Abhiraj D Bhimani, James S Harrop, Emery Monnig, Yehia Elkersh, John K Houten
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引用次数: 0
摘要
老年 II 型蝶骨骨折的治疗颇具争议,因为这些患者通常有许多合并症,增加了手术风险,但他们也可能无法通过非手术治疗实现骨折愈合。最近技术和外科医生态度的变化可能会影响许多临床医生对手术和非手术治疗方法的偏好。虽然骨性骨折愈合仍是治疗的目标,但稳定的纤维结合也越来越被认为是令人满意的结果。最佳的手术方法仍存在争议,一些学者担心吞咽功能障碍的风险,尤其是蝶骨螺钉置入术对老年人造成的问题。目前正在研究的新手术技术包括:在骨折部位前方或椎间孔后方使用 BMP-2,并放置临时后方固定物,待前方骨愈合后再将其移除。更清楚地了解目前可用的治疗方案和相关争议,可以改善临床医生的决策,在治疗日益增多的老年患者的 II 型蝶骨骨折时,可能会为患者带来更好的治疗效果。
Controversies in the Management of Type II Odontoid Fractures.
The management of type II odontoid fractures in the elderly is controversial, as these patients often have numerous medical comorbidities that increase the risks of surgery, but they may also fail to achieve fracture healing with nonsurgical management. Recent changes in technology and surgeon attitudes may influence the preferred approach to both surgical and nonsurgical treatments for many clinicians. While bony fracture healing remains the goal of management, a stable fibrous union is increasingly considered a satisfactory outcome. The optimal surgical approach remains debated, with some authors raising concerns about the risk of swallowing dysfunction being particularly problematic with odontoid screw placement in the elderly. The use of BMP-2 applied either anteriorly into the fracture site or posteriorly in the interlaminar space and placement of temporary posterior fixation to be removed upon demonstration of anterior bony healing are novel surgical techniques that are presently the subject of investigation. A clearer understanding of the currently available treatment options and the associated controversies may improve clinician decision-making and potentially better patient outcomes in the management of type II odontoid fractures for the growing geriatric population.
期刊介绍:
Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure.
Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.