性和非刚性固定、齿突前路螺钉固定和C1-C2后路融合）仍存在争议，对治疗外科医生来说是一项独特的挑战。老年患者的治疗目标是在降低因活动减少、使用刚性颈托固定和长期住院相关的发病率和死亡率的同时，迅速恢复伤前功能。Ⅱ型齿突骨折的保守治疗与相对较高的不愈合率相关，在少数情况下会出现延迟性不稳定。有症状的不愈合的治疗选择包括手术固定或长期刚性固定。在本报告中，我们介绍了一例73岁女性创伤后齿突不愈合患者，通过特立帕肽全身合成代谢疗法成功治疗的病例。治疗开始12周后实现了完全融合并症状消失。多项动物和临床研究证实了特立帕肽在促进骨折愈合方面的潜在作用。我们的病例表明，特立帕肽可能在提高老年患者C2骨折的融合率方面发挥作用。
