Grabel Zachary J, Armaghani Sheyan J, Vu Catphuong, Jain Amit, Yoon S Tim
Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Florida Orthopedic Institute, Temple Terrace, Florida, Washington, USA.
World Neurosurg. 2018 May;113:e535-e541. doi: 10.1016/j.wneu.2018.02.083. Epub 2018 Feb 21.
The optimal form of treatment for C2 spine fractures is controversial. This investigation analyzed the variations in treatment of C2 fractures over time, by age group, and by geographic location.
The Nationwide Emergency Department Sample database was queried to identify patients 18 years and older who sustained C2 fracture without neurologic injury from 2006 to 2012. Subsequently, patients were further filtered based on the intervention they received: collar, halo, and surgery. Regions of hospital used in analysis were defined as Northeast, Midwest, South, and West. Linear regression models were used to analyze trends for C2 incidence rates and treatment type. Analysis of variance tests were used to determine differences among procedure groups when stratified by regions and age groups.
Surgical intervention for C2 fracture increased from 36.5% in 2006 to 55.7% in 2012 (r = 0.116, P < 0.001). In contrast, the rate of halo use decreased from 57.8% in 2006 to 37.1% in 2012 (r = -0.139, P < 0.001). Surgery displayed increasing trend across all age groups. A greater proportion of patients in the Northeast were treated by collar compared with all other regions (P < 0.001). In contrast, halo use was significantly lower in the Northeast than the other 3 regions (P < 0.001).
This investigation demonstrated that surgical management of C2 fractures is increasing in frequency over time and at all age groups. Furthermore, the treatment of these fractures varies by region-the Northeast had the highest incidence of collar use and lowest rate of halo use.
C2 颈椎骨折的最佳治疗方式存在争议。本研究分析了 C2 骨折治疗方式随时间、年龄组和地理位置的变化情况。
查询全国急诊科样本数据库，以确定 2006 年至 2012 年期间 18 岁及以上无神经损伤的 C2 骨折患者。随后，根据患者接受的干预措施进一步筛选：颈托、头环和手术。分析中使用的医院地区定义为东北部、中西部、南部和西部。采用线性回归模型分析 C2 发病率和治疗类型的趋势。方差分析用于确定按地区和年龄组分层时各治疗组之间的差异。
C2 骨折的手术干预率从 2006 年的 36.5% 增至 2012 年的 55.7%（r = 0.116，P < 0.001）。相比之下，头环的使用率从 2006 年的 57.8% 降至 2012 年的 37.1%（r = -0.139，P < 0.001）。手术在所有年龄组中均呈上升趋势。与所有其他地区相比，东北部采用颈托治疗的患者比例更高（P < 0.001）。相比之下，东北部的头环使用率显著低于其他三个地区（P < 0.001）。
本研究表明，C2 骨折的手术治疗频率随时间推移在所有年龄组中均有所增加。此外，这些骨折的治疗因地区而异——东北部颈托使用率最高，头环使用率最低。
