An age-stratified follow-up of complications and clinical benefit of posterior lumbar intervertebral fusion procedure in middle-aged and older patients / 中国修复重建外科杂志

Objective: To compare the complications and clinical scores of posterior lumbar intervertebral fusion (PLIF) in middle-aged and older patients of different ages, and to assess the risk of complications of PLIF in different ages, providing a reference for clinical treatment. Methods: The clinical data of 1 136 patients, who were more than 55 years old and underwent PLIF between June 2013 and June 2016, were retrospectively analyzed. According to the age of patients undergoing surgery, they were divided into 3 groups as 55-64 years old, 65-74 years old, and ≥75 years old. The general characteristics, comorbidities, and surgical data of the three groups were compared, with comparison the morbidity of complications. According to the minimal clinical important difference (MCID), the improvement of patient's pain visual analogue scale (VAS) score and the Oswestry disability index (ODI) score were compared. Univariate logistic regression analysis was used to analyze the difference of complications and the improvement of VAS and ODI scores. Multivariate logistic regression analysis was performed for the risk factors of complications. Results: There were significant differences in the number of surgical fusion segments and osteoporosis between groups ( P0.05). All patients were followed up 6-62 months with an average of 27.4 months. Among the results of postoperative complications, there were significant differences in the total incidence of intraoperative complications, systemic complications, minor complications, and the percentage of improvement of ODI score to MCID between groups ( P0.05). Univariate logistic regression analysis showed that after adjusting the confounding factors, there were significant differences in intraoperative complications and the percentage of improvement of ODI score to MCID between 55-64 and 65-74 years old groups ( P<0.05); systemic complications, minor complications, complications at the end of long-term follow-up, and the percentage of improvement of ODI score to MCID in ≥75 years old group were significantly different from those in the other two groups ( P<0.05). Multivariate logistic regression analysis showed that age was a risk factor for systemic complications, minor complications, and complications at the end of long-term follow-up. Except for age, long operation time was a risk factor for intraoperative complications, increased number of fusion segments was a risk factor for systemic complications, the number of comorbidities was a risk factor for minor complications, and osteoporosis was a risk factor for complications at the end of long-term follow-up. Conclusion: The risk of surgical complications is higher in the elderly patients (≥75 years) with lumbar degenerative diseases than in the middle-aged and older patients (<75 years), while the improvements of postoperative VAS and ODI scores were similar. Under the premise of fully assessing surgical indications, PLIF has a positive effect on improving the elderly patients' quality of life.

Arthroscopic rotator cuff repair using suture bridge technique as treatment of traumatic shoulder dislocation combined with rotator cuff injury in older patients / 中国内镜杂志

Objective To compare the clinical results of arthroscopic rotator cuff repair using a suture bridge technique and conservative therapy as treatment of traumatic shoulder dislocation combined with rotator cuff injury in older patients. Methods From August 2010 to August 2013 a total of 63 patients were prospectively enrolled. In the case of documented tears of the rotator cuff in combination with symptoms persisting after conservative therapy, patients were free to decide between arthroscopic rotator cuff repair using a suture bridge technique and conservative treatment. Patients were monitored for changes in visual analogue scale (VAS) scores, range of motion, the Simple Shoulder Test (SST), the Constant score and recurrences over a minimum follow-up period of 1 year. Results 60 pa-tients (30 in surgical group and 30 in conservative treatment group) were follow-up for at least 1 year. There was no significant difference between the two groups at baseline. The surgical group resulted in better improvements in pre-operative to postoperative VAS scores, range of motion, SST scores and the Constant score. There were five recur-rences in the conservative treatment group, while no recurrences were documented in surgical group. Conclusion In this selected patient group, we believe arthroscopic repair using a suture bridge technique for the treatment of symp-tomatic rotator cuff tear can improve shoulder function and decrease recurrences in older patients suffered from trau-matic shoulder dislocation combined with rotator cuff injury. The long-term outcomes remain to be determined.

Surgical Removal of Subfoveal Choroida l Neovascular Membranes in Older Patients

We report the result of surgical removal of subfoveal choroidal neovascular membranes[CNVM] in patients older than 50 years. Eleven eyes treated consecutively by submacular surgery were included. Etiology of CNVM was age-related macular degeneration in 7 eyes, myopia in 2 eyes, and idiopathic in 2 eyes. All the eyes had vision of 20/200 or worse and had undergone surgeries within 3 months from the onset of visual symptom. After creation of posterior vitreous detachment, neovascular membranes were completely dissected and removed through 36Gsize retinotomies. No laser photocoagulation was placed to the retinotomies, and air bubble of 30% volume of vitreous cavity was left for tamponade at the end of the surgery. Within one month postoperatively, fluorescein angiogram was obtained and confirmed the absence of residual CNVM in all cases. One eye developed a recurrent CNVM 6 months following surgery and was lasered successfully. At the mean follow-up period of 6.4 months, visual acuity was improved in 6 eyes[55%], unchanged in 4 eyes[36%], and worsened in 1 eye[9%] which suffered from diffuse RPE loss during surgery. Although the visual outcome of submacular surgery is expected to be poor in older patients, surgical approach may be beneficial in carefully selected cases with CNVM for improvement or preservation of vision.

The effects of long-term mild aerobic training at lactate threshold and its cessation on blood pressure in older hypertensive patients under medication / 体力科学

After a general clinical observation period of 3 months, men and women from 66-82 yr. of age with hypertension (n=10) were studied to assess the effects of long-term mild aerobic training and detraining on their blood pressure. Ten patients agreed to take part in aerobic training using a treadmill with the intensity at the lactate threshold (LT) for 30minutes 3-6 times a week for mean 17.1±9.8 months while the time course of changes in the resting blood pressure was monitored.<BR>Following the training period the LT increased significantly by the end of the training period (P<0.001) . After 3months of training both the systolic and diastolic blood pressure decreased significantly (P<0.05, respectively) and both blood pressures stabilized at a significantly lower level throughout the remainder of the study. The mean blood pressure decreased significantly for 9 months (P<0.05) . Finally, the systolic, mean and diastolic blood pressure were found to have decreased significantly, by 9, 5, 11 mmHg, respectively by the end of the training period. (SBP and MBP: P<0.05, DBP: P<0.01, respectively) . One month after the training ended the systolic, mean and diastolic blood pressure all increased significantly (SBP and MBP: P<0.001, DBP: P<0.01, respectively) and approached the initial pre-training levels.<BR>In conclusion, the antihypertensive effect of mild aerobic training at the LT was confirmed for older patients taking antihypertensive medications. However, the cessation of such training resulted in a quick return to pre-training levels.