Department of Spine Surgery, Zentralklinik Bad Berka, Germany.
Department of Orthopedic Surgery, Alexandria University, Egypt.
Spine (Phila Pa 1976). 2018 Jun 1;43(11):761-766. doi: 10.1097/BRS.0000000000002417.
A prospective study of 20 multimorbid patients older than 65 years undergoing minimally invasive surgical treatment for odontoid fracture.
To analyze the results of percutaneous transarticular atlantoaxial screw fixation as a new minimally invasive treatment modality in this high risk group of patients.
Odontoid fractures are a common injury pattern in the elderly. These fractures typically present significant challenges as geriatric patients often have multiple comorbidities that may adversely affect fracture management. Despite numerous publications on this subject, with a trend toward primary operative stabilization, the appropriate treatment for this frequent and potentially life threatening injury remains controversial.
Between January 2013 and December 2015, 20 consecutive patients underwent posterior percutaneous transarticular atlantoaxial screw fixation for odontoid fracture type II. The two main inclusion criteria were age 65 years or older and ASA score of III or IV. The screws were inserted percutaneously with the help of two fluoroscopy devices. Clinical and radiological examinations were regularly performed for a minimum of 18 months postoperatively.
The mean age was 81 years, all of them with multiple comorbidities. Reduction of the fracture and screw insertion was possible in all cases. The mean operative time was 51.75 minutes and mean blood loss was 41.7 mL. Three patients died in the first 3 months after surgery. Healing of the fracture occurred in 15 patients (88.2%). Revision surgery was not necessary in any of the patients. Mean visual analogue scale (VAS) at the final follow-up was 2.4, and mean patient satisfaction score was 7.1.
Percutaneous transarticular atlantoaxial fixation in elderly patients offers a good minimally invasive operative treatment in this multimorbid group of patients. This new technique with short operative time is well tolerated by the geriatric patients leading to a healing rate up to 88%.
对 20 名 65 岁以上行微创手术治疗寰椎齿状突骨折的多系统疾病患者进行前瞻性研究。
分析经皮寰枢关节螺钉固定作为一种新的微创治疗方式，在该高风险老年患者人群中的结果。
齿状突骨折是老年人常见的骨折类型。这些骨折通常具有显著的挑战性，因为老年患者通常存在多种合并症，这可能对骨折管理产生不利影响。尽管关于这一主题有大量的出版物，且存在倾向于主要手术固定的趋势，但这种常见且可能危及生命的损伤的适当治疗仍存在争议。
2013 年 1 月至 2015 年 12 月，20 例连续患者因寰椎齿状突骨折 II 型接受后路经皮寰枢关节螺钉固定。两个主要纳入标准为年龄 65 岁或以上和 ASA 评分 III 或 IV 级。在 2 个透视设备的帮助下经皮插入螺钉。术后至少 18 个月定期进行临床和影像学检查。
平均年龄为 81 岁，均有多种合并症。所有病例均能复位骨折并插入螺钉。平均手术时间为 51.75 分钟，平均失血量为 41.7 毫升。3 例患者在术后 3 个月内死亡。15 例患者（88.2%）骨折愈合。所有患者均无需再次手术。末次随访时，平均视觉模拟评分（VAS）为 2.4，平均患者满意度评分为 7.1。
在多系统疾病老年患者中，经皮寰枢关节固定为该患者群体提供了一种良好的微创治疗选择。这种新的技术具有较短的手术时间，老年患者耐受性良好，愈合率高达 88%。
4 级。
