Heiler Ute, Schray D, Pitzen T
Zentrum für Wirbelsäulenchirurgie, Orthopädie und Traumatologie, SRH Klinikum Karlsbad-Langensteinbach, Guttmannstraße 1, 76307, Karlsbad, Deutschland.
Unfallchirurgie (Heidelb). 2022 Oct;125(10):792-800. doi: 10.1007/s00113-021-01080-w. Epub 2021 Oct 28.
Fractures of the axis are among the most frequent spinal injuries. Posterior C1-C2 fixation according to Goel-Harms is an accepted alternative to the more traditional procedures: initial stability has been shown and there is a wide range of indications but there is a paucity of data on possible complications. Such knowledge, however, is essential in order to improve outcomes.Thus, the aim of the study was:1. to describe the frequency, type and severity of early postoperative complications following C1-C2 fixation according to Goel-Harms,2. to investigate whether there is a correlation between frequency and severity of complications,3. to detect risk factors for complications.Patients included in this study were treated surgically using the C1-C2 fixation according to Goel-Harms between March 2011 and July 2018. Data were taken from our hospital database and checked via OPS 10 code "S12.1". We analyzed age, sex, ASA score, blood loss, operating time and complications. These data were extracted from clinical data sheets.A total of 134 patients were detected, 54% female, mean age 75 years and mean ASA score 3. There were 122 complications. All these complications were observed in 50% of the patients. These were mainly minor complications (32%), and 18% severe complications. Mortality was 2%. We found that patients with more severe complications also had significantly more complications when compared to patients with minor complications (Fisher's exact test, p = 0.001). Preoperative ASA score was the only risk factor to significantly influence the number (p = 0.001) and severity (p = 0.002) of postoperative complications. Each increase of the preoperative ASA score increased the risk to get one more complication by a factor of 2.55 (odds ratio 2.55) and increased the risk to get a severe complication by a factor of 2.43 (odds ratio 2.43). Intraoperative blood loss, patient age and duration of surgery, however, were not identified as risk factors for complications.
枢椎骨折是最常见的脊柱损伤之一。根据戈尔 - 哈姆斯法进行的C1 - C2后路固定术是一种被认可的替代传统手术的方法：已证实其具有初始稳定性且适应证广泛，但关于可能并发症的数据却很匮乏。然而，此类知识对于改善治疗结果至关重要。因此，本研究的目的是：1. 描述根据戈尔 - 哈姆斯法进行C1 - C2固定术后早期并发症的发生率、类型和严重程度；2. 调查并发症的发生率与严重程度之间是否存在相关性；3. 检测并发症的危险因素。本研究纳入的患者在2011年3月至2018年7月期间接受了根据戈尔 - 哈姆斯法进行的C1 - C2固定手术治疗。数据取自我们医院的数据库，并通过OPS 10编码“S12.1”进行核对。我们分析了年龄、性别、美国麻醉医师协会（ASA）评分、失血量、手术时间和并发症情况。这些数据从临床数据表中提取。共检测到134例患者，其中女性占54%，平均年龄75岁，平均ASA评分为3分。发生了122例并发症。所有这些并发症在50%的患者中出现。主要为轻微并发症（32%），严重并发症为18%。死亡率为2%。我们发现，与轻微并发症患者相比，严重并发症患者的并发症数量也显著更多（费舍尔精确检验，p = 0.001）。术前ASA评分是唯一显著影响术后并发症数量（p = 0.001）和严重程度（p = 0.002）的危险因素。术前ASA评分每增加一分，发生额外一例并发症的风险增加2.55倍（比值比2.55），发生严重并发症的风险增加2.43倍（比值比2.43）。然而，术中失血量、患者年龄和手术时长未被确定为并发症的危险因素。
