Stockholm Spine Center, Löwenströmska Sjukhuset, 194 89 Upplands-Väsby, Sweden; Department of Surgical Sciences, Uppsala University Hospital, 751 85 Uppsala, Sweden.
Department of Surgical Sciences, Uppsala University Hospital, 751 85 Uppsala, Sweden.
Spine J. 2018 Oct;18(10):1853-1860. doi: 10.1016/j.spinee.2018.03.021. Epub 2018 Apr 9.
Fractures of the axis (C2) are the most common cervical spinal injuries in the elderly population. Several authors have reported improved survival among elderly patients with C2 fractures when treated surgically.
We aimed to analyze whether surgery improves survival of elderly with C2 fractures.
STUDY DESIGN/SETTING: An observational population-based longitudinal multi-registry study was carried out.
Swedish Patient Registry 1997 to 2014 and Swedish Cause of Death Registry 1997 to 2014 served as source of patient sample.
Survival after C2 fracture according to non-surgical and surgical treatment was the outcome measure.
We included all patients treated for the primary diagnosis of C2 fracture (10th revision of the International Statistical Classification of Diseases and Related Health Problems or ICD-10: S12.1) at an age ≥70 years and receiving treatment at a health-care facility. Non-surgical treatment comprises cervical collar or halo-vest treatment. Surgical treatment was identified in the Swedish patient registry extract using the Swedish classification of procedural codes. Survival was determined using the Kaplan-Meier method. Comorbidity was determined using the Charlson Comorbidity Index.
Of the included 3,375 elderly patients with C2 fractures (43% men, aged 83±7 years), 22% were treated surgically. Surgical treatment was assigned based on age, gender, and year of treatment. The 1-year survival of 2,618 non-surgically treated patients was 72% (n=1,856), and 81% (n=614) for the 757 surgically treated (p<.001, relative risk reduction=11%). Adjusted for age, gender, comorbidity, and year of injury, surgically treated patients had greater survival than non-surgically treated patients (hazard ratio=0.88, 95% confidence interval: 0.79-0.97). Among those above 88 years of age (95% confidence interval: 85-92), surgical treatment lost its effect on survival.
Despite the frailty of elderly patients, the morbidity of cervical external immobilization with a rigid collar seemingly weighs greater than surgical morbidity, even in octogenarians. For those above 88 years of age, non-surgical treatment should be primarily attempted.
颈椎（C2）骨折是老年人中最常见的颈椎脊柱损伤。有几位作者报告说，对 C2 骨折的老年患者进行手术治疗可以提高生存率。
我们旨在分析手术是否可以提高 C2 骨折老年患者的生存率。
研究设计/设置：进行了一项观察性基于人群的纵向多登记研究。
瑞典患者登记处 1997 年至 2014 年和瑞典死因登记处 1997 年至 2014 年作为患者样本的来源。
C2 骨折后的生存情况，根据非手术和手术治疗进行评估。
我们纳入了所有在 70 岁以上因 C2 骨折（国际疾病分类第 10 次修订版或 ICD-10：S12.1）首次诊断而接受治疗并在医疗机构接受治疗的患者。非手术治疗包括颈圈或 halo-vest 治疗。在瑞典患者登记处的提取中，使用瑞典手术分类编码识别手术治疗。使用 Kaplan-Meier 方法确定生存情况。使用 Charlson 合并症指数确定合并症。
在纳入的 3375 名患有 C2 骨折的老年患者（43%为男性，年龄 83±7 岁）中，22%接受了手术治疗。手术治疗是根据年龄、性别和治疗年份确定的。2618 名未接受手术治疗的患者的 1 年生存率为 72%（n=1856），757 名接受手术治疗的患者的生存率为 81%（n=614）（p<.001，相对风险降低=11%）。在调整年龄、性别、合并症和受伤年份后，手术治疗的患者比未手术治疗的患者有更高的生存率（风险比=0.88，95%置信区间：0.79-0.97）。在 88 岁以上的患者中（95%置信区间：85-92），手术治疗对生存率的影响消失。
尽管老年患者身体虚弱，但与颈椎外固定用刚性颈圈的发病率相比，手术发病率似乎更为严重，即使是在 80 多岁的患者中也是如此。对于 88 岁以上的患者，应首先尝试非手术治疗。
