Gouzoulis Michael J, Seddio Anthony E, Rancu Albert, Jabbouri Sahir S, Moran Jay, Varthi Arya, Rubio Daniel R, Grauer Jonathan N
Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06511, United States.
N Am Spine Soc J. 2024 Sep 1;20:100553. doi: 10.1016/j.xnsj.2024.100553. eCollection 2024 Dec.
Odontoid fractures are relatively common. However, the literature is unclear how these fractures are best managed in many scenarios. As such, care is varied and poorly characterized.
To investigate the trends and predictive factors of surgical versus nonsurgical treatment and anterior versus posterior stabilization of odontoid fractures.
STUDY DESIGN/SETTING: Retrospective database cohort study.
Adult patients with odontoid fractures between 2010 and 2021.
Yearly trends and predictors of odontoid fracture management.
Adult patients with odontoid fractures were abstracted from the large, national, administrative M161Ortho Pearldiver dataset. For operative versus nonoperative care of odontoid fractures, yearly rates were determined (since 2016 based on coding limitations). For anterior versus posterior stabilization, yearly rates were determined (2010-2021). Univariate and multivariable analyses were performed for both sets of comparisons.
For assessment of nonsurgical versus surgical management from 2016 to 2021, a total of 42,754 patients with odontoid fracture were identified, of which surgical intervention was done for 7.9%. Predictive factors of surgical intervention included being managed by a neurosurgeon (OR:1.29), being from Midwest United States (OR:1.35 relative to West), male sex (OR:1.20), and decreasing age (OR: 0.82 per decade) (p < .001 for each). Of those undergoing surgical intervention, 33.6% had anterior surgery while 66.4% had posterior surgery (anterior surgery decreased from 36.4% in 2010 to 27.2% in 2021, p < .001). Predictive factors of undergoing anterior versus posterior approach include having a neurosurgeon surgeon (OR:1.98), being from the Southern (OR:1.61 relative to Northeast), and having Medicare insurance (OR: 1.31) (p < .001 for each).
The overall rate of surgery for odontoid fractures has remained similar over the past years. Of those undergoing surgery, less are being done from anterior. While these decisions were predicted by some clinical factors, both also correlated with nonclinical factors suggesting room for more consistent algorithms.
齿突骨折相对常见。然而，在许多情况下，文献中并不清楚如何对这些骨折进行最佳治疗。因此，治疗方法各不相同且特征不明确。
探讨齿突骨折手术与非手术治疗以及前路与后路固定的趋势和预测因素。
研究设计/地点：回顾性数据库队列研究。
2010年至2021年间患有齿突骨折的成年患者。
齿突骨折治疗的年度趋势和预测因素。
从大型国家行政M161Ortho Pearldiver数据集中提取患有齿突骨折的成年患者。对于齿突骨折的手术与非手术治疗，确定年度发生率（自2016年起基于编码限制）。对于前路与后路固定，确定年度发生率（2010 - 2021年）。对两组比较均进行单变量和多变量分析。
对于2016年至2021年非手术与手术治疗的评估，共识别出42754例齿突骨折患者，其中7.9%接受了手术干预。手术干预的预测因素包括由神经外科医生治疗（比值比：1.29）、来自美国中西部（相对于西部，比值比：1.35）、男性（比值比：1.20）以及年龄降低（每十年比值比：0.82）（每项p < 0.001）。在接受手术干预的患者中，33.6%进行了前路手术，66.4%进行了后路手术（前路手术从2010年的36.4%降至2021年的27.2%，p < 0.001）。采用前路与后路手术方式的预测因素包括由神经外科医生治疗（比值比：1.98）、来自南部（相对于东北部，比值比：1.61）以及拥有医疗保险（比值比：1.31）（每项p < 0.001）。
在过去几年中，齿突骨折的总体手术率保持相似。在接受手术的患者中，前路手术的比例有所下降。虽然这些决策受到一些临床因素的影响，但两者也与非临床因素相关，这表明需要更一致的算法。
