ABSTRACT
Objective@#To evaluate the clinical and radiological outcomes,and the complications of staged minimally invasive surgery for adult degenerative scoliosis, comparing with that of the conventional open surgery.@*Methods@#From Jun 2013 to Jun 2017, a total of 42 cases of degenerative scoliosis underwent surgical treatment. Among which, 23 cases underwent staged minimally invasive surgery(MIS group) and 19 cases underwent posterior open surgery(open group). The intra-operative bleeding, and operation time were recorded.The clinical outcomes were assessed using the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) for low back pain and leg pain.The radiological outcome was evaluated with Cobb angles and sagittal balance parameters (Sagittal Vertical Axis (SVA), Pelvic Incidence (PI)-Lumbar Lordosis (LL), Pelvic Tilt (PT)). The occurrence of complications was recorded.@*Results@#The baseline demographic features of both groups (gender, age, medical comorbidity, etc.) were similar.The mean follow-up period for both groups was more than 2 years.The intraoperative bleeding in the MIS group 405.7±144.8 ml was significantly lower than that in the open group (2 005.3±728.4 ml, t=10.31, P<0.001); The total operation time 414.3±63.0 min of MIS group was significantly longer than that of the open group (304.2±51.8 min, t=6.10, P<0.001), but the operating time of each stage was shorter than the open group. The VAS score for back pain and leg pain,the ODI scores were significantly improved after surgery for both group, there was no significant difference between the two groups, but the low back pain and function in MIS group were better than the open group. The parameters of the coronal and sagittal deformity were significantly improved in both groups, correction of coronal deformity in MIS groupwassignificantly superior to the open group (F=12.02, P=0.001), there was no significant difference in sagittal balance correction between the two groups. The overall complication rate (63.2%) was slightly higher in the open group than in the MIS group (34.8%) without significant difference(χ2=3.36, P=0.07). The incidence of major complications in the open group was significantly higher than that in the MIS group (P=0.014).@*Conclusion@#Staged minimally invasive surgery can significantly relieve the patient's pain, improve functionand the coronal and sagittal balance of the patient, the early clinical and radiological outcomes were comparable to the open surgery; Minimally invasive surgery may significantly reduce the amount of bleeding and major complications. Minimally invasive surgery is safe and effective for carefully selected patients with degenerative scoliosis.However, the long-term outcomes of minimally invasive surgery remains to be followed up.
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Objective To explore the relationship between psychosocial factors and risk of vascular dementia. Methods A cohort study of people 55 years old and over were followed up 10 years after a baseline screening. 5055 older subjects in Shanghai were stratified and cluster sampled from community. Information about psychosocial factors was collected during the baseline screening with an interview in 1987. The clinical diagnosis of dementia and vascular dementia (VD) were made according to DSM-Ⅲ-R and Hachinski Ischemic Score (HIS). In 1997,the elders who were not having dementia in 1987 were surveyed; Clinical diagnosis terms of that was made in above mentioned criteria. Then we analyzed the relationship between the psychosocial factors and VD in community elderly population by means of Logistic regression and estimated the incidence of VD.Results 1203 subjects were re-surveyed in 1997 and among them 124 new cases of dementia including 36 cases of VD were identified. By calculating the relative risk (RR) of psychosocial factors to the VD, we found that several psychosocial factors were correlated with the VD including not taking group activities, unsatisfying life, negative life events and depression (RR＞1). ADL total score are also good predictive points for VD.Conclusions Psychosocial factor may play an important role in the vascular dementia developed.
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Objective To study the rule of dynamic change of cognitive function in community elderly and predicting for dementia through using items of MMSE. Methods A 10 year follow up of cognitive function survey was carried out in the non dementia old people using Chinese version Mini Mental State Examination(MMSE). The elder people were divided into two groups (dementia group and non dementia group) according to the DSM Ⅲ R diagnostic criteria 10 years later. Results (1) A total of 1 192 subjects completed all data sheets by two surveys and 124 cases(10 4%)were identified in the second survey 10 years later. (2)Almost all the baseline item scores and its change of MMSE of the dementia group were higher than that of the non dementia group. (3)Orientation of time, serial subtration by seven, reading items of MMSE were effective predictors for the dementia, resding and orientation of time were significant predictors for Alzheimer's disease through logistic regression model. Conclusions The item analysis of MMSE is important information for the epidemiological research.