Prabhat Anjali M, Liu David S, Cohen Lara, Gabriel Daniel, Hines Kristen E, Hogue Grant D
Harvard Medical School, Boston, MA, USA.
Harvard Combined Orthopedic Residency Program, Boston, MA, USA.
J Child Orthop. 2024 Sep 19;18(5):486-494. doi: 10.1177/18632521241283232. eCollection 2024 Oct.
The management of odontoid fractures in adult patients has been widely described. However, there is sparse literature about this injury in the pediatric population. This study aimed to review published literature regarding the management and outcomes of pediatric odontoid fractures to develop a stepwise treatment algorithm.
A literature review was conducted using PRISMA guidelines on PubMed to identify studies between 1960 and 2023 that reported on the management and outcomes of odontoid fracture in pediatric patients. Studies were included if they were published in English and if their sample included at least four patients aged 0-18, minimum follow-up of 6 weeks, and outcomes for each patient clearly differentiated.
In total, 15 studies including 125 pediatric patients with odontoid fractures were included. Treatment options varied from non-operative management with immobilization in rigid collars, halo vests, cervicothoracic orthosis, or soft collars to surgical management with fixation and/or arthrodesis. There were 73 patients initially treated nonoperatively, 47 initially treated surgically, 2 who healed with observation alone, and 3 who died acutely of concomitant injuries. The nonunion rate for nonoperative management was 5.5%. Surgery was successful, demonstrating bony union at final follow-up, in 94.6% of cases treated via a posterior approach and 85.7% of cases treated with an anterior approach.
Odontoid fractures must be considered in pediatric patients with cervical spine trauma. This is the largest literature review of pediatric odontoid fractures. Various management strategies exist and can be considered. The proposed algorithm offers an evidence-based framework for the management of pediatric odontoid fractures.
成人齿突骨折的治疗方法已有广泛描述。然而，关于儿童人群中此类损伤的文献却很少。本研究旨在回顾已发表的关于儿童齿突骨折治疗及预后的文献，以制定逐步治疗方案。
根据PRISMA指南在PubMed上进行文献综述，以确定1960年至2023年间报道儿童齿突骨折治疗及预后的研究。纳入标准为研究以英文发表，样本中至少有4名0至18岁患者，最短随访6周，且能明确区分每位患者的预后情况。
共纳入15项研究，涉及125例儿童齿突骨折患者。治疗选择从非手术治疗（采用硬颈托、头环背心、颈胸矫形器或软颈托固定）到手术治疗（采用固定和/或关节融合术）不等。73例患者最初接受非手术治疗，47例最初接受手术治疗，2例仅通过观察治愈，3例因合并伤急性死亡。非手术治疗的不愈合率为5.5%。手术治疗成功，经后路治疗的病例在最终随访时骨愈合率为94.6%，经前路治疗的病例为85.7%。
儿童颈椎创伤患者必须考虑齿突骨折。这是关于儿童齿突骨折的最大规模文献综述。存在多种治疗策略可供考虑。所提出的方案为儿童齿突骨折的治疗提供了一个基于证据的框架。
