Neurosurgery Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy.
Neurosurgery Division, University Hospital S.Anna, Viale Aldo Moro 8, 44121, Cona di Ferrara, Italy.
Eur Spine J. 2019 May;28(5):1064-1071. doi: 10.1007/s00586-019-05898-2. Epub 2019 Jan 23.
Analysis of functional outcome of elderly patients with type II odontoid fractures treated conservatively in relation to their radiological outcome.
A total of 50 geriatric patients with type II odontoid fractures were treated with Aspen/Vista collars. On admission, each patient was assessed assigning ASA score, modified Rankin Scale (mRS-pre) and Charlson Comorbidity Index (CCI). From 12-15 months after treatment, functional evaluations were performed employing a second modified Rankin Scale (mRS-post) together with Neck Disability Index (NDI) and Smiley-Webster pain scale (SWPS). Radiological outcome was evaluated through dynamic cervical spine X-rays at 3 months and cervical spine CT scans 6 months after treatment. Three different conditions were identified: stable union, stable non-union and unstable non-union. Surgery was preferred whenever a fracture gap > 2 mm, an antero-posterior displacement > 5 mm, an odontoid angulation > 11° or neurological deficits occurred.
Among the 50 patients, 24 reached a stable union, while 26 a stable non-union. Comparing the two groups, no differences in ASA (p = 0.60), CCI (p = 0.85) and mRS-pre (p = 0.14) were noted. Similarly, no differences in mRS-post (p = 0.96), SWPS (p = 0.85) and NDI (p = 0.51) were observed between patients who reached an osseous fusion and those with a stable fibrous non-union. No effects of age, sex, ASA, mRS-pre, fracture dislocation and radiological outcome were discovered on functional outcome. At logistic regression analysis, female sex and high values of CCI emerged associated with worse NDI.
In geriatric type II odontoid fractures, pre-injury clinical status and comorbidities overcome imaging in determining post-treatment level of function. Hard collar immobilization led to a favourable functional outcome with mRS-post, NDI and SWPS values diffusely encouraging whatever a bony union or a fibrous non-union was obtained. These slides can be retrieved under Electronic Supplementary Material.
分析保守治疗Ⅱ型齿状突骨折老年患者的功能结果与影像学结果的关系。
50 例老年Ⅱ型齿状突骨折患者采用 Aspen/Vista 颈圈治疗。入院时，每位患者均进行美国麻醉医师协会（ASA）评分、改良 Rankin 量表（mRS-pre）和 Charlson 合并症指数（CCI）评估。治疗后 12-15 个月，采用改良 Rankin 量表（mRS-post）、颈部残疾指数（NDI）和 Smiley-Webster 疼痛量表（SWPS）进行功能评估。通过治疗后 3 个月的颈椎动态 X 线片和 6 个月的颈椎 CT 扫描评估影像学结果。确定了三种不同的情况：稳定愈合、稳定未愈合和不稳定未愈合。只要出现骨折间隙>2mm、前后移位>5mm、齿状突成角>11°或出现神经功能缺损，就优先选择手术。
50 例患者中，24 例达到稳定愈合，26 例达到稳定未愈合。比较两组患者，ASA（p=0.60）、CCI（p=0.85）和 mRS-pre（p=0.14）无差异。同样，达到骨性融合的患者与稳定纤维性未愈合的患者在 mRS-post（p=0.96）、SWPS（p=0.85）和 NDI（p=0.51）方面无差异。年龄、性别、ASA、mRS-pre、骨折脱位和影像学结果对功能结果均无影响。Logistic 回归分析显示，女性和高 CCI 值与 NDI 较差相关。
在老年Ⅱ型齿状突骨折中，受伤前的临床状况和合并症比影像学结果更能决定治疗后的功能水平。硬领固定导致功能结果良好，mRS-post、NDI 和 SWPS 值普遍令人满意，无论获得骨性愈合还是纤维性未愈合。这些幻灯片可在电子补充材料中检索到。
