Service de Chirurgie Orthopédique-Traumatologique-Chirurgie Vertébrale, Institut Universitaire Locomoteur et du Sport, Hôpital Pasteur 2, CHU de Nice, 30, avenue voie romaine, 06100 Nice, France.
Service de Chirurgie Orthopédique-Traumatologique-Chirurgie Vertébrale, Institut Universitaire Locomoteur et du Sport, Hôpital Pasteur 2, CHU de Nice, 30, avenue voie romaine, 06100 Nice, France.
Orthop Traumatol Surg Res. 2020 Nov;106(7):1399-1403. doi: 10.1016/j.otsr.2019.12.017. Epub 2020 Feb 21.
Odontoid fractures are very common in older adults and are associated with a high mortality rate. The aim of this study was to evaluate the outcomes after conservative treatment of non-displaced odontoid fractures and surgical treatment of displaced fractures in patients older than 70 years. It was hypothesized that early mortality of displaced fractures is higher than in non-displaced fractures.
This was a single-center retrospective observational study of odontoid fractures (type II in the Anderson and Alonzo classification) in patients older than 70 years that occurred between 2014 and 2017. Conservative treatment with immobilization for 3 months was proposed when the fracture was displaced less than 2 mm (non-displaced fracture group). Surgical treatment in the form of anterior screw fixation was proposed when the fracture displacement was more than 2 mm (displaced fracture group). The primary endpoint was the mortality rate at 3 months.
The study included 79 patients (46 women) who had a mean age of 85 years (70-105). The 3-month mortality in the entire cohort was 27% and the 1-year mortality was 30%. Conservative treatment was provided to the 36 patients with non-displaced fractures. The 3-month mortality rate in this group was 11%. A displaced fracture occurred in 43 patients: 17 were treated surgically by anterior screw fixation; 20 could not be operated on because of anesthesia contraindications and 6 died within 24hours of the fracture event. The 3-month mortality rate in this group was 40%; 3 of the 17 operated patients died from postoperative respiratory complications; 8 of the 20 patients with contraindications died, in addition to the 6 that died soon after the fracture occurred.
This study confirms that mortality and morbidity are high following odontoid fractures. The mortality rate was significantly higher in patients with displaced fractures, confirming our hypothesis. The mortality rate was especially high when patients with displaced fractures could not undergo surgery because of anesthesia contraindications. Also, there was a high rate of respiratory complications after anterior screw fixation of displaced fractures.
Given our findings, conservative treatment should be compared to surgical treatment for displaced fractures and the anterior approach should be compared to the posterior one for surgical cases.
IV.
寰椎骨折在老年人中非常常见，且与高死亡率相关。本研究旨在评估 70 岁以上患者中保守治疗非移位型寰椎骨折和手术治疗移位型骨折的结果。我们假设，移位型骨折的早期死亡率高于非移位型骨折。
这是一项单中心回顾性观察研究，纳入了 2014 年至 2017 年期间 70 岁以上安德森和阿隆佐（Anderson and Alonzo）分类 II 型寰椎骨折患者。当骨折移位小于 2mm（非移位骨折组）时，建议采用 3 个月固定的保守治疗。当骨折移位大于 2mm（移位骨折组）时，建议采用前路螺钉固定的手术治疗。主要终点是 3 个月时的死亡率。
研究共纳入 79 例患者（46 例女性），平均年龄 85 岁（70-105 岁）。全组患者 3 个月死亡率为 27%，1 年死亡率为 30%。36 例非移位骨折患者接受了保守治疗。该组 3 个月死亡率为 11%。43 例患者发生了移位骨折：17 例行前路螺钉固定术；20 例因麻醉禁忌证不能手术；6 例在骨折发生后 24 小时内死亡。该组 3 个月死亡率为 40%；3 例手术患者死于术后呼吸并发症；20 例有禁忌证的患者中除了 6 例在骨折发生后不久死亡外，还有 8 例死亡。
本研究证实，寰椎骨折后死亡率和发病率均较高。移位型骨折患者的死亡率明显更高，证实了我们的假设。因麻醉禁忌证而无法手术的移位型骨折患者死亡率尤其高。此外，移位型骨折前路螺钉固定后呼吸并发症发生率较高。
根据我们的发现，对于移位型骨折，保守治疗应与手术治疗进行比较，对于手术病例，前路方法应与后路方法进行比较。
IV 级。
