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Therapiekonzept und Outcome bei Typ-II-Frakturen des Dens axis

Management and outcome of type II fractures of the odontoid process

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Zusammenfassung

Hintergrund

Die effektivste Therapie der Typ-II-Dens-Fraktur nach Anderson und D’Alonzo bleibt umstritten, da Leitfäden fehlen, die Anhaltspunkte für die Wahl zwischen konservativer und operativer Therapie sowie für den individuell vorteilhafteren Operationszugang geben. Eysel und Roosen stellten 1993 die Frakturmorphologie als Prädiktor für die Konsolidationsrate heraus und entwickelten eine Unterklassifikation mit entsprechender Behandlungsempfehlung.

Fragestellung

In dieser Untersuchung soll das Outcome der Typ-II-Dens-Frakturen bei Beachtung der Behandlungsempfehlungen von Eysel und Roosen evaluiert werden.

Material und Methoden

Densfrakturen von 72 Patienten wurden hinsichtlich ihrer Morphologie analysiert und nach Eysel und Roosen klassifiziert. Darüber hinaus wurden retrospektiv Therapiekonzept und radiographische Daten evaluiert und das Outcome dokumentiert.

Ergebnisse

Das Durchschnittsalter der 72 nachuntersuchten Patienten betrug 70,7 Jahre. Es hatten 19,4 % der Patienten eine Typ-A-, 75 % eine Typ-B- und 5,6 % eine Typ-C-Fraktur nach Eysel und Roosen. Weiter analysiert wurden 45 Patienten mit postoperativer Computertomographie (CT)-Bildgebung. Nach Empfehlung der Autoren erhielten 34 von 41 der Patienten mit Typ-A- oder Typ-B-Fraktur eine ventrale Schraubenosteosynthese des Dens, 3 von 4 der Patienten mit Typ-C-Fraktur eine dorsale C1-C2-Fusion. Nach durchschnittlich 7 Monaten zeigte sich bei 15,6 % der Patienten eine Pseudarthrosenbildung, wobei 6 dieser Patienten operativ und einer konservativ behandelt worden waren. Alle Patienten, bei denen sich eine Pseudarthrose entwickelt hatte, hatten eine Typ-B-Fraktur.

Schlussfolgerung

Die einfache klinische Anwendbarkeit, einhergehend mit einer geringen Rate an Pseudarthrosenbildung, zeigt, dass die Eysel-Roosen-Klassifikation, inklusive der Therapieempfehlungen, ein gut anwendbarer Leitfaden zur Behandlung von Typ-II-Frakturen des Dens axis ist.

Abstract

Background

The most effective treatment of type II dens fractures according to Anderson and D’Alonzo remains controversial as there is no guidance on the choice of conservative or surgical therapy and if the anterior or the posterior approach is more advantageous. In 1993 Eysel and Roosen showed that the consolidation rate of type II odontoid fractures mostly depends on the morphology of the fracture and established a classification with corresponding treatment recommendations.

Objective

The investigation aimed at clarifying the outcome of type II dens fractures treated according to the recommendations of Eysel and Roosen.

Material and methods

Data of dens fractures from 72 patients were analyzed and categorized according to the Eysel and Roosen classification. Furthermore, the treatment was analyzed and the outcome was evaluated retrospectively using radiographs acquired during follow-up.

Results

The mean age of the 72 patients was 70.7 years. Of the patients 19.4% suffered from type A, 75% from type B and 5.6% from type C fractures according to Eysel and Roosen. Out of the 72 patients 45 were assessed by computed tomography (CT) scan during follow-up. According to the recommendations of the authors 34 of the 41 patients with type A or type B fractures underwent anterior screw fixation of the dens and 3 out of the 4 patients with a type C fracture underwent a dorsal C1 and C2 fusion. After a mean follow-up of 7 months non-union was observed in 15.6% of the patients whereby 6 of the these patients were treated by surgery and 1 patient was managed conservatively. All of the patients who developed a non-union had a type B fracture.

Conclusion

The simple clinical applicability together with the low rate of non-union development shows that the Eysel and Roosen classification appears to be a suitable guide for clinical use when deciding on the appropriate treatment regimen.

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Authors and Affiliations

  1. Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    Carolin Meyer, Johannes Oppermann, Peer Eysel & Lars Peter Müller

  2. Medizinische Fakultät, Universität zu Köln, 50924, Köln, Deutschland

    Ingo Meermeyer

  3. Klinik für Orthopädie und Unfallchirurgie, Helios-Klinikum Siegburg, Ringstraße 49, 53721, Siegburg, Deutschland

    Gregor Stein

Authors
  1. Carolin Meyer
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  2. Johannes Oppermann
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  3. Ingo Meermeyer
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  4. Peer Eysel
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  5. Lars Peter Müller
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  6. Gregor Stein
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Corresponding author

Correspondence to Carolin Meyer.

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Interessenkonflikt

C. Meyer, J. Oppermann, I. Meermeyer, P. Eysel, L.P. Müller und G. Stein geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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W. Mutschler, München

H. Polzer, München

B. Ockert, München

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Meyer, C., Oppermann, J., Meermeyer, I. et al. Therapiekonzept und Outcome bei Typ-II-Frakturen des Dens axis. Unfallchirurg 121, 397–402 (2018). https://doi.org/10.1007/s00113-017-0428-9

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  • DOI: https://doi.org/10.1007/s00113-017-0428-9

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