Sheikh Hassaan Q, Athanassacopoulos Michael, Doshi Arpan B, Breakwell Lee, Cole Ashley, Rex Michael Antony Louis, Chiverton Neil
Sheffield Teaching Hospitals, Trauma and Orthopaedic, Herries Road, Sheffield, S5 7AU, UK.
Sheffield Teaching Hospitals, Trauma and Orthopaedic, Herries Road, Sheffield, S5 7AU, UK.
Surgeon. 2018 Oct;16(5):297-301. doi: 10.1016/j.surge.2018.03.007. Epub 2018 Apr 12.
We aimed to analyse the rates of early and causes of death in patients aged over 65 years with a type II odontoid fracture.
A consecutive series of 93 patients with a type II fracture of the odontoid process was retrospectively identified. Data collected included patient demographics, co-morbidities, associated injuries, neurological injury, date of death and cause of death. Mean patient age was 81. Five patients (5%) were treated operatively while the rest were treated in a hard cervical collar. Five patients (5%) had an incomplete cervical cord injury secondary to the fracture.
The rate of mortality at 30 days was 10% (9 patients) and at 90 days it was 16% (15 patients). Following multivariate analysis, the factors found to significantly increase the risk of 30-day mortality included increasing age, increasing injury severity score and leukaemia. Following univariate analysis the only factor found to increase the risk of 90-day mortality was advancing age. The commonest causes of death were pneumonia and ischaemic coronary disease.
Our results suggest that this patient cohort is frail and at risk of early mortality. We suggest that their inpatient care be provided in close conjunction with elderly care physicians.
我们旨在分析65岁以上II型齿状突骨折患者的早期死亡率及死亡原因。
回顾性纳入93例连续性II型齿状突骨折患者。收集的数据包括患者人口统计学资料、合并症、相关损伤、神经损伤、死亡日期及死亡原因。患者平均年龄为81岁。5例（5%）患者接受了手术治疗，其余患者采用硬颈托治疗。5例（5%）患者因骨折继发颈髓不完全损伤。
30天死亡率为10%（9例患者），90天死亡率为16%（15例患者）。多因素分析显示，显著增加30天死亡风险的因素包括年龄增加、损伤严重程度评分增加及白血病。单因素分析显示，增加90天死亡风险的唯一因素是年龄增长。最常见的死亡原因是肺炎和缺血性冠状动脉疾病。
我们的结果表明，该患者群体身体虚弱，存在早期死亡风险。我们建议其住院治疗应与老年科医生密切合作。
