21例老年人齿状突骨折的特点

Fracture of the odontoid process in elderly patients

目的探讨老年人齿状突骨折的特点及治疗方法的选择。方法回顾性分析２１例老年人齿状突骨折，其中Ａｎｄｅｒｓｏｎ－ＤＡｌｏｎｚｏⅡ型骨折１４例，Ⅲ型７例。１４例新鲜骨折均采用非手术治疗；７例陈旧性损伤，有６例寰枢椎不稳患者行枕颈融合术。结果１９随访３个月至１１年，平均３年８个月。１４例行非手术治疗患者中，２例失去随访，１０例达到骨性愈合，２例未愈合者无明显症状遗留；６例行手术治疗患者植入骨块均获得骨性愈合，临床症状消失或明显减轻者３例，稍有改善２例，无变化１例。结论对于老年患者的新鲜齿状突骨折可选择非手术治疗，陈旧性骨折引起迟发性寰枢椎不稳及脊髓压迫者则应行融合手术。

Objective Fractures of the odontoid process in elderly patients have been rarely documented.The authors tried to delineate the characteristics and therapeutic selection of this injury. Methods A retrospective analysis of 21 cases of odontoid process fracture was presented. Anderson-D'Alonzo type Ⅱ fractures were seen in 14 patients and type Ⅲ fractures in seven. Fourteen patients with acute injury were treated conservatively and six of seven patients with old fractures underwent occipito-cervical fusion.Results The mean follow-up period in 19 of the patients was three years and eight months(range,3 months to 11 years). Of the 14 patients treated conserveatively,10 obtained fracture healing,two had no obvious symptoms in spite of nonunion,and two were lost during the follow-up.All of the six patients treated with spinal fusion had solid healing.Of them,three were noticed with no or mild symptoms,two had their deficits slightly resolved,and no change was found in one.Conclusions Conservative therapy is preferred for elderly patients having odontoid fracture during the acute stage while posterior arthrodesis should be considered in those patients with atlantoaxial instability and spinal cord compression induced by old fractures.