Girardo Massimo, Rava Alessandro, Gargiulo Giosuè, Coniglio Angela, Artiaco Stefano, Massè Alessandro, Fusini Federico
Department of Orthopaedic and Trauma Surgery, Orthopaedic and Trauma Centre, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy.
Department of Orthopaedic and Trauma Surgery, Orthopaedic and Trauma Centre, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, University of Turin, Turin, Italy.
J Craniovertebr Junction Spine. 2018 Oct-Dec;9(4):254-259. doi: 10.4103/jcvjs.JCVJS_93_18.
Odontoid fracture is a very common cervical injury, especially in elderly patients. Despite the high frequency, the appropriate management is still debated. The aim of this study is to evaluate clinical and radiological outcomes after anterior screw fixation or halo vest (HV) in type II odontoid fracture in elderly patients.
Between January 2013 and December 2015, 135 consecutive patients affected by odontoid process were found. According to inclusion and exclusion criteria, 57 patients were included in the study. Patients were evaluated with visual analog scale (VAS), Smiley-Webster Scale (SWS), Italian Version of the Neck Disability Index (NDI), and patient satisfaction during follow-up. Furthermore, radiological data were evaluated for bone healing. Student's -test or Fisher's exact test was used between groups, analyzing radiological and clinical results, and level of statistical significance was set at < 0.05.
Seventeen patients were female and 40 were male. Twenty-seven patients were included in surgical group (SG) while 30 were included in HV group with a mean follow-up of 37.74 ± 10.52 months. A significant difference ( < 0.05) between groups was found for pseudoarthrosis, with a lower rate for SG. No significant differences in term of VAS, NDI, and SWS were found between groups ( > 0.05); SG reached higher satisfaction than HV group ( = 0.0271).
Both treatments are equivalent in terms of clinical outcomes, and they are a valuable choice in the management of type II odontoid fracture. However, it must be considered that patients could slightly tolerate HV and may need a change of treatment.
齿突骨折是一种非常常见的颈椎损伤，尤其在老年患者中。尽管其发生率很高，但合适的治疗方法仍存在争议。本研究的目的是评估老年患者II型齿突骨折采用前路螺钉固定或头环背心（HV）治疗后的临床和影像学结果。
在2013年1月至2015年12月期间，共发现135例连续的齿突骨折患者。根据纳入和排除标准，57例患者被纳入本研究。在随访期间，采用视觉模拟量表（VAS）、斯迈利 - 韦伯斯特量表（SWS）、意大利版颈部功能障碍指数（NDI）以及患者满意度对患者进行评估。此外，对影像学数据进行骨愈合评估。在组间使用学生t检验或费舍尔精确检验，分析影像学和临床结果，设定统计学显著性水平为<0.05。
17例为女性，40例为男性。27例患者被纳入手术组（SG），30例被纳入HV组，平均随访时间为37.74±10.52个月。在假关节形成方面，组间存在显著差异（<0.05），手术组发生率较低。组间在VAS、NDI和SWS方面未发现显著差异（>0.05）；手术组的满意度高于HV组（=0.0271）。
两种治疗方法在临床结果方面相当，它们是II型齿突骨折治疗中的宝贵选择。然而，必须考虑到患者对HV的耐受性可能稍差，可能需要更换治疗方法。
