Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association · 2023
Worsening ambulation in elderly patients with cervical odontoid fractures: A nationwide multicenter study in Japan.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Segi Naoki, Nakashima Hiroaki, Ito Sadayuki, Yokogawa Noriaki, Ikegami Shota, Watanabe Kota, Funayama Toru, Hasegawa Tomohiko, Tonomura Hitoshi, Kakutani Kenichiro, Furuya Takeo, Suzuki Nobuyuki, Kiyasu Katsuhito, Tominaga Hiroyuki, Miyazaki Masashi, Terashima Yoshinori, Suzuki Hidenori, Hashimoto Ko, Uei Hiroshi, Funao Haruki, Kaito Takashi, Kawaguchi Kenichi, Sakai Daisuke, Seki Shoji, Otsuki Bungo, Inoue Gen, Okada Seiji, Imagama Shiro, Kato Satoshi
Аннотация
BACKGROUND: Despite the increasing prevalence of cervical odontoid fractures in older adults, the treatment strategy is controversial. The objectives of the current study are to investigate the prognosis and complications of cervical odontoid fractures in elderly patients and to identify factors associated with worsening of ambulation after 6 months.
METHODS: This multicenter, retrospective study included 167 patients aged 65 years or older with odontoid fractures. Patient demographic and treatment data were investigated and compared according to the treatment strategy. To determine associations with worsening ambulation after 6 months, we focused on the treatment strategies (nonsurgical treatment [collar immobilization or halo vest], conversion to surgery, or initial surgery) and patients' background.
RESULTS: Patients who received nonsurgical treatment were significantly older, and patients who underwent surgery had more Anderson-D'Alonzo type 2 fractures. Of the patients initially treated nonsurgically, 26% later underwent surgery. Numbers of complications, including death, and degrees of ambulation after 6 months did not differ significantly among treatment strategies. Patients who had worsened ambulation after 6 months were significantly more likely to be older than 80 years, to have needed assistance with walking before injury, and to have cerebrovascular disease. Multivariable analysis showed that a score of ≥2 on the 5-item modified frailty index (mFI-5) was significantly associated with worsening ambulation.
CONCLUSIONS: Preinjury mFI-5 scores of ≥2 were significantly associated with worsening ambulation 6 months after treatment of cervical odontoid fractures in older adults.
METHODS: This multicenter, retrospective study included 167 patients aged 65 years or older with odontoid fractures. Patient demographic and treatment data were investigated and compared according to the treatment strategy. To determine associations with worsening ambulation after 6 months, we focused on the treatment strategies (nonsurgical treatment [collar immobilization or halo vest], conversion to surgery, or initial surgery) and patients' background.
RESULTS: Patients who received nonsurgical treatment were significantly older, and patients who underwent surgery had more Anderson-D'Alonzo type 2 fractures. Of the patients initially treated nonsurgically, 26% later underwent surgery. Numbers of complications, including death, and degrees of ambulation after 6 months did not differ significantly among treatment strategies. Patients who had worsened ambulation after 6 months were significantly more likely to be older than 80 years, to have needed assistance with walking before injury, and to have cerebrovascular disease. Multivariable analysis showed that a score of ≥2 on the 5-item modified frailty index (mFI-5) was significantly associated with worsening ambulation.
CONCLUSIONS: Preinjury mFI-5 scores of ≥2 were significantly associated with worsening ambulation 6 months after treatment of cervical odontoid fractures in older adults.