Coleman Nichola, Chan Hoi-Ying H, Gibbons Veronique, Baker Joseph F
Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand.
Clinical Effectiveness, Quality and Patient Safety, Waikato Hospital, Hamilton, New Zealand.
Geriatr Orthop Surg Rehabil. 2022 Mar 18;13:21514593211070263. doi: 10.1177/21514593211070263. eCollection 2022.
Odontoid peg fractures (OF) are the most common cervical spine fracture in the elderly. This retrospective analysis aimed to compare the outcomes of older patients with OF who had been managed non-operatively with either a hard or soft cervical collar.
We analysed the retrospective data of the clinical and radiographic records of patients 60 years or older who presented over a 10-year period with OF and were treated non-operatively with a cervical collar. Mortality was the primary outcome measure with mechanism of injury, complications, and fracture healing secondary measures.
45 patients (hard collar n = 22; soft collar n = 23) were included with comparable demographics for frailty and co-morbidities in each group; age was significantly higher in the soft collar group (80.6 vs 86.4 years; = .0065). Associated injuries and complications were not significantly different overall, or when Type II fractures were separately analysed ( = .435 associated injuries, = .121 complications). All-cause mortality was greater in the soft collar group (30-day mortality hard: 0%, soft: 9%; 1-year mortality hard: 18%, soft: 48% = .035). However, once corrected for age, this proved not to reach significance ( = .333) in any fracture type. Non-union was common (77%) but was not significantly different (hard = 70%; soft = 87%; = .419).
Consistent with other reports, non-union rates remained substantial regardless of which collar was used. After controlling for age, there was no difference in all-cause mortality between elderly patients treated with a hard or soft cervical collar for odontoid peg fractures.
Soft collars appear suitable for the treatment of odontoid peg fractures in the elderly without compromising outcome. Larger cohort analyses will help confirm this finding.
齿突骨折（OF）是老年人中最常见的颈椎骨折。本回顾性分析旨在比较采用硬式或软式颈托非手术治疗的老年齿突骨折患者的治疗结果。
我们分析了10年间60岁及以上因齿突骨折前来就诊且采用颈托非手术治疗患者的临床和影像学记录的回顾性数据。死亡率是主要结局指标，损伤机制、并发症和骨折愈合情况是次要指标。
纳入45例患者（硬式颈托组n = 22；软式颈托组n = 23），两组在虚弱程度和合并症方面的人口统计学特征具有可比性；软式颈托组年龄显著更高（80.6岁对86.4岁；P = 0.0065）。总体上，相关损伤和并发症无显著差异，单独分析II型骨折时也是如此（相关损伤P = 0.435，并发症P = 0.121）。软式颈托组全因死亡率更高（30天死亡率：硬式颈托组为0%，软式颈托组为9%；1年死亡率：硬式颈托组为18%，软式颈托组为48%；P = 0.035）。然而，校正年龄后，在任何骨折类型中这均未达到显著差异（P = 0.333）。骨折不愈合很常见（77%），但差异不显著（硬式颈托组为70%；软式颈托组为87%；P = 0.419）。
与其他报告一致，无论使用哪种颈托，骨折不愈合率仍然很高。校正年龄后，采用硬式或软式颈托治疗老年齿突骨折患者的全因死亡率无差异。
软式颈托似乎适合治疗老年齿突骨折，且不影响治疗结果。更大规模的队列分析将有助于证实这一发现。
