Department of Neurosurgery, University Neurosurgical Centre Holland, Leiden University Medical Centre, Leiden, The Netherlands.
Department of Neurosurgery, University Neurosurgical Centre Holland, Haaglanden Medical Centre, The Hague, The Netherlands.
Age Ageing. 2024 Aug 6;53(8). doi: 10.1093/ageing/afae189.
The optimal treatment for odontoid fractures in older people remains debated. Odontoid fractures are increasingly relevant to clinical practice due to ageing of the population.
An international prospective comparative study was conducted in fifteen European centres, involving patients aged ≥55 years with type II/III odontoid fractures. The surgeon and patient jointly decided on the applied treatment. Surgical and conservative treatments were compared. Primary outcomes were Neck Disability Index (NDI) improvement, fracture union and stability at 52 weeks. Secondary outcomes were Visual Analogue Scale neck pain, Likert patient-perceived recovery and EuroQol-5D-3L at 52 weeks. Subgroup analyses considered age, type II and displaced fractures. Multivariable regression analyses adjusted for age, gender and fracture characteristics.
The study included 276 patients, of which 144 (52%) were treated surgically and 132 (48%) conservatively (mean (SD) age 77.3 (9.1) vs. 76.6 (9.7), P = 0.56). NDI improvement was largely similar between surgical and conservative treatments (mean (SE) -11 (2.4) vs. -14 (1.8), P = 0.08), as were union (86% vs. 78%, aOR 2.3, 95% CI 0.97-5.7) and stability (99% vs. 98%, aOR NA). NDI improvement did not differ between patients with union and persistent non-union (mean (SE) -13 (2.0) vs. -12 (2.8), P = 0.78). There was no difference for any of the secondary outcomes or subgroups.
Clinical outcome and fracture healing at 52 weeks were similar between treatments. Clinical outcome and fracture union were not associated. Treatments should prioritize favourable clinical over radiological outcomes.
老年人寰枢椎骨折的最佳治疗方法仍存在争议。由于人口老龄化，寰枢椎骨折在临床实践中越来越受到关注。
在 15 个欧洲中心进行了一项国际前瞻性比较研究，纳入了年龄≥55 岁的 II/III 型寰枢椎骨折患者。手术医生和患者共同决定采用的治疗方法。比较了手术治疗和保守治疗。主要结局为 52 周时 Neck Disability Index（NDI）改善、骨折愈合和稳定性。次要结局为 52 周时视觉模拟量表颈部疼痛、Likert 患者感知恢复和 EuroQol-5D-3L。亚组分析考虑了年龄、II 型和移位骨折。多变量回归分析调整了年龄、性别和骨折特征。
研究纳入了 276 例患者，其中 144 例（52%）接受了手术治疗，132 例（48%）接受了保守治疗（平均年龄 77.3（9.1）岁比 76.6（9.7）岁，P=0.56）。手术治疗和保守治疗的 NDI 改善差异不大（平均差值（SE）-11（2.4）比-14（1.8），P=0.08），愈合率（86%比 78%，优势比 2.3，95%CI 0.97-5.7）和稳定性（99%比 98%，优势比 NA）也相似。在有愈合和未愈合的患者中，NDI 改善无差异（平均差值（SE）-13（2.0）比-12（2.8），P=0.78）。次要结局或亚组分析均无差异。
52 周时的临床结局和骨折愈合在治疗间相似。临床结局和骨折愈合无关。治疗应优先考虑有利的临床结果而非影像学结果。
