Gembruch Oliver, Lemonas Elias, Ahmadipour Yahya, Sure Ulrich, El Hindy Nicolai, Müller Oliver
Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany.
Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany.
Clin Neurol Neurosurg. 2018 Jun;169:166-173. doi: 10.1016/j.clineuro.2018.04.021. Epub 2018 Apr 22.
The demographic change in the population leads to a rising number of patients presenting with fractures of the cervical spine, especially C-2, due to falls. With an increase of co-morbidities in these elder patients, the risk for intra- and postoperative complications is increased likewise. Thus, an alternative strategy instead of operative management of these fractures should be taken into account whenever possible. Conservative management of dens fractures in the elderly is still a subject of great controversy despite numerous studies on this topic. The aim of this study was to analyze the rate of successful osseous consolidation of C-2 fractures with conservative treatment by wearing a semi-rigid collar or halo thoracic vest without further surgical intervention.
We analyzed the medical records and CT-scan of the cervical spine of 254 patients with C-2 fractures retrospectively, who were admitted to our department between January 1990 and September 2015. Fractures were diagnosed by CT-scan of the cervical spine and classified according to the Anderson - D`Alonzo classification. 183 patients were submitted to surgery as treatment of choice. In 71 patients a conservative management with external immobilization was chosen. The latter group was subjected to study analysis.
71 patients (mean age 74.08 years ± 16.06 years) were diagnosed with C-2 fractures (Typ I: 4; Typ II 36; Typ III: 31) and treated conservatively using a Philadelphia collar (n = 57), or a halo-thoracic vest (n = 14), respectively. 12 patients were lost to follow up and excluded from further analysis. Conservative treatment of the fractures was deemed successful when a bony consolidation of the fracture in follow-up CT scans was seen (45 of 59 patients; 76.3%). 20 patients with a Type II fracture (20/28, 71.4%) showed a successful ossification. In 14 patients (overall 23.7%; Typ I: 1 (7.14%), Typ II: 8 (57.14%), Typ III: 5 (35.71%)) external immobilization failed to achieve primary stability. These patients were submitted to consecutive surgery.
From our data it can be concluded that elderly patients, presenting with non-dislocated Type II fractures of the axis without accompaining neurological deficits, will have a more than 70% chance for a bony consolidation by conservative management. Consolidation rates may be estimated even higher in Type I and III fractures. Therefore, we suggest that external immobilization might be a valuable option to treat elderly patients with these fractures under certain circumstances.
人口结构的变化导致因跌倒而出现颈椎骨折（尤其是C2骨折）的患者数量不断增加。随着这些老年患者合并症的增多，术中及术后并发症的风险也同样增加。因此，应尽可能考虑采用替代策略而非对这些骨折进行手术治疗。尽管针对该主题已有大量研究，但老年齿状突骨折的保守治疗仍是一个极具争议的话题。本研究的目的是分析通过佩戴半刚性颈托或头环胸背心进行保守治疗且无需进一步手术干预的情况下，C2骨折成功骨愈合的发生率。
我们回顾性分析了1990年1月至2015年9月间收治入本科的254例C2骨折患者的病历及颈椎CT扫描结果。通过颈椎CT扫描诊断骨折，并根据Anderson - D`Alonzo分类法进行分类。183例患者接受了首选的手术治疗。71例患者选择了采用外部固定的保守治疗。后一组患者接受研究分析。
71例患者（平均年龄74.08岁±16.06岁）被诊断为C2骨折（I型：4例；II型36例；III型：31例），分别使用费城颈托（n = 57）或头环胸背心（n = 14）进行保守治疗。12例患者失访，被排除在进一步分析之外。当在随访CT扫描中看到骨折部位出现骨愈合时，骨折的保守治疗被认为是成功的（59例患者中的45例；76.3%）。20例II型骨折患者（20/28，71.4%）显示骨化成功。14例患者（总体23.7%；I型：1例（7.14%），II型：8例（57.14%），III型：5例（35.71%））外部固定未能实现初始稳定性。这些患者接受了后续手术。
从我们的数据可以得出结论，对于无神经功能缺损的老年II型枢椎非脱位骨折患者，通过保守治疗实现骨愈合的几率超过70%。I型和III型骨折的愈合率可能估计更高。因此，我们建议在某些情况下，外部固定可能是治疗这些骨折老年患者的一个有价值的选择。
