Segi Naoki, Nakashima Hiroaki, Ito Sadayuki, Ouchida Jun, Yokogawa Noriaki, Sasagawa Takeshi, Furuya Takeo, Yunde Atsushi, Funayama Toru, Eto Fumihiko, Watanabe Kota, Nori Satoshi, Ikegami Shota, Uehara Masashi, Hashimoto Ko, Onoda Yoshito, Nakajima Hideaki, Suzuki Hidenori, Imajo Yasuaki, Yamada Tomohiro, Hasegawa Tomohiko, Kawaguchi Kenichi, Haruta Yohei, Terashima Yoshinori, Hirota Ryosuke, Tonomura Hitoshi, Sakata Munehiro, Iizuka Yoichi, Uei Hiroshi, Suzuki Nobuyuki, Akeda Koji, Tominaga Hiroyuki, Seki Shoji, Oshima Yasushi, Kaito Takashi, Otsuki Bungo, Nakanishi Kazuo, Kakutani Kenichiro, Funao Haruki, Yoshii Toshitaka, Sakai Daisuke, Ohba Tetsuro, Miyazaki Masashi, Terai Hidetomi, Inoue Gen, Okada Seiji, Imagama Shiro, Kato Satoshi
Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.
Spine Surg Relat Res. 2024 Apr 3;8(6):560-567. doi: 10.22603/ssrr.2024-0030. eCollection 2024 Nov 27.
Elderly patients have a higher frequency of upper cervical fractures caused by minor trauma; nevertheless, the clinical differences between mid- and lower-cervical (C6-C7) injuries are unclear. The aim of this study was to compare the epidemiology of lower- and mid-cervical injuries in the elderly.
This multicenter, retrospective study included 451 patients aged 65 years or older who had mid- or lower-cervical fractures/dislocations. Patients' demographic and treatment data were examined and compared based on mid- and lower-cervical injuries.
There were 139 patients (31%) with lower-cervical injuries and 312 (69%) with mid-cervical injuries. High-energy trauma (60% vs. 47%, p=0.025) and dislocation (55% vs. 45%, p=0.054) were significantly experienced more often by elderly patients with lower-cervical injuries than by patients with mid-cervical injuries. Although the incidence of key muscle weakness at the C5 to T1 levels were all significantly lower in patients with lower-cervical injuries than those with mid-cervical injuries, impairments at C5 occurred in 49% of them, and at C6, in 65%. No significant differences were found in the rates of death, pneumonia, or tracheostomy requirements, and no significant differences existed in ambulation or ASIA impairment scale grade for patients after 6 months of treatment.
Elderly patients with lower-cervical fractures/dislocations were injured by high-energy trauma significantly more often than patients with mid-cervical injuries. Furthermore, half of the patients with lower-cervical injuries had mid-cervical level neurological deficits with a relatively high rate of respiratory complications.
老年患者因轻微创伤导致上颈椎骨折的频率较高；然而，中下段颈椎（C6 - C7）损伤之间的临床差异尚不清楚。本研究的目的是比较老年患者中下段颈椎损伤的流行病学情况。
这项多中心回顾性研究纳入了451例65岁及以上的中下段颈椎骨折/脱位患者。根据中下段颈椎损伤情况对患者的人口统计学和治疗数据进行检查和比较。
139例（31%）患者为下段颈椎损伤，312例（69%）为中段颈椎损伤。下段颈椎损伤的老年患者比中段颈椎损伤的患者更常经历高能创伤（60%对47%，p = 0.025）和脱位（55%对45%，p = 0.054）。尽管下段颈椎损伤患者C5至T1水平关键肌肉无力的发生率均显著低于中段颈椎损伤患者，但其中49%的患者C5出现损伤，65%的患者C6出现损伤。在死亡率、肺炎发生率或气管切开需求率方面未发现显著差异，治疗6个月后患者的行走能力或美国脊髓损伤协会（ASIA）损伤分级也未发现显著差异。
下段颈椎骨折/脱位的老年患者比中段颈椎损伤的患者更常因高能创伤受伤。此外，下段颈椎损伤患者中有一半存在中段颈椎水平的神经功能缺损，且呼吸并发症发生率相对较高。
