老年上颈椎损伤的临床特点与治疗

Clinical characteristics and treatment of upper cervical spine injuries in the elderly

目的探讨老年上颈椎损伤的临床特点与治疗方法。方法回顾性分析我科2003年1月-2007年12月间收治的〉60岁上颈椎骨折脱位患者28例的临床资料，其中男20例，女8例；年龄60～86岁，平均68．1岁。致伤原因：跌伤16例，交通伤8例，高处坠落伤4例。寰椎骨折5例；枢椎骨折15例，其中齿状突骨折8例，C2椎弓骨折6例，C2椎体骨折1例；寰枢椎损伤伴下颈椎损伤5例；寰枢椎同时损伤2例，其中齿状突骨折伴寰椎侧块骨折1例，齿状突骨折伴寰椎前弓骨折1例；寰枢关节脱位1例。并发脊髓损伤4例。保守治疗8例，开放手术治疗8例，微创经皮手术治疗12例。结果平均住院时间比较，保守组与传统手术组间差异无统计学意义（P〉0．05），而微创经皮组短于保守组与传统手术组（P〈0．05）。保守治疗组2例死亡，开放手术组1例死亡，其余25例均获得随访，随访时间9～56个月，平均16．8个月。保守治疗组患者满意率为50％，开放手术组为72％，微创手术组为75％。保守治疗组中4例发生并发症，传统手术组3例，微创手术组2例。结论老年上颈椎损伤发生率较高，其损伤特点以低能量暴力为主，损伤类型以齿状突骨折最常见，具有脊髓损伤发生率低、漏诊率高等特点。在排除手术禁忌证的情况下，手术治疗特别是微创手术可取得较好的临床疗效。

Objective To discuss the clinical characteristics and treatment of upper cervical spine injuries in the elderly. Methods A retrospective study was done on clinical data of 28 elderly patients （ 〉 60 years old） with upper cervical spine injuries treated from January 2003 to December 2007. There were 20 males and 8 females, at age range of 60-86 years （ mean 68.1 years）. Injury causes included slip in 16 patients, traffic injury in eight and fall from height in four. Atlas fractures occurred in five patients and axis ones in 15, of which there were eight patients with odontoid fractures, six with C2 vertebral arch fractures and one with C2 body fractures. Upper cervical spine injury was combined with lower cervical spine injuries in five patients. There were combined atlantoaxial injuries including odontoid fractures combined with lateral atlas fracture in one and odontoid fractures combined with anterior atlas arch fracture in one. Atlantoaxial dislocation occurred in one patient and combined spinal injury in four. Of all, eight patients were treated conservatively, eight with open surgical operation and 12 with minimally invasive surgery. Results The average hospital stay was 16.5 days, with no statistical difference between conservative treatment group and open surgical operation group （ P 〉 0.05 ）. While the average haspital stay in minimally invasive surgery group was shorter than that in conservative treatment and open surgical operation groups （ P 〈 0.05 ）. Of all, two patients in conservative treatment group and one in open surgical operation group died and the other 25 patients were followed up for average 16.8 months （9-56 months）. The satisfaction rate was 50% in conservative treatment group, 72% in open surgical operation group and 75% in minimally invasive surgery group. Complications occurred in four patients in conservative treatment group, three in open surgical operation group and two in minimally invasive surgery group.Conclusions With odontoid fracture the most common injury type, upper cervical spine injuries aremainly caused by low-energy force and characterized by low mobidity of spinal cord injuries and high possibility of missed diagnosis in the elderly patients. The surgical treatment especially minimally invasive surgery can bring good results compared with conservative methods.