Lyons Joseph Gabriel, Mian Humza Moghis
Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, OH, USA.
J Craniovertebr Junction Spine. 2022 Jan-Mar;13(1):85-93. doi: 10.4103/jcvjs.jcvjs_164_21. Epub 2022 Mar 9.
Fractures of the atlas represent a large portion of cervical spine trauma in the geriatric population. With an aging and more active population, it is expected that the number of patients sustaining atlas fractures is increasing. However, epidemiologic data regarding the incidence of atlas fractures in large populations are scarce. The aim of this study was to investigate the incidence and demographic characteristics of patients with fractures of the atlas in the United States (US) over the last 20 years.
This descriptive epidemiology study retrospectively analyzed the National Electronic Injury Surveillance System database to identify cases of atlas fractures presenting to US Emergency Departments (EDs) from 2001 to 2020. Annual and overall numbers of fractures and fracture incidence rates, patient demographics (age, gender, race), and injury characteristics (mechanism, associated injuries) were analyzed. Incidence rates are expressed as the number of fractures per million at-risk person-years. Patients were split into four different age groups for comparisons (<18, 18-64, 65-79, 80+ years).
An estimated 38,092 cases of acute atlas fractures were identified, representing 11.1% of all cervical fractures and corresponding to an overall incidence rate of 6.2. Slightly more than half (54%) occurred in females and the mean age was 71 years. Overall, a majority (64%) of cases occurred in patients > 70 years old. There was substantial increase in incidence rate with age (<18 years: 0.7; 18-64 years: 2.6; 65-79 years: 17.1; 80 + years: 71.8). The most common injury mechanism was a low-energy fall (74%). Overall, only 42% of atlas fractures were isolated injuries, with 58% of patients sustaining at least one concomitant injury and 48% sustaining at least one additional fracture. Accounting for population growth yielded a significantly increasing incidence over the study period from 1.7 in 2001 to 13.4 in 2020 (annual percent increase = 11, < 0.00001). Disproportionately large increases in incidence rates were observed in the oldest patient groups.
Atlas fractures occur in older patients and are often associated with concomitant injuries to the head and spine. These types of fractures are increasing in the US, especially among the elderly. The annual incidence increased nearly 700% over the course of the study period and in 2020 was over 13 per million overall. In elderly patients >80 years old, the most recent annual incidence rate was over 157 per million.
寰椎骨折在老年人群的颈椎创伤中占很大比例。随着人口老龄化以及人口活动增多，预计寰椎骨折患者数量会不断增加。然而，关于大量人群中寰椎骨折发病率的流行病学数据却很匮乏。本研究的目的是调查过去20年美国寰椎骨折患者的发病率及人口统计学特征。
这项描述性流行病学研究回顾性分析了国家电子伤害监测系统数据库，以确定2001年至2020年期间前往美国急诊科就诊的寰椎骨折病例。分析了骨折的年度和总数、骨折发病率、患者人口统计学特征（年龄、性别、种族）以及损伤特征（机制、合并伤）。发病率以每百万危险人年的骨折数表示。患者被分为四个不同年龄组进行比较（<18岁、18 - 64岁、65 - 79岁、80岁及以上）。
共识别出约38,092例急性寰椎骨折病例，占所有颈椎骨折的11.1%，总体发病率为6.2。略超过一半（54%）的病例发生在女性，平均年龄为71岁。总体而言，大多数（64%）病例发生在70岁以上的患者中。发病率随年龄显著增加（<18岁：0.7；18 - 64岁：2.6；65 - 79岁：17.1；80岁及以上：71.8）。最常见的损伤机制是低能量跌倒（74%）。总体而言，只有42%的寰椎骨折为孤立伤，58%的患者至少有一处合并伤，48%的患者至少有一处额外骨折。考虑到人口增长，研究期间发病率显著增加，从2001年的1.7增至2020年的13.4（年增长率 = 11，<0.00001）。在最年长的患者组中观察到发病率的大幅增加。
寰椎骨折发生于老年患者，且常伴有头部和脊柱的合并伤。这类骨折在美国呈上升趋势，尤其是在老年人中。在研究期间，年发病率增加了近700%，2020年总体发病率超过每百万13例。在80岁及以上的老年患者中，最近的年发病率超过每百万157例。
