Bokhari Ali R, Sivakumar Brahman, Sefton Andrew, Lin Juin-Lih, Smith Margaret M, Gray Randolph, Hartin Nathan
Department of Orthopaedics and Trauma Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.
ANZ J Surg. 2019 Apr;89(4):412-417. doi: 10.1111/ans.14875. Epub 2018 Oct 8.
The aim of our study was to identify the demographics and complications in elderly cervical spine injuries and predictive factors for surgery, complications and mortality. We hypothesized younger healthier patients were more likely to undergo surgical intervention.
A retrospective review of 225 consecutive patients aged 65 years and over with cervical spine injuries was carried out over a 3-year period.
There were 113 males and 112 females with an average of 79.7 years (range 65-98). The most common fracture was C2 peg type (21.8%). Five patients had complete spinal cord injury (2.2%), 25 had incomplete spinal cord injury (11.1%) and 84% were neurologically intact. Fifty-four patients were managed operatively (24%), while 171 patients were managed non-operatively (76%). The operative group had higher rates of pneumonia (odds ratio (OR) 5.3, 95% confidence interval (CI) 2.6-10.7, P < 0.01), cardiac arrhythmia (OR 4.1, 95% CI 1.5-11.2, P < 0.01) and respiratory failure (OR 2.6, 95% CI 1.2-5.5, P < 0.05). There was no difference in mortality between the operative and non-operative group (18.5% and 12.9%, P = 0.3). Patients with complete spinal cord injury had 100% mortality. Significant predictive factors for complications and death were neurological deficits, comorbidities and the presence of other injuries (P < 0.05). Surgery was not predictive for death and the operative group was younger than the non-operative group (P < 0.05).
In the setting of a high complication rate, consideration should be given to palliation in elderly patients with complete spinal cord injury and there must be good rational for surgery.
我们研究的目的是确定老年颈椎损伤患者的人口统计学特征、并发症以及手术、并发症和死亡率的预测因素。我们假设年龄较小、身体状况较好的患者更有可能接受手术干预。
对连续225例年龄在65岁及以上的颈椎损伤患者进行了为期3年的回顾性研究。
男性113例，女性112例，平均年龄79.7岁（范围65 - 98岁）。最常见的骨折类型是C2齿突型（21.8%）。5例患者为完全性脊髓损伤（2.2%），25例为不完全性脊髓损伤（11.1%），84%神经功能完好。54例患者接受了手术治疗（24%），171例患者接受了非手术治疗（76%）。手术组肺炎发生率较高（比值比（OR）5.3，95%置信区间（CI）2.6 - 10.7，P < 0.01）、心律失常发生率较高（OR 4.1，95% CI 1.5 - 11.2，P < 0.01）以及呼吸衰竭发生率较高（OR 2.6，95% CI 1.2 - 5.5，P < 0.05）。手术组和非手术组的死亡率无差异（分别为18.5%和12.9%，P = 0.3）。完全性脊髓损伤患者的死亡率为100%。并发症和死亡的显著预测因素是神经功能缺损、合并症和其他损伤的存在（P < 0.05）。手术不是死亡的预测因素，且手术组比非手术组年龄更小（P < 0.05）。
在并发症发生率较高的情况下,对于老年完全性脊髓损伤患者应考虑姑息治疗，且手术必须有充分合理的依据。
