八旬老人移位性 II 型齿状突骨折后路 C1-2 融合术后死亡率。

Mortality Rates After Posterior C1-2 Fusion for Displaced Type II Odontoid Fractures in Octogenarians.

机构信息

Department of Orthopedics; Spine Division, University of Maryland Medical Center.

出版信息

Spine (Phila Pa 1976). 2018 Sep 15;43(18):E1077-E1081. doi: 10.1097/BRS.0000000000002637.

DOI:10.1097/BRS.0000000000002637

PMID:29538245

Abstract

STUDY DESIGN

Retrospective cohort study OBJECTIVE.: To assess 30-day and 1-year mortality rates as well as the most common complications associated with posterior C1-2 fusion in an octogenarian cohort.

SUMMARY OF BACKGROUND DATA

Treatment of unstable type II odontoid fractures in elderly patients can present challenges. Recent evidence indicates in patients older than 80 years, posterior C1-2 fusion results in improved survival as compared to other modes of treatment.

METHODS

Retrospective analysis of 43 consecutive patients (25 female and 18 male; mean age 84.3 yr, range 80-89 yr; mean Charlson Comorbidity Index 1.4, (range 1-6); mean body mass index 24.8 ± 4.2 kg/m, who underwent posterior C1-C2 fusion for management of unstable type II odontoid fracture by four fellowship trained spine surgeons at a single institution between January 2006 to June 2016.

RESULTS

Mean fracture displacement was 5.1 ± 3.6 mm and mean absolute value of angulation was 19.93° ± 12.93°. The most common complications were altered mental status (41.9%, n = 18), dysphagia (27.9%, n = 12) with 50% of those patients (6/12) requiring a feeding tube, and emergency reintubation (9.3%, n = 4). To the date of review completion, 25 of 43 patients expired (58.1%), median survival of 1.76 years from the date of surgery. Thirty-day and 1-year mortality rates were 2.3% and 18.6%, respectively. Patients who developed dysphagia were 14.5 times more likely to have expired at 1 year; dysphagia was also found to be significantly associated with degree of displacement. Fracture displacement was found to be associated with increased odds for 1-year mortality when accounting for age and requirement of a feeding tube.

CONCLUSION

Posterior C1-2 fusion results in acceptably low mortality rates in octogenarians with unstable type II odontoid fractures when compared to nonoperative management mortality rates in current literature. Initial fracture displacement is associated with higher mortality rate in this patient population.

LEVEL OF EVIDENCE

摘要

研究设计

回顾性队列研究

目的

评估 80 岁以上患者接受后路 C1-2 融合术的 30 天和 1 年死亡率以及最常见的并发症。

背景资料总结

治疗老年不稳定型 II 型齿状突骨折可能具有挑战性。最近的证据表明，对于年龄大于 80 岁的患者，后路 C1-2 融合术的生存率优于其他治疗方式。

方法

对 43 例连续患者（25 例女性，18 例男性；平均年龄 84.3 岁，范围 80-89 岁；平均 Charlson 合并症指数 1.4（范围 1-6）；平均体重指数 24.8±4.2kg/m，由四位 fellowship培训的脊柱外科医生在一家机构接受后路 C1-C2 融合术治疗不稳定型 II 型齿状突骨折。

结果

平均骨折移位为 5.1±3.6mm，平均绝对成角为 19.93°±12.93°。最常见的并发症是精神状态改变（41.9%，n=18），吞咽困难（27.9%，n=12），其中 50%（6/12）的患者需要置管喂养，9.3%（n=4）需要紧急重新插管。截至审查完成时，43 例患者中有 25 例死亡（58.1%），从手术日期算起的中位生存期为 1.76 年。30 天和 1 年的死亡率分别为 2.3%和 18.6%。发生吞咽困难的患者在 1 年内死亡的可能性高 14.5 倍；吞咽困难也与移位程度显著相关。在考虑年龄和置管需求的情况下，骨折移位与 1 年死亡率的增加有关。