Faure A, Graillon T, Pesenti S, Tropiano P, Blondel B, Fuentes S
Unité de chirurgie du rachis, hôpital de la Timone, université Aix-Marseille, CHU Timone, 264, rue Saint-Pierre, 13005 Marseille, France.
Unité de chirurgie du rachis, hôpital de la Timone, université Aix-Marseille, CHU Timone, 264, rue Saint-Pierre, 13005 Marseille, France.
Orthop Traumatol Surg Res. 2017 Dec;103(8):1221-1228. doi: 10.1016/j.otsr.2017.07.008. Epub 2017 Aug 5.
Odontoid fractures are the most common upper cervical spine fracture in adults over 70 years of age. Hence, treatment of these fractures has public health implications.
Evaluate the early complications, bone healing and mortality in patients above 75 years of age who undergo surgical treatment of an odontoid fracture. Compare the results between patients operated with the Harms technique or anterior screw fixation.
This was a retrospective study of 70 patients with an odontoid fracture who were treated surgically between 2000 and 2015 at the Hôpital de la Timone in France. The age at the time of diagnosis, comorbidities, ASA score and autonomy were evaluated. Bone healing was determined using computed tomography.
In the cohort, 22 patients underwent anterior screw fixation, 38 were treated using the Harms technique and 10 with other procedures. The average age was 85.1 years. Fifty-four percent of patients had an ASA score above 3. The average follow-up was 23.4 months. An Anderson type II fracture was present in 80.6% of patients. In the anterior screw fixation group, the operative time was significantly shorter than in the Harms group and no blood transfusions were needed. However, 13.6% of these patients had to be re-operated because the initial construct was unstable; no patients in the Harms group underwent revision surgery. There were more complications in the anterior screw fixation group than in the Harms group: 41% versus 13.2% (P<0.02). The fractures had healed in all patients reviewed after 1 year. The 3-month survival in the anterior screw fixation group was 64.7% and it was 81.3% in the Harms group. These rates were stable at 1 year with no statistical differences between groups.
Surgical treatment of odontoid fractures in the elderly results in an excellent union rate. The mortality rate is stable after 3 months. In our experience, the Harms technique has a lower risk of complications and better mechanical stability than anterior screw fixation. Despite the steep learning curve, we believe the Harms technique is probably the best choice for treating odontoid fractures in the elderly.
IV.
齿状突骨折是70岁以上成年人中最常见的上颈椎骨折。因此，这些骨折的治疗具有公共卫生意义。
评估75岁以上接受齿状突骨折手术治疗患者的早期并发症、骨愈合情况及死亡率。比较采用哈姆斯技术或前路螺钉固定手术的患者结果。
这是一项对2000年至2015年期间在法国蒂蒙医院接受手术治疗的70例齿状突骨折患者的回顾性研究。评估诊断时的年龄、合并症、美国麻醉医师协会（ASA）评分和自主能力。使用计算机断层扫描确定骨愈合情况。
在该队列中，22例患者接受了前路螺钉固定，38例采用哈姆斯技术治疗，10例采用其他手术方法。平均年龄为85.1岁。54%的患者ASA评分高于3。平均随访时间为23.4个月。80.6%的患者为安德森II型骨折。在前路螺钉固定组中，手术时间明显短于哈姆斯组，且无需输血。然而，该组13.6%的患者因初始固定结构不稳定而不得不再次手术；哈姆斯组无患者接受翻修手术。前路螺钉固定组的并发症比哈姆斯组更多：分别为41%和13.2%（P<0.02）。所有接受复查的患者在1年后骨折均已愈合。前路螺钉固定组3个月时的生存率为64.7%，哈姆斯组为81.3%。这些比率在1年时稳定，组间无统计学差异。
老年人齿状突骨折的手术治疗可实现极佳的愈合率。3个月后死亡率稳定。根据我们的经验，哈姆斯技术比前路螺钉固定的并发症风险更低，机械稳定性更好。尽管学习曲线较陡，但我们认为哈姆斯技术可能是治疗老年人齿状突骨折的最佳选择。
IV级
