重新评估分类系统：老年患者稳定和不稳定的齿状突骨折-放射学结果测量。

Reevaluation of a classification system: stable and unstable odontoid fractures in geriatric patients-a radiological outcome measurement.

机构信息

Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria.

Department of Trauma Surgery, KABEG-Klinikum Klagenfurt a.W, Klagenfurt, Austria.

出版信息

Eur J Trauma Emerg Surg. 2022 Aug;48(4):2967-2976. doi: 10.1007/s00068-022-01985-0. Epub 2022 May 21.

DOI:10.1007/s00068-022-01985-0

PMID:35597894

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9360123/

Abstract

OBJECTIVES

We carried out a retrospective cohort study to differentiate geriatric odontoid fractures into stable and unstable and correlated it with fracture fusion rates. Results are based on the literature and on our own experience. The authors propose that the simple Anderson and D'Alonzo classification may not be sufficient for geriatric patients.

METHODS

There were 89 patients ≥ 65 years who presented at our institution with type II and III odontoid fractures from 2003 until 2017 and were included in this study. Each patient was categorized with CT scans to evaluate the type of fracture, fracture gap (mm), fracture angulation (°), fracture displacement (mm) and direction (ventral, dorsal). Fractures were categorized as stable [SF] or unstable [UF] distinguished by the parameters of its angulation (< / > 11°) and displacement (< / > 5 mm) with a follow-up time of 6 months. SFs were treated with a semi-rigid immobilization for 6 weeks, UFs surgically-preferably with a C1-C2 posterior fusion.

RESULTS

The classification into SFs and UFs was significant for its angulation (P = 0.0006) and displacement (P < 0.0001). SF group (n = 57): A primary stable union was observed in 35, a stable non-union in 10, and an unstable non-union in 8 patients of which 4 were treated with a C1/2 fixation. The overall consolidation rate was 79%. UF group (n = 32): A posterior C1-C2 fusion was carried out in 23 patients, a C0 onto C4 stabilization in 7 and an anterior odontoid screw fixation in 2. The union rate was 100%. Twenty-one type II SFs (91%) consolidated with a nonoperative management (P < 0.001). A primary non-union occurred more often in type II than in type III fractures (P = 0.0023). There was no significant difference in the 30-day overall case fatality (P = 0.3786).

CONCLUSION

To separate dens fractures into SFs and UFs is feasible. For SFs, semi-rigid immobilization provides a high consolidation rate. Stable non-unions are acceptable, and the authors suggest a posterior transarticular C1-C2 fixation as the preferred surgical treatment for UFs.

LEVEL OF EVIDENCE

Level III.

摘要

目的

我们进行了一项回顾性队列研究，将老年型齿状突骨折分为稳定型和不稳定型，并将其与骨折融合率相关联。结果基于文献和我们自己的经验。作者认为，简单的安德森和 D'Alonzo 分类法可能对老年患者不够充分。

方法

2003 年至 2017 年，我院共收治 89 例年龄≥65 岁的 II 型和 III 型齿状突骨折患者，将这些患者纳入本研究。对每位患者进行 CT 扫描以评估骨折类型、骨折间隙（mm）、骨折角度（°）、骨折移位（mm）和方向（腹侧、背侧）。根据其角度（< 11°/ > 11°）和位移（< 5mm/ > 5mm）将骨折分为稳定型[SF]或不稳定型[UF]，随访时间为 6 个月。SF 采用半刚性固定 6 周，UF 则采用 C1-C2 后路融合术治疗。

结果

SFs 和 UFs 的分类在角度（P=0.0006）和位移（P<0.0001）方面具有统计学意义。SF 组（n=57）：35 例观察到原发性稳定愈合，10 例稳定不愈合，8 例不稳定不愈合，其中 4 例采用 C1/2 固定治疗。总体愈合率为 79%。UF 组（n=32）：23 例患者行 C1-C2 后路融合术，7 例行 C0 至 C4 稳定术，2 例行前路齿状突螺钉固定术。愈合率为 100%。21 例 II 型 SF（91%）采用非手术治疗（P<0.001）。与 III 型骨折相比，II 型骨折更易发生原发性不愈合（P=0.0023）。30 天总病死率无显著差异（P=0.3786）。