Vetter S
Klinik für Orthopädie und Unfallchirurgie, BG-Klinik Ludwigshafen, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Deutschland.
Chirurg. 2019 Oct;90(10):782-790. doi: 10.1007/s00104-019-01020-w.
Studies have shown that the numbers of injuries of the cervical spine increase in elderly patients. An early clinical examination and adequate diagnostics are necessary to initiate the appropriate treatment. A computed tomography (CT) scan is recommended to exclude injuries of the cervical spine. Dynamic fluoroscopy and magnetic resonance imaging (MRI) can additionally be helpful to detect instabilities. The treatment of the injury depends on the extent of the fracture and includes conservative treatment options with soft or rigid ortheses for cervical spine immobilization, retention with a halo fixator or open/closed reduction and fixation. In the selection of treatment it should be taken into consideration that the use of rigid immobilization or a halo fixator is associated with a significant reduction of the quality of life. In the region of the upper cervical spine only unstable fractures of the atlas and of the axis should be operatively treated. In the region of the subaxial cervical spine fractures are prone to be unstable due to the lack of flexibility of the cervical spine in elderly patients. Therefore, fractures of types B and C according to AO Spine, for which operative treatment is recommended, are regularely seen. In addition, a pre-existing stenosis of the spinal cord may lead to neurological symptoms which negatively influence the clinical outcome.
研究表明，老年患者颈椎损伤的数量有所增加。早期临床检查和充分的诊断对于启动适当的治疗是必要的。建议进行计算机断层扫描（CT）以排除颈椎损伤。动态荧光透视和磁共振成像（MRI）有助于检测颈椎不稳定情况。损伤的治疗取决于骨折的程度，包括采用软质或硬质矫形器进行颈椎固定的保守治疗方案、使用头环固定器进行固定或进行开放/闭合复位及固定。在选择治疗方法时，应考虑到使用刚性固定或头环固定器会显著降低生活质量。在上颈椎区域，只有寰椎和枢椎的不稳定骨折才应进行手术治疗。在颈椎下区域，由于老年患者颈椎缺乏灵活性，骨折容易不稳定。因此，根据AO脊柱分型，推荐手术治疗的B型和C型骨折较为常见。此外，脊髓先前存在的狭窄可能导致神经症状，对临床结果产生负面影响。
