Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA.
Klinika Úrazovej Chirurgie SZU a FNsP F.D.Roosevelta, Banská Bystrica, Slovakia.
Eur Spine J. 2021 Jun;30(6):1635-1650. doi: 10.1007/s00586-021-06818-z. Epub 2021 Apr 2.
To determine the variation in the global treatment practices for subaxial unilateral cervical spine facet fractures based on surgeon experience, practice setting, and surgical subspecialty.
A survey was sent to 272 members of the AO Spine Subaxial Injury Classification System Validation Group worldwide. Questions surveyed surgeon preferences with regard to diagnostic work-up and treatment of fracture types F1-F3, according to the AO Spine Subaxial Cervical Spine Injury Classification System, with various associated neurologic injuries.
A total of 161 responses were received. Academic surgeons use the facet portion of the AO Spine classification system less frequently (61.6%) compared to hospital-employed and private practice surgeons (81.1% and 81.8%, respectively) (p = 0.029). The overall consensus was in favor of operative treatment for any facet fracture with radicular symptoms (N2) and for any fractures categorized as F2N2 and above. For F3N0 fractures, significantly less surgeons from Africa/Asia/Middle East (49%) and Europe (59.2%) chose operative treatment than from North/Latin/South America (74.1%) (p = 0.025). For F3N1 fractures, significantly less surgeons from Africa/Asia/Middle East (52%) and Europe (63.3%) recommended operative treatment than from North/Latin/South America (84.5%) (p = 0.001). More than 95% of surgeons included CT in their work-up of facet fractures, regardless of the type. No statistically significant differences were seen in the need for MRI to decide treatment.
Considerable agreement exists between surgeon preferences with regard to unilateral facet fracture management with few exceptions. F2N2 fracture subtypes and subtypes with radiculopathy (N2) appear to be the threshold for operative treatment.
根据医生经验、执业环境和手术亚专科，确定寰枢椎单侧关节突骨折的全球治疗实践的变化。
向全球 272 名 AO 脊柱下颈椎损伤分类系统验证组成员发送了一份调查问卷。问题调查了根据 AO 脊柱下颈椎损伤分类系统，在伴有各种相关神经损伤的情况下，外科医生对 F1-F3 型骨折的诊断和治疗的偏好。
共收到 161 份回复。与医院任职和私人执业的外科医生（分别为 81.1%和 81.8%）相比，学术外科医生较少使用（61.6%）AO 脊柱分类系统的关节突部分（p=0.029）。总体共识是对有神经根症状（N2）的任何关节突骨折以及任何 F2N2 及以上骨折均进行手术治疗。对于 F3N0 骨折，来自非洲/亚洲/中东（49%）和欧洲（59.2%）的外科医生选择手术治疗的比例明显低于北美/拉丁美洲/南美洲（74.1%）（p=0.025）。对于 F3N1 骨折，来自非洲/亚洲/中东（52%）和欧洲（63.3%）的外科医生推荐手术治疗的比例明显低于北美/拉丁美洲/南美洲（84.5%）（p=0.001）。无论骨折类型如何，超过 95%的外科医生在进行关节突骨折的评估时都包括 CT。在决定治疗方法时是否需要 MRI 方面，没有发现统计学上的显著差异。
在单侧关节突骨折处理方面，外科医生的偏好存在很大的一致性，只有少数例外。F2N2 骨折亚型和伴有神经根病（N2）的亚型似乎是手术治疗的阈值。
