后路寰枢椎融合与非融合术治疗老年齿状突Ⅱ型骨折的短期与中期疗效分析OA

Objective To compare the short-term and mid-term therapeutic effects of posterior atlanto-axial fusion surgery and non-fusion surgery in the treatment of elderly type Ⅱ odontoid fractures,and to guide clinical decision-making.Methods Sixty elderly patients with type Ⅱ odontoid fractures who underwent sur-gical treatment in this hospital from January 2021 to December 2023 were selected as the research subjects.They were randomly divided into the fusion group and the non-fusion group using a random number table,with 30 cases in each group.The fusion group underwent posterior atlantoaxial pedicle screw fixation com-bined with autologous iliac bone graft fusion surgery,while the non-fusion group underwent screw fixation a-lone.Both groups wore cervical collars for external fixation for 12 weeks after surgery,and were followed up for 12 to 17 months.The baseline data,surgical-related indicators,and fracture healing conditions of the two groups were compared;the Visual Analogue Scale(VAS)score and the Japanese Orthopaedic Association(JOA)score were evaluated before surgery and at 3,6,9,and 12 months after surgery;the Cervical Disability Index(NDI)and cervical range of motion were evaluated 3 months after fracture healing(in the fusion group)or 3 months after removal of internal fixation(in the non-fusion group).Results VAS scores improved sig-nificantly over time in both groups(F=798.00,P<0.05);the fusion group showed greater improvement at 12 months(P=0.009),but no significant differences were observed at other time points(P>0.05).JOA scores improved non-linearly over time in both groups,with a significant time effect(F=186.34,P<0.001);the most pronounced improvement occurred between 3 and 6 months.The non-fusion group showed greater JOA improvement at 9 months(P=0.046),with no significant differences at other time points(P>0.05).No significant between-group differences were observed in bone healing rate,fibrous union,nonunion,or frac-ture healing time(P>0.05).Postoperatively,the non-fusion group had a lower NDI score and greater cervical range of motion than the fusion group(both P<0.001).The C1-C2 fusion rate in the non-fusion group was 96.7%(29/30),with good inter-rater agreement(Kappa=0.82).Conclusion Both posterior atlantoaxial fu-sion and non-fusion surgery provide satisfactory pain relief and neurological recovery in elderly patients with type Ⅱ odontoid fractures.Non-fusion surgery offers significant advantages in preserving cervical mobility and reducing functional disability,and may serve as an effective option for suitable elderly patients.