Objective To explore the effectiveness of bipolar femoral head replacement combined with tension band wire fixation for intertrochanteric fracture in elderly osteoporotic patients. Methods Bipolar femoral head replacement combined with tension band wire fixation were used for intertrochanteric fracture in 48 elderly osteoporotic patients between January 2004 and December 2010. Of 48 patients, 15 were male and 33 were female, aged 90-99 years (mean, 94.1 years). All fractures were caused by falling, and pathological fracture was excluded. It was 2-7 days (mean, 4.2 days) from fracture to surgery. According to the Tronzo Evans classification, 25 cases were rated as type IV, 20 cases as type III, and 3 cases as type II. And all of the cases were accompanied with severe osteoporosis and accompanied by more than one medical diseases, and 10 cases had spinal compression fracture. Results All patients underwent the operation successfully. Six cases died of underlying medical illness within 2 years postoperatively. A total of 39 cases were followed up 2-7 years, averaged 3.1 years. After operation, short-term mental disorders occurred in 9 cases, suspected urinary tract infection in 2 cases, sacral rear bedsore in 1 case, hip pain in 1 case, thigh pain in 1 case, and deep vein thrombosis of affected limb in 1 case. All the incisions healed by first intension, and X-ray film showed bone union in all cases; no complications of bone osteolysis, prosthesis loosening, subsidence, rupture, and heterotopic ossification occured postoperatively. No case needed revision. According to the Harris score system, the results were excellent in 5 cases, good in 28 cases, fair in 5 cases, and poor in 1 case, with an excellent and good rate of 84.6%; the score at 2 years was significantly higher than that at 6 weeks (t= — 14.79, P=0.00). The physical health score and mental health score of SF-12 at 2 years postoperatively were significantly higher than those at 6 weeks postoperatively (P lt; 0.05). The visual analogue scale (VAS) scores at 6 weeks and 2 years postoperatively were significantly lower than those at preoperation (P lt; 0.05), and the score at 2 years was significantly lower than that at 6 weeks (P lt; 0.05). Conclusion The bipolar femoral head replacement combined with tension band wire fixation for intertrochanteric fracture in elderly osteoporotic patients has the advantages of firm fixation, early function exercise with load bearing, pain relieving, improving hip function, and avoiding complication in bed.
Objective To observe the clinical effect of enhanced recovery after surgery (ERAS) in elderly patients with right colon cancer. MethodsA total of 90 elderly patients who were diagnosed as right colon cancer and underwent radical resection of right colon cancer in the Department of Gastrointestinal Surgery of the Affiliated Hospital of Qingdao University from April 2018 to October 2018 were enrolled prospectively. These patients were randomly divided into two groups: ERAS group (n=44) receiving ERAS during perioperative period and control group (n=46) undergoing conventional surgical treatment. To compare the occurrence of postoperative complications, the recovery of gastrointestinal function, and the changes of serum inflammatory factors between the two groups before and after operation. Results① There was no significant difference in the incidence of total postoperative complications and the incidence of complications (including anastomotic leakage, incision infection, postoperative bleeding, intestinal obstruction, cardiovascular complications, pulmonary infection, and urethral infection） between the ERAS group and the control group (P>0.05). ② The first anal exhaust time, postoperative fever time, postoperative hospitalization time, quality of life score, and hospitalization cost of the ERAS group were better than those of the control group (P<0.05). ③ There were no significant difference in serum IL-6, TNF-α, and CRP levels between the two groups before operation (P>0.05), but on the 1st and 3rd day after operation, the three indexes of the control group were higher than those of the ERAS group (P<0.05). ConclusionThe application of the idea of ERAS in the elderly patients with right colon cancer can promote the recovery of gastrointestinal function, shorten the hospitalization time, and improve the clinical outcome.
Objective To conclude the research progress of unicompartmental knee arthroplasty (UKA) in the treatment of elderly patients with knee osteoarthritis (KOA). Methods The literature on UKA at home and abroad in recent years was reviewed to summarize the clinical characteristics of elderly patients with KOA, perioperative management (including evaluating indications preoperatively, intraoperative prosthesis selection, postoperative complication management, etc). Results Through reasonable preoperative evaluation, prosthesis selection, and advanced perioperative management, for elderly patients with KOA who meet the indications, UKA can be considered. Compared with total knee arthroplasty, the incidence of postoperative complications in elderly patients undergoing UKA is lower, joint awareness is reduced, functional improvement and satisfaction are higher. Meanwhile, choosing appropriate prostheses and fixation methods can lead to a good survival rate. ConclusionUKA can provide a safe and effective treatment option for elderly patients with KOA within a certain range of indications.
Objective To investigate the operative procedure and the therapeutic effects of unstable femoral intertrochanteric fracture in elderly patients with rebuild septum bronchiale in artificial femoral head replacement. Methods From October 2005 to October 2007, 113 elderly patients with unstable femoral intertrochanteric fracture were treated with artificial femoral head replacement with fixation of femoral greater trochanter and smaller trochanter in the help of bone cement in 58 cases (test group) and with γ-type bone nail in 55 cases (control group). In test group, there were 21 males and 37 females with an average age of 75 years, including 10 cases of type IIIA, 16 cases of type IIIB and 32 cases of type IV according to Evans-Jenson standard. In control group, there were 17 males and 38 females with an average age of 72.5 years,including 13 cases of type IIIA, 14 cases of type IIIB and 28 cases of type IV according to Evans-Jenson standard. All fractures were caused by fall damage. The disease course was 3 hours to 7.5 days (mean 1.4 days). The patients of two group compl icated with osteoporosis, and compl icated by one or several compl ications of coronary heart disease, hypertension, diabetes and chronic bronchitis. And all patients did not had fracture at other sites. There was no significant difference in general data between two groups (P gt; 0.05). Results The operations were successful, the incision healed by first intention. There were significant differences in operation time, operative blood loss and blood-transfusion between two groups (P lt; 0.05). The two group were followed 12-36 months. There were significant differences (P lt; 0.05) in the incidence rate of compl ication and the excellent and good rate of hip function (by Harris standard) between the test group (3.4% and 93.1%) and the control group (16.4% and 70.9%) 12 months after operation. Conclusion The aged patients with intertrochanteric fracture can get good result through caput femoris replacement, and rebuild septum bronchiale is of great significance.
Objective To evaluate the clinical efficacy of coronary artery bypass grafting in the treatment of coronary artery disease patients aged over 70 years. Methods A total of 160 patients with coronary atherosclerotic heart disease underwent off-pump coronary artery bypass grafting from January 2013 to December 2017. There were 94 males and 66 females at age of 70–85 (76.67±2.33) years. Operations were performed by using sternal median incision with the assistance of local myocardial surface fixator and shunt plug, and the saphenous vein and internal mammary arterywere used as grafted vessels. Results All the patients were received successful off-pump coronary artery bypass grafting without death, and the cardiac function improved significantly. There were 62 patients with the internal mammary artery bridge and 98 patients with the whole vein bridge. All the patients were followed-up for 1 to 4 years. All the patients had obvious relief of angina pectoris. Conclusion Off-pump coronary artery bypass grafting for the treatment of elderly patients with coronary heart disease is an effective and safe operation, especially for patients with renal insufficiency, cerebrovascular disease, respiratory disease and severe left ventricular dysfunction.
Objective To observe the short-term efficacy and the incidence of adverse cardiovascular events in patients aged over 80 years with multivessel coronary artery disease following two-stage Hybrid surgery. Methods We retrospectively analysed the clinical data of 67 patients aged over 80 years with multivessel coronary artery disease undergoing surgery in our hospital. The were 44 males and 23 females with an anverage age of 82.4±2.1 years. According to the operation pattern, the patients were divided into two groups: a two-stage Hybrid surgery group (n=29, 19 males, 10 females, aged 83.2±3.1 years) and a traditional thoracotomy group (n=38, 25 males, 13 females, aged 83.3±3.4 years). We compared the clinical results of perioperation between the two groups. Results Conpared with the traditional thoracotomy group, the two-stage Hybrid surgery group had shorter postoperative duration of mechanical ventilation (6.7±2.2 hvs. 18.2±3.4 h) and hospitalization stay (15.7±3.0 dvs. 20.7±5.6 d) and had less volume of chest drainage during the first 24 h after surgery (176.5±32.3 mlvs. 443.8±51.5 ml). The incidence of adverse cardiovascular events in the two-stage Hybrid surgery group was significantly lower than that in the traditional thoracotomy group (6.9%vs. 23.1%, P<0.05). Conclusion The two-stage Hybrid surgery in patients aged over 80 years with multivessel coronary artery disease can significantly decrease the postoperative incidence of adverse cardiovascular events, shorten the postoperative duration of mechanical ventilation and hospitalization stay, reduce the volume of chest drainage during the first 24 h after surgery and improve prognosis of surgery for the elderly patients.
目的总结75岁以上高龄冠心病患者行冠状动脉旁路移植术（CABG）的围手术期临床经验，以提高手术疗效。 方法2014年2～6月沈阳军区总医院心外科为20例75～84岁冠状动脉粥样硬化患者行非体外循环冠状动脉旁路移植术，其中男11例、女9例，主要病变均为三支冠状动脉严重狭窄或伴左主干狭窄，其中5例患者伴急性心肌梗死，所有患者均为限期手术。分析全组手术时间、住院时间、围手术期并发症、术后结果等。 结果全组均采用左乳内动脉吻合前降支，大隐静脉吻合其他分支，平均桥血管数量为3.2支；平均手术时间3.3 h；术后平均呼吸机辅助时间9.6 h；术后平均重症监护时间26.4 h；术后平均住院时间为12.3 d。术后出现阵发性心房颤动3例；术后呼吸机辅助期间低氧血症2例，术后因咳痰无力及误吸并发严重肺炎1例；术后明显腹胀、纳差6例，其中1例因腹胀行短期胃肠减压及完全胃肠道外营养，1例因纳差再次入院治疗；术后伤口愈合不良清创缝合1例。所有患者均痊愈出院，心功能改善，心绞痛症状消失。 结论对于高龄患者，非体外循环冠状动脉旁路移植术疗效满意；胃肠功能、呼吸功能及手术耐受力为影响高龄患者围手术期恢复较为突出的因素，应采取更为积极的治疗和应对策略。
目的:比较人工股骨头置换与骨折内固定治疗高龄股骨转子间骨折的临床疗效。方法:筛选1997年6月至2008年6月间收治的60例高龄新鲜不稳定性股骨转子间骨折患者分为A、B两组。A组为行人工股骨头置换者,B组为行骨折内固定者。A组30例,平均年龄83.6岁;B组30例,平均年龄81.7岁。随访时间8个月～9年(平均2.3年)。结果:两种术式在住院时间和术后引流量的差异无统计学意义(Pgt;0.05);而在手术时间、术中出血量、下地开始行走时间、术后早期并发症、术后内科合并症和髋关节功能恢复、术后1年内死亡率等方面,两组比较差异均有统计学意义(Plt;0.05)。结论:人工股骨头置换术可以作为治疗高龄股骨转子间骨折的一种选择,术后能早期离床负重活动、较快恢复伤前活动能力、降低术后短期并发症和内科合并症的发生率、减低术后一年内死亡率。
目的探讨高龄胰腺癌的外科治疗方法。方法回顾性分析1995～2000年间我科收治的33例70岁以上胰腺癌患者的外科治疗资料。结果高龄胰腺癌患者发病隐匿，并发疾病多（88.9%），根治性切除困难，术后并发症发生率高（21.2%）。结论手术切除是治疗高龄胰腺癌最好的方法，早期诊断、早期治疗、加强围手术期处理以及有效地预防和治疗并发症是提高疗效的关键。