老年人Ⅱ型齿突骨折治疗:手术还是保守?  

Type ll odontoid fractures in the elderly: surgical or conservative method?

作　　者：杜诗尧 倪斌[1] 

机构地区：[1]解放军第二军医大学附属长征医院骨科,上海市200003

出　　处：《中国组织工程研究》2017年第15期2424-2431,共8页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金面上项目(81472127)~~

摘　　要：背景:老年人上颈椎损伤易导致严重的神经功能损伤,而随着社会的发展,其发生率逐年增高,而目前关于老年人Ⅱ型齿突骨折的诊断、治疗仍存在诸多争议。目的:拟对老年人Ⅱ型齿突骨折的分类、治疗方法及不同方法之间的疗效作一综述。方法:计算机检索Pub Med数据库和中国万方全文数据库1996年1月至2016年7月有关Ⅱ型齿突骨折老年患者诊断与治疗的临床与基础实验研究,检索关键词分别为"odontoid fracture,elderly,treatment,conservative,surgical"和"齿状突骨折,老年,治疗,保守,手术",以及早期相关研究的经典文章。结果与结论:(1)Ⅱ型齿突骨折老年患者与年轻患者治疗目标不尽相同;(2)保守治疗的齿状突骨不连概率高于手术治疗,但对于老年患者,并不影响临床结局;(3)文献报道的老年Ⅱ型齿突骨折患者并发症发生率及死亡率,保守与手术治疗无明显差别;(4)对于身体基础条件无法满足开放手术要求,或者合并其他严重心肺疾病,以及无法耐受保守治疗的Ⅱ型齿突骨折老年患者,可以考虑微创手术。BACKGROUND： Upper cervical spine fractures are easy to lead to severe neurologic dysfunction in the elderly, and along with social progress, the incidence is on the rise. However, the diagnosis and treatment of type Ⅱ odontoid fractures in senile patients remain controversial.OBJECTIVE： To review the classification, treatment methods and clinical outcomes of type Ⅱ odontoid fractures in elderly patients.METHODS： A computer-based online search was performed in the PubMed and Wanfang databases for the articles concerning the diagnosis and treatment of type Ⅱ odontoid fractures in the elderly published from January 1996 to July 2016. The keywords were ＆quot;odontoid fracture, elderly, treatment, conservative, surgical＆quot; in English and Chinese,respectively.RESULTS AND CONCLUSION： （1） The treatment goals of type Ⅱ odontoid fractures are different between elderly and young patients. （2） The incidence of nonunion in the conservative approach is higher than that in the surgical treatment, but for elderly patients, it makes no difference. （3） No significant differences are found in the incidence of complications and mortality between conservative and surgical methods in the elderly with type Ⅱ odontoid fractures. （4） Minimally invasive surgery is commended for the elderly suffering type Ⅱ fractures who cannot tolerate the conservative approach due to poor conditions or accompanied with other serious heart and lung diseases.

关 键 词：颈椎 齿突尖 骨折 外科手术 微创性 组织工程 骨科植入物 脊柱植入物 Ⅱ型齿突骨折 保守治疗 外科治疗 微创 老年人 国家自然科学基金 

分 类 号：R318[医药卫生—生物医学工程]