Sommer Andreas, Klein Lukas, Obid Peter
Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland.
Unfallchirurgie (Heidelb). 2025 Feb;128(2):81-86. doi: 10.1007/s00113-024-01522-1. Epub 2025 Jan 15.
The treatment of odontoid fractures in geriatric patients, particularly type II fractures, remains controversial. In biologically young patients, studies suggest advantages of surgical treatment in terms of mortality; however, this advantage is not observed in geriatric patients. While the mortality appears to be higher after conservative treatment in patients aged 65-80 years, there are studies that have shown no differences in mortality for patients aged 80 years or older and even showed advantages of conservative treatment in this age group. The complication rates of both surgical and conservative approaches are comparable. Although conservative treatment is associated with a higher rate of pseudarthrosis, healing in a "rigid" pseudarthrosis is associated with a good clinical outcome and can therefore be considered a treatment success. The central problem with the currently available literature, including the present prospective but nonrandomized data, is selection bias, which significantly limits the comparability of the patient cohorts. So far, no clear superiority of either treatment method has been demonstrated. Therefore, conservative treatment retains its importance in the geriatric patient population and the majority of these patients achieve a very good functional outcome with conservative treatment.
老年患者齿状突骨折的治疗，尤其是Ⅱ型骨折，仍存在争议。在生理上年轻的患者中，研究表明手术治疗在死亡率方面具有优势；然而，在老年患者中未观察到这种优势。虽然65 - 80岁患者保守治疗后的死亡率似乎更高，但有研究表明80岁及以上患者的死亡率没有差异，甚至显示出该年龄组保守治疗的优势。手术和保守治疗方法的并发症发生率相当。虽然保守治疗与假关节形成率较高相关，但“坚固”假关节的愈合与良好的临床结果相关，因此可被视为治疗成功。包括目前的前瞻性但非随机数据在内的现有文献的核心问题是选择偏倚，这显著限制了患者队列的可比性。到目前为止，尚未证明任何一种治疗方法具有明显优势。因此，保守治疗在老年患者群体中仍然很重要，并且这些患者中的大多数通过保守治疗可获得非常好的功能结果。
