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Typ-II-Densfrakturen des alten Menschen und therapiebedingte Mortalität

Konservative oder operative Behandlung

Type 2 dens fracture in the elderly and therapy-linked mortality

Conservative or operative treatment

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Zusammenfassung

Hintergrund

Frakturen des Dens axis vom Typ II stellen die häufigste Verletzung der Halswirbelsäule alter Patienten dar. Für die Entscheidung, ob ein Patient operativ oder konservativ behandelt werden sollte, enthält die Literatur nur wenig Evidenz.

Material und Methoden

Die Mortalität und Überlebenswahrscheinlichkeit stratifiziert nach Behandlung für 51 Patienten wurde in einer retrospektiven Untersuchung bestimmt. Klinisch wurden die Beweglichkeit der Halswirbelsäule, Schmerzen und Beschwerden mittels Neck Disability Index ermittelt.

Ergebnisse

Von den 51 Patienten wurden 37 operativ und 14 konservativ behandelt. Während des Beobachtungszeitraums wurde in der konservativ behandelten Gruppe ein erhöhtes Versterben (64 vs. 32 %) beobachtet. Die Kaplan-Meier-Analyse ergab eine mediane Überlebenszeit der konservativen Gruppe von 29 Monaten, in den ersten 3 Monaten ist die Überlebenswahrscheinlichkeit in der konservativen Gruppe größer, danach in der operativen Gruppe. Die klinische Untersuchung von 20 Patienten ergab eine eingeschränkte Beweglichkeit der Halswirbelsäule und mäßige Schmerzen. Die mittels Neck Disability Index erfassten Beschwerden waren moderat.

Schlussfolgerung

Die Densfraktur stellt eine einschneidende Verletzung des älteren Menschen dar. Ein gründliches Abwägen des Allgemeinzustands der Patienten sollte am Beginn der Behandlung stehen. Im frühen Zeitraum nach Trauma zeigten sich bzgl. der Überlebensrate keine Unterschiede, die langfristig in der operativ therapierten Gruppe beobachteten Vorteile sind vorhanden, jedoch nicht kausal auf die Therapiewahl zurückzuführen.

Abstract

Background

Type II fractures of the odontoid process of the axis are the most common injury of the cervical spine in elderly patients. Only little evidence exists on whether elderly patients should be treated conservatively or surgically.

Material and methods

The mortality and survival probability of 51 patients were determined in a retrospective study. The range of motion, pain and the neck disability index were clinically investigated.

Results

Of the 51 patients 37 were treated surgically and 14 conservatively. The conservatively treated group showed a higher mortality (64 % vs. 32 %). Kaplan-Meier analysis revealed a median survival of the conservatively treated group of 29 months, whereby during the first 3 months of treatment this group showed a higher survival probability and afterwards the surgically treated group showed a higher survival probability. The clinical examination of 20 patients revealed limited range of motion of the cervical spine. Additionally, moderate levels of pain and complaints were recorded using the neck disability index.

Conclusion

Fractures of the odontoid process pose a far-reaching danger for elderly patients. A balanced assessment of the general condition should be carried out at the beginning of treatment of these patients. In the early phase following trauma no differences were found with respect to survival rates but for long-term survival the operatively treated group showed advantages; however, these advantages cannot be causally attributed to the choice of therapy.

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Authors and Affiliations

  1. Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Klinikum der Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    G. Stein, C. Meyer, L. Marlow, L.P. Müller, P. Eysel & C. Faymonville

  2. Institut für Medizinische Statistik, Informatik und Epidemiologie, Universität zu Köln, Köln, Deutschland

    H. Christ

  3. Klinik für Unfallchirurgie und Orthopädie, Klinikum Nordstadt, Klinikum Region Hannover, Hannover, Deutschland

    J. Isenberg

  4. Abteilung Unfallchirurgie, Handchirurgie und Orthopädie, Vinzenz Palotti Hospital, Bergisch Gladbach, Deutschland

    G. Schiffer

Authors
  1. G. Stein
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  2. C. Meyer
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  3. L. Marlow
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  4. H. Christ
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  5. L.P. Müller
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  6. J. Isenberg
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  7. P. Eysel
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  8. G. Schiffer
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  9. C. Faymonville
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Corresponding author

Correspondence to G. Stein.

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Interessenkonflikt

G. Stein, C. Meyer, L. Marlow, H. Christ, L.P. Müller, J. Isenberg, P. Eysel, G. Schiffer, C. Faymonville geben an, dass kein Interessenkonflikt besteht.

Aufgrund des retrospektiven Charakters der Studie lag keine Zustimmungspflicht der zuständigen Ethikkommission vor.

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Redaktion

W. Mutschler, München

V. Braunstein, München

H. Polzer, München

G. Stein und C. Meyer haben zu gleichen Teilen zur Erstellung des Manuskripts beigetragen.

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Stein, G., Meyer, C., Marlow, L. et al. Typ-II-Densfrakturen des alten Menschen und therapiebedingte Mortalität. Unfallchirurg 120, 122–128 (2017). https://doi.org/10.1007/s00113-015-0057-0

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  • DOI: https://doi.org/10.1007/s00113-015-0057-0

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