德国骨科和创伤学会基于专家共识和系统评价的治疗方案指南：老年齿状突骨折

Check for updatesSpecial Issue ArtideDG0小8eGlobal Spine Joumal2023.VoL131S)13S-21SGeriatric Odontoid Fractures:Treatment©The Author()s2023Article reuse guidelines:Algorithms of the German Society forsagepub.com/journals-permissionsD0L101I772192568223引157316Orthopaedics and Trauma Based on Expertjournals.sagepub.com/home/gsjSSAGEConsensus and a Systematic ReviewGeorg Osterhoff,MD',Matti Scholz,MD2,Alexander C.Disch,MD3,Sebastian Katscher,MD,Ulrich J.A.Spiegl,MD',Klaus John Schnake,MD5.6,andMax J.Scheyerer,MD7AbstractStudy Design:Systematic review/expert consensus.Objectives:Fractures of the axis represent the most frequent injury of the spine in elderly patients.Both,operative and non-operative treatment are associated with a high rate of complications and mortality.The aim of this article was to summarize the currentliterature on the management of odontoid fractures in geriatric patients and to weigh it based on an expert consensus process.Methods:In a joint consensus process,members of the Spine Section of the German Orthopaedic and Trauma Society(DGOU)aimed to formulate recommendations for the diagnostic workup and treatment of odontoid fractures in geriatricpatients.Based on the previously published recommendations,this article is an updated version with incorporating a systematicreview of the recent literature.Results:Based on the new data available,the recommendations established in the initial consensus process were adapted.Conclusions:Computed tomography represents the diagnostic standard for patients with suspected injuries of the upper cervicalspine.Anderson/D'Alonzo odontoid fractures type I,non-displaced type 2,and type 3 can be treated conservatively.Even non-unions do not necessarily result in poor clinical outcome.In Anderson/D'Alonzo type 2 fractures,surgical therapy offers theadvantage of relatively safe osseous healing with no increased complication rate even in elderly patients and can thus be rec-ommended.In very high aged patients,however,a case-by-case decision should be made.When surgical stabilization of osteo-porotic odontoid fractures is indicated,posterior techniques are biomechanically advantageous and can be considered the stan dard.Keywordscervical,odontoid fracture,treatment,guidelinesDepartment of Orthopaedics,Trauma and Plastic Surgery,University Hospital Leipzig,Leipzig Germany2ATOS Orthopaedic Clinic Braunfels,Braunfels,Germany3 University Comprehensive Spine Center(UCSC).University Centerfor Orthopaedics,Traumatology&Plastic Surgery.University Hospital Carl Gustav Carusat the TU Dresden,GermanyInterdisciplinary Center for Spine and Neurotrauma,Sana Klinikum Borna,Borna,GermanysCenter for Spinal and Scoliosis Surgery.Waldkrankenhaus Erlangen,Erlangen.Germany6 Department of Orthopedics and Traumatology.Paracelsus Private Medical University Nuremberg.Nuremberg.Germany7 Department of Orthopaedics and Trauma Surgery.University of Cologne,Faculty of Medicine and University Hospital Cologne.Koln,GermanyCorresponding Au