Musbahi Omar, Khan Ameer Hamid A, Anwar Mohammed Omer, Chaudery Hannan, Ali Adam M, Montgomery Alexander Sheriff
Oxford University Clinical Academic Graduate School, Oxford, UK.
Spinal Department, The Royal London Hospital, Whitechapel, London, UK.
Clin Neurol Neurosurg. 2018 Oct;173:130-139. doi: 10.1016/j.clineuro.2018.08.013. Epub 2018 Aug 9.
The objectives of this review are to determine the level of evidence for the management of OCF, compare outcomes of different immobilisation, and to review the prognosis.
A literature search was conducted using 3 databases (MEDLINE, PubMed and EMBASE). All papers between 1940 and July 2017 were screened using PRISMA guidelines. Inclusion criteria were patients with a confirmed diagnosis of occipital condyle fracture(s) on CT managed with any form of immobilisation with no age restriction. Primary outcome was clinical improvement in symptoms or Neck Disability Index. MINORS and OCEBM level was assigned to each study.
25 studies met the inclusion criteria. Most studies used a single form of C-spine immobilisation support (58%) with a semi rigid collar and halo device being the most common. From these studies, the average length of time for immobilisation was 11.7 weeks, 9 weeks and 8.3 weeks for halo, semi-rigid and rigid cervical collars respectively. Neuro deficit was found in 20.3% of patients. OCEBM level of evidence and MINORS score was low.
Management of OCF is associated with low level of evidence. Further studies are needed to determine optimal management of these under-diagnosed fractures.
本综述的目的是确定枕髁骨折（OCF）治疗的证据水平，比较不同固定方式的治疗结果，并评估预后。
使用3个数据库（MEDLINE、PubMed和EMBASE）进行文献检索。按照PRISMA指南筛选1940年至2017年7月期间的所有论文。纳入标准为经CT确诊为枕髁骨折且采用任何形式固定治疗的患者，无年龄限制。主要结局为症状的临床改善或颈部残疾指数。为每项研究指定MINORS评分和牛津循证医学中心（OCEBM）证据水平。
25项研究符合纳入标准。大多数研究采用单一形式的颈椎固定支持（58%），其中半刚性颈托和头环装置最为常见。从这些研究来看，采用头环、半刚性颈托和刚性颈托固定的平均时间分别为11.7周、9周和8.3周。20.3%的患者存在神经功能缺损。证据的OCEBM水平和MINORS评分较低。
OCF的治疗证据水平较低。需要进一步研究以确定这些诊断不足的骨折的最佳治疗方法。
