von der Höh Nicolas H, Keuchel Jonathan, Pieroh Phillip, Spiegl Ulrich Josef Albert, Osterhoff Georg, Heyde Christoph-Eckhard
Department for Orthopaedics, Trauma Surgery and Plastic Surgery, University Hospital Leipzig, Liebigstr. 18, Leipzig, 04103, Germany.
Department of Anesthesiology and Intensive Care Medicine, Heart Center Leipzig, Leipzig, Germany.
BMC Geriatr. 2025 Apr 9;25(1):237. doi: 10.1186/s12877-025-05862-4.
The incidence of upper cervical fractures in elderly individuals is increasing, necessitating enhanced treatment approaches.
A retrospective study of 268 elderly patients with upper cervical fractures was conducted to assess inpatient outcomes aged 75 and older with atlas and/or axis fractures. Patient risk was evaluated using the ASA score and Charlson comorbidity index (CCI). In-hospital mortality and functional outcomes were assessed, with fracture treatment strategies following AO principles.
Patients with C1, C2 or combined fractures did not differ in age, CCI, Barthel score or length of hospital stay (p > 0.05). C2 fractures were predominant, and the majority of patients suffered at least from a severe general disease (ASA ≥ 3). Comparing operatively and conservatively treated patients, regardless of fracture localization, revealed no significant differences in mortality, both overall and time-related. Surgical patients experienced a higher frequency of general complications, notably dyspnea. The overall mortality rate was 14.9%, with 15.7% in the nonoperative group and 14.4% in the surgical group (p = 0.8628). The overall rate of general complications was 51.4% (n = 51) in the nonoperative group and 71.9% (n = 110) in the operatively treated group. Anterior fixation procedures showed significantly higher rates of pneumonia and respiratory complications, while mortality and other complications did not differ significantly between posterior and anterior surgical approaches.
The in-hospital mortality and morbidity of elderly patients with upper cervical fractures are high but do not significantly differ between operatively and nonoperatively treated patients. The complexity of the geriatric patient population highlights the need for peri- and postinpatient geriatric complex treatment, emphasizing the importance of establishing geriatric-specialized care structures.
老年个体中上颈椎骨折的发生率正在上升，需要改进治疗方法。
对268例老年上颈椎骨折患者进行回顾性研究，以评估75岁及以上伴有寰椎和/或枢椎骨折患者的住院结局。使用美国麻醉医师协会（ASA）评分和查尔森合并症指数（CCI）评估患者风险。评估住院死亡率和功能结局，骨折治疗策略遵循AO原则。
C1、C2或合并骨折的患者在年龄、CCI、Barthel评分或住院时间方面无差异（p>0.05）。C2骨折最为常见，大多数患者至少患有一种严重的全身性疾病（ASA≥3）。比较手术治疗和保守治疗的患者，无论骨折部位如何，总体死亡率和与时间相关的死亡率均无显著差异。手术患者发生一般并发症的频率更高，尤其是呼吸困难。总体死亡率为14.9%，非手术组为15.7%，手术组为14.4%（p = 0.8628）。非手术组一般并发症的总体发生率为51.4%（n = 51），手术治疗组为71.9%（n = 110）。前路固定手术的肺炎和呼吸并发症发生率显著更高，而后路和前路手术方法在死亡率和其他并发症方面无显著差异。
老年上颈椎骨折患者的住院死亡率和发病率较高，但手术治疗和非手术治疗患者之间无显著差异。老年患者群体的复杂性凸显了围住院期和住院后老年综合治疗的必要性，强调了建立老年专科护理结构的重要性。
