Objective
To investigate the difference in the effectiveness between proximal femoral nail anti-rotation (PFNA) and proximal femoral locking compression plate (PFLCP) for intertrochanteric fracture in elderly patients combined with hemiplegia due to cerebral infarction.
Methods
The clinical data of 67 cases of intertrochanteric femoral fractures combined with hemiplegia due to cerebral infarction between October 2013 and January 2017 were retrospectively analyzed. Among them, 32 cases were treated with PFNA internal fixation (PFNA group), and 35 cases were treated with PFLCP internal fixation (PFLCP group). There was no significant difference in gender, age, injury side, modified Evans classification of fracture, preoperative medical disease, and interval from injury to operation between 2 groups (P>0.05). The operation time, intraoperative blood loss, postoperative bed time, incidence of perioperative complications, time of fracture healing, and hip Harris score at 6 months and 1 year after operation were recorded and compared.
Results
Both groups were followed up 12-24 months with an average of 14 months. Compared with the PFLCP group, the PFNA group had shorter operation time, less intraoperative blood loss, and shorter bed time, and the differences were significant (P<0.05). X-ray films showed that the fractures healed in both groups. The fracture healing time of the PFNA group was shorter than that of the PFLCP group, but the difference was not significant (t=0.743, P=0.460). During hospitalization, there were 3 cases of pulmonary infection, 2 cases of deep venous thrombosis of lower limbs, and 1 case of urinary tract infection in the PFNA group; and the incidence of perioperative complications was 18.8% (6/32). There were 4 cases of pulmonary infection, 6 cases of deep venous thrombosis of lower limbs, 1 case of recurrent cerebral infarction, and 1 case of stress ulcer in the PFLCP group; and the incidence of perioperative complications was 34.3% (12/35). There was no significant difference in the incidence of perioperative complications between 2 groups (χ2=2.053, P=0.152). At 6 months after operation, the Harris total score and individual scores in the PFNA group were higher than those in the PFLCP group (P<0.05). At 1 year after operation, there was no significant difference in the Harris total score and pain score, life ability score, and walking ability score between the PFNA group and the PFLCP group (P>0.05); However, the joint deformity and activity score of the PFNA group was significantly better than that of the PFLCP group (t=4.112, P=0.000).
Conclusion
For intertrochanteric fracture in elderly patients with cerebral infarction hemiplegia, the PFNA has shorter operative time, less intraoperative blood loss, shorter bed time after operation, and better short-term hip function when compared with the PFLCP.
ObjectiveTo investigate the clinical effect and prognosis of laparoscopic complete mesocolic resection (CME) in the treatment of elderly patients with stage Ⅲ right colon cancer.MethodsClinical data of 280 elderly patients (aged 60 years or older) who underwent stage Ⅲ right hemicolectomy in the First Hospital of Lanzhou University from 2010 to 2015 were collected. Among them, 160 patients underwent laparoscopic CME treatment were set as the observation group, and 120 patients underwent conventional laparotomy were set as the control group. The mean operative time, intraoperative blood loss, postoperative first anal exhaust time, number of lymph nodes dissection, number of positive lymph nodes, length of hospital stay and postoperative complications were compared between the two groups. The postoperative local recurrence rate, distant metastasis rate, 3-year cumulative survival rate and postoperative recurrence risk factors were analyzed.ResultsThere were no statistically significant differences between the observation group and the control group in operative time, number of lymph node dissection, number of positive lymph nodes and postoperative distant metastasis rate (P>0.05). The amount of intraoperative blood loss, postoperative anal first exhaust time, days of hospitalization, and postoperative recurrence rate in the observation group were less or shorter or lower than those in the control group, with statistically significant differences (P<0.05). The 3-year survival rate in the observation group was higher than that in the control group (log-rank χ2 =11.865, P=0.001), and the disease free survival in the observation group was also higher than that in the control group (log-rank χ2=7.567, P=0.006). Logistic regression was used to analyze the cases of postoperative recurrence in the two groups, and it was found that the degree of tumor differentiation, vascular invasion and lymph node metastasis were independent risk factors for postoperative tumor recurrence.ConclusionLaparoscopic CME in the treatment of elderly patients with stage Ⅲ right colon cancer is effective, it is safe and feasible, which can effectively prolong the survival time of patients.
ObjectiveTo investigate the effect of omega-3 polyunsaturated fatty acids on delirium in elderly patients after taking gastric cancer surgery.MethodsA prospective study was conducted. Elderly patients with gastric cancer undergoing radical gastrectomy in West China Hospital of Sichuan University from June 2015 to June 2018 were divided into experimental group and control group for the purpose of research. All patients were operated by the same group of surgeons and anesthesiologists. Patients in the experimental group received intravenous infusion of 10% fish fat emulsion (Ewing) 100 mL daily from the first day after operation extra to routine treatment; patients in the control group received routine treatment after operation. The postoperative delirium, inflammation, complications, hospital stay, andre-admission on 30 days were compared between the two groups.ResultsA total of 205 patients were under research. The results were as follows. ① There were 47 delirium patients in the control group and 22 delirium patients in the experimental group. The difference between the two groups was statistically significant (P<0.001). There were 32 cases and 19 cases discovered with delirium in the control group and the experimental group during 1-3 days after operation; there were 19 cases and 6 cases were detected with delirium in the control group and the experimental group during 4-7 days after operation, respectively. The difference was considered statistically significant (P<0.05). ② Inflammation indexes of the experimental group were significantly lower than those of the control group on the 3rd and 7th day after operation, including count of WBC, C-reactive protein, interleukin-6, tumor necrosis factor-α, and platelet crit, and the difference were statistically significant (P<0.05). ③ Postoperative fever occurred in 46 patients in the experimental group, while 71 patients in the control group. The difference was statistically significant (P<0.01). ④ There were 2 cases of incision liquefaction in the control group and 1 case of mild chylous leakage in the experimental group. There was no significant difference in incision liquefaction rate and chylous leakage rate between the two groups (P>0.05). ⑤ The average hospitalization time of the experimental group was shorter than that of the control group ［(8±1) d vs. (9±2) d］. The difference was considered statistically significant (P<0.01).Conclusionω-3 polyunsaturated fatty acids can reduce postoperative delirium and improve short-term prognosis in elderly patients with gastric cancer by controlling inflammation and stress response.
China has entered an aging society. Elderly patients with acute abdomen have complex clinical manifestations and often have more complications. For elderly acute abdomen, the results of abdominal physical examination and laboratory testing often can not reflect the patient’s condition. The differential diagnosis of diseases should be emphasized in clinical diagnosis and treatment. The treatment of acute abdomen in the elderly not only needs standardized analgesic treatment, but also pays attention to the evaluation of the disease, and adopts multidisciplinary cooperation to formulate appropriate treatment plans.
ObjectiveTo evaluate the conditions of activity of daily living (ADL) and influence factors of ADL of hospitalized elderly (≥60 years old) patients.
MethodsA cross-sectional study was conducted to investigate the health and ADL conditions of hospitalized elderly patients in the geriatric department of a tertiary hospital in Chongqing by ADL scale. The influence factors of ADL were analysed by using logistic regression analysis.
ResultsA total of 375 hospitalized elderly patients were included. The ADL impairment rate of female was 59.60% (93/156), the one of male was 75.90% (166/219), and there was significant difference between different sex (χ2=11.169, P=0.001). The impairment rate by age were 95.40% at 60 to 69 years old, 91.40% at 70 to 79 years old, 87.20% at 80 to 89 years old, and 98.55% at above 90 years old, respectively; there was significant difference among different age groups (χ2=8.575, P=0.036). The result of logistic regression analysis showed that age was the individual risk factor of ADL (OR=0.188, 95%CI 0.085 to 0.416, P=0.000). The difficulty of walking up and down stairs occupied the highest proportion (68.80%) in 10 items of ADL scale.
ConclusionHospitalized elderly patients should be equipped with specialized paramedics to minimize the difficulties of ADL, in order to improve their quality of life.
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 explore clinical effect of primary suture following laparoscopic common bile duct exploration (LCBDE) in treatment of patients aged over 70 years old with common bile duct (CBD) stones.
Methods
The clinical data of 62 patients aged over 70 years old with CBD stones underwent the LCBDE from January 2013 to December 2016 were retrospectively analyzed. Among them, 30 patients underwent the T tube drainage (T tube drainage group) and 32 patients underwent the primary suture (primary suture group) following the LCBDE. The intraoperative and postoperative statuses of these two groups were compared.
Results
There were no significant differences in the gender, age, body mass index, preoperative comorbidities and ASA classification, number and maximum diameter of CBD stone, and diameter of CBD between the two groups (P>0.05). There were no significant differences in the operative time, hospitalization cost, rates of total postoperative complications and readmission between the two groups (P>0.05). Compared with the T tube drainage group, the amount of intraoperative bleeding was less (P<0.05) and the postoperative hospital stay was shorter (P<0.05) in the primary suture group.
Conclusion
Primary suture is safe and feasible following LCBDE for patients aged over 70 years old with CBD stones in case of strict indications and proficiency intraoperation and it is more beneficial to recovery of patient.
ObjectiveTo investigate perioperative safety of laparoscopic pancreaticoduodenectomy (LPD) in elderly patients (age ≥70 years old).MethodsThe retrospective cohort study was conducted. The clinicopathologic data of the patients underwent LPD and open pancreaticoduodenectomy (OPD) in the Affiliated Hospital of North Sichuan Medical College from January 2016 to December 2019 were collected. The patients who met the inclusion and exclusion criteria were divided into LPD with aged ≥70 years old group (group A), OPD with aged ≥70 years old group (group B), and LPD with aged <70 years old group (group C). The baseline data, intraoperative situations, and postoperative situations were compared between the group A and group B, and between the group A and group C, respectively.Results① There were no statistic differences in the age, gender, body mass index, hemoglobin, albumin, and total bilirubin, American Society of Anesthesiologists (ASA) grade, and comorbidity index before operation between the group A and group B (P>0.05). However, there were statistic differences in the hemoglobin, albumin, ASA grade, and comorbidity index before operation between the group A and group C (P<0.05). ② There were no significant differences in the operation time between the group A and group B (P>0.05), but the intraoperative blood loss of the group A was significantly less than the group B (P<0.05). The operation time, intraoperative blood loss, and conversion rate had no significant differences between the group A and group C (P>0.05). ③ There were no significant differences in the pathological pattern, tumor size, R0 resection rate, reoperative rate, and postoperative 90 d mortality between the group A and group B, and between the group A and group C, respectively. For the elderly patients, cases in the ICU, overall complications, specific complications (except for delayed gastric emptying) and Clavien-Dindo classification of complication after operation had no significant differences between the group A and group B (P>0.05), but there were more harvesting lymph nodes, lower postoperative pain score, shorter postoperative hospital stay, and less delayed gastric emptying cases in the group A than the group B (P<0.05). For the patients accepted LPD, there were no significant differences in the harvesting lymph nodes, postoperative pain score, postoperative hospital stay, and specific complications (except for pulmonary infection rate) between the group A and the group C (P>0.05), but the postoperative cases in the ICU were more, pulmonary infection rate was higher, overall complications rate and the ratio of Clavien-Dindo Ⅲ–Ⅳ classification of complication were higher in the group A as compared with the group C (P<0.05). ConclusionCompared with OPD, LPD might have some advantages in blood loss, harvesting lymph nodes, and recovery after surgery, even though perioperative safety of LPD in elderly patients is inferior to younger patients.
Objective To compare the effectiveness and shoulder function of reverse total shoulder arthroplasty (RTSA) and open reduction and internal fixation (ORIF) in the treatment of Neer three/four-part proximal humeral fractures in the elderly. Methods Randomized controlled analysis was conducted on 68 patients over 70 years old with Neer three/four-part proximal humeral fractures treated with RTSA or ORIF between January 2020 and June 2022. The patients were randomly divided into RTSA group (n=32) and ORIF group (n=36). There was no significant difference (P>0.05) in the baseline data such as age, gender, body mass index, injured side, Neer classification, and preoperative Charlson comorbidity index, visual analogue scale (VAS) score, Constant shoulder score, Oxford shoulder score (OSS), and hemoglobin (Hb). The operation time, intraoperative blood loss, reduction of Hb on the 3rd day after operation, hospital stay, total cost of hospitalization, complication incidence, range of motion of shoulder joint at 2 years after operation, VAS score before operation and at 5 days and 1 month after operation, Constant shoulder score and OSS score before operation and at 2 years after operation, and imaging results during follow-up were recorded and compared between the two groups.ResultsCompared with the ORIF group, the RTSA group had longer operation time, less intraoperative blood loss, and higher total cost of hospitalization (P<0.05). There was no significant difference in Hb reduction on the 3rd day after operation between the two groups (P>0.05). The VAS scores significantly improved in both groups at 5 days and 1 month after operation (P<0.05), but there was no significant difference between the two groups (P>0.05). All patients were followed up 26-35 months, with an average of 31.2 months. In the RTSA group, there were 2 cases of poor healing of superficial incision and 1 case of transient nerve injury. There was no complication such as bone resorption around the prosthesis, lucent band, prosthesis loosening, or periprosthetic fracture in all patients. In the ORIF group, there was 1 case of poor healing of superficial incision, 3 cases of nonunion of fracture, 1 case of arthritis secondary to humeral head necrosis, and 1 case of bone absorption of large tuberosity, and no displacement or fracture failure of internal fixation was found in all patients. There was no significant difference in the incidence of complications [9.4% (3/32) vs 16.7% (6/36)] between the two groups [OR (95%CI): 0.828 (0.171, 4.014), P=0.814]. In the RTSA group, 28 cases were graded 0 and 4 cases were graded 1 at 2 years after operation. Constant and OSS scores of RTSA group were significantly better than those of ORIF group (P<0.05). The Constant score was significantly better than ORIF group in activity and strength, range of motion, lifting, abduction, and external rotation (P<0.05), and there was no significant difference in pain, daily function, and internal rotation between the two groups (P>0.05). The RTSA group had a significantly greater range of motion in lifting, abduction, and external rotation than ORIF group (P<0.05), but there was no significant difference in internal rotation between the two groups (P>0.05). ConclusionApplication of RTSA as the initial treatment of Neer three/four-part proximal humeral fractures in the elderly can achieve better rehabilitation of joint activity and lower risk of early reoperation, and improve the quality of life of elderly fracture patients. However, the difficulty of revision and the high cost of treatment require the surgeon to pay full attention and strictly grasp the indications.
Objective
To evaluate the safety and efficacy of laparoscopic-assisted gastrectomy (LAG) comparing with conventional open gastrectomy (COG) in elderly patients with gastric cancer.
Methods
Databases included PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, Wanfang, and VIP were searched to collect the case-control studies about LAG versus COG for elderly patients with gastric cancer, and the searched time was from inception to May 2017. Then meta-analysis was performed by using RevMan 5.2 software.
Results
Finally, ten case-control studies included 1 522 patients were enrolled. There were 757 patients in observation group (underwent LAG) and 765 patients in control group (underwent COG). Results of meta-analysis showed that: the observation group was associated with less intraoperative blood loss ［MD=–121.12, 95% CI was (–179.93, –62.31), P<0.000 1］, more harvested lymph nodes ［MD=1.62, 95% CI was (0.60, 2.65), P=0.002］, shorter time to the first ambulation ［SMD=–2.58, 95% CI was(–4.58, –0.58), P=0.01］, shorter the postoperative intestinal function recovery time ［SMD=–0.85, 95% CI was (–1.20, –0.51), P<0.000 01］, shorter the time of oral intake ［MD=–0.90, 95% CIwas (–1.27, –0.52), P<0.000 01］, shorter hospital stay ［MD=–4.03,95% CI was (–5.62, –2.44), P<0.000 01］, lower incidences of overall postoperative complications ［OR=0.49, 95% CI was (0.38,0.64), P<0.000 01］, surgical-related complications ［OR=0.54, 95% CI was (0.39, 0.74), P=0.000 1］, incision relatedcomplications ［OR=0.42, 95% CI was (0.22, 0.81), P=0.010］, and respiratory complications ［OR=0.60, 95% CI was (0.38, 0.95), P=0.03］, but there was no significant difference on the operative time ［MD=8.36, 95% CI was (–10.97, 27.69), P=0.40］ and incidence of anastomotic fistula ［OR=0.60, 95% CI was (0.27, 1.31), P=0.20］.
Conclusions
The available evidences suggest that LAG is equally safe and feasible compared with COG, it has a significant advantages in reducing intraoperative blood loss and ensuring the number of lymph node dissected during surgery, with less trauma, shorter postoperative hospital stay, lower overall postoperative complications rate, and other short-term efficacy advantages.
