Lenga Pavlina, Gülec Gelo, Kiening Karl, Unterberg Andreas W, Ishak Basem
Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
Front Med (Lausanne). 2023 Sep 29;10:1082848. doi: 10.3389/fmed.2023.1082848. eCollection 2023.
The prevalence of trauma is increasing in the geriatric population. The optimal therapy for type II odontoid fractures in the elderly is controversial. This study aims to assess the morbidity and mortality associated with odontoid fractures in octogenarians undergoing C1/C2 posterior screw fixation and describe the perioperative and post-operative complications and risk factors associated with mortality.
Electronic medical records from a single institution pertaining to the period between September 2005 and December 2020 were retrieved. Data on patient demographics, neurological conditions, surgical characteristics, complications, hospital course, and 90-day mortality were collected.
Over a 16-year period, 60 patients aged ≥80 years diagnosed with type II odontoid fractures were enrolled in the study. The mean age was 85.0 ± 1.9 years. The mean Charlson Comorbidity Index (CCI) was >6 indicating a poor baseline reserve (8.5 ± 1.9), while cardiovascular diseases were the most prevalent among comorbidities. The mean surgical duration was 217.5 ± 65.9 min, with a mean blood loss of 725.5 ± 275.7 mL. The in-hospital was 5-0% and the 90-day mortality rates increased at 10.0%. No revision surgery was needed in any of the cases. Intraoperative and post-operative X-ray and computed tomography (CT) imaging revealed correct screw placement. Proper alignment of the atlantoaxial spine and fusion could be achieved in all cases. The unique risk factors for mortality included the presence of comorbidities and the occurrence of post-operative complications.
The complication and mortality rates associated with odontoid fractures in octogenarians are relatively high. However, the therapeutic goals in this population also include bone union and preservation of neurological status. Despite the often-high comorbidity rate, we still recommend that surgery should be considered in patients over 80 years. However, it is necessary to evaluate several approaches when treating such frail patients.
老年人群中创伤的患病率正在上升。老年患者II型齿状突骨折的最佳治疗方法存在争议。本研究旨在评估接受C1/C2后路螺钉固定的八旬老人齿状突骨折相关的发病率和死亡率，并描述围手术期和术后并发症以及与死亡率相关的危险因素。
检索了一家机构在2005年9月至2020年12月期间的电子病历。收集了患者人口统计学、神经状况、手术特征、并发症、住院过程和90天死亡率的数据。
在16年期间，60例年龄≥80岁且诊断为II型齿状突骨折的患者纳入本研究。平均年龄为85.0±1.9岁。平均Charlson合并症指数（CCI）>6，表明基线储备较差（8.5±1.9），而心血管疾病是合并症中最常见的。平均手术时间为217.5±65.9分钟，平均失血量为725.5±275.7毫升。住院死亡率为5.0%，90天死亡率为10.0%。所有病例均无需翻修手术。术中及术后X线和计算机断层扫描（CT）成像显示螺钉位置正确。所有病例均能实现寰枢椎的正确对线和融合。死亡的独特危险因素包括合并症的存在和术后并发症的发生。
八旬老人齿状突骨折相关的并发症和死亡率相对较高。然而，该人群的治疗目标还包括骨愈合和神经功能状态的保留。尽管合并症发生率通常较高，但我们仍建议80岁以上患者应考虑手术。然而，在治疗此类体弱患者时，有必要评估几种方法。
