虚弱状态与创伤性跌倒后寰椎骨折的关系：70 例老年寰椎骨折患者不同损伤机制的研究。

Association Between Frailty Status and Odontoid Fractures After Traumatic Falls: Investigation of Varying Injury Mechanisms Among 70 Elderly Odontoid Fracture Patients.

机构信息

Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, NYU Langone Medical Center, NY Spine Institute, New York, NY.

Department of Orthopedic Surgery, Waikato Hospital, Hamilton, New Zealand.

出版信息

J Orthop Trauma. 2019 Dec;33(12):e484-e488. doi: 10.1097/BOT.0000000000001597.

DOI:10.1097/BOT.0000000000001597

PMID:31365449

Abstract

OBJECTIVES

To determine significant associations between patient frailty status and odontoid fractures across common traumatic mechanisms of injuries (MOIs) in the elderly.

DESIGN

Retrospective review.

SETTING

Single, academic-affiliated hospital with full surgical services.

PATIENTS/PARTICIPANTS: Patients 65 years or older with traumatic odontoid fractures were included.

INTERVENTION

Nonoperative management (soft/hard collar, halo, traction tongs, and Minerva) and/or operative fixation.

MAIN OUTCOME MEASUREMENTS

Modified frailty index (mFI), MOI, concurrent injuries, inpatient length of stay (LOS), reoperation, and mortality rates.

RESULTS

Seventy patients were included (80.6 ± 8.5 years, 60% F, 88% European, 10% Maori/Pacific, 1.4% Asian, Charlson Comorbidity Index 5.3 ± 2.2, mFI 0.21 ± 0.15). The most common MOIs were falls (74.3%), high-speed motor vehicle accidents (MVAs) (17.1%), low-speed MVAs (5.7%), and pedestrian versus car (2.9%). Patients with traumatic falls exhibited significantly higher mFI scores (0.25) compared with low-speed MVAs (0.16), high-speed MVAs (0.08), and pedestrian versus car (0.01) (P = 0.003). Twenty-seven patients with odontoid fractures were frail, 33 were prefrail, and 10 were robust. Ninety-two percent of frail patients had a traumatic fall as their MOI, as opposed to 73% of prefrail and 30% of robust patients (P < 0.001). Prefrail and frail patients were 4.3 times more likely than robust patients to present with odontoid fractures through traumatic fall [odds ratio (OR): 4.33 (1.47-12.75), P = 0.008], and frailty increased likelihood of reoperation [OR: 4.2 (1.2-14.75), P = 0.025] and extended LOS [OR: 5.71 (1.05-10.37), P = 0.017]. Frail patients had the highest 30-day (P = 0.017) and 1-year mortality (P < 0.001) compared with other groups.

CONCLUSION

Patients with traumatic odontoid fractures from falls were significantly more frail in comparison with any other MOIs, with worse short- and long-term outcomes.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

目的

确定老年人常见创伤机制（MOI）下患者虚弱状态与枢椎骨折之间的显著关联。

设计

回顾性研究。

地点

拥有全面外科服务的单一学术附属医院。

患者/参与者：纳入 65 岁及以上创伤性枢椎骨折患者。

干预措施

非手术治疗（软/硬领、环、牵引钳和 Minerva）和/或手术固定。

主要观察指标

改良虚弱指数（mFI）、MOI、并发损伤、住院时间（LOS）、再次手术和死亡率。

结果

共纳入 70 例患者（80.6±8.5 岁，60%女性，88%欧洲人，10%毛利/太平洋人，1.4%亚洲人，Charlson 合并症指数 5.3±2.2，mFI 0.21±0.15）。最常见的 MOI 是跌倒（74.3%）、高速机动车事故（MVA）（17.1%）、低速 MVA（5.7%）和行人与汽车（2.9%）。创伤性跌倒患者的 mFI 评分明显更高（0.25），与低速 MVA（0.16）、高速 MVA（0.08）和行人与汽车（0.01）相比（P=0.003）。27 例枢椎骨折患者为虚弱，33 例为虚弱前期，10 例为健壮。92%的虚弱患者的 MOI 是创伤性跌倒，而虚弱前期和健壮患者分别为 73%和 30%（P<0.001）。虚弱前期和虚弱患者发生创伤性跌倒所致枢椎骨折的可能性是健壮患者的 4.3 倍[优势比（OR）：4.33（1.47-12.75），P=0.008]，且虚弱程度增加了再次手术的可能性[OR：4.2（1.2-14.75），P=0.025]和延长 LOS 的可能性[OR：5.71（1.05-10.37），P=0.017]。与其他组相比，虚弱患者在 30 天（P=0.017）和 1 年死亡率（P<0.001）方面均最高。