RESUMEN
Approximately 200,000 spinal fractures occur each year in Germany. The decimated stability of the vertebra often leads to type A fractures with a substantial influence by osteoporosis. A mobility preserving and gentle treatment has clear advantages compared to conservative treatment. The hybrid stabilization as a combination of minimally invasive dorsal stabilization and vertebral augmentation has become an established method. In the period from July 2014 to June 2015 a total of 205 spinal operations were documented. In the group of very old patients more than 80% were treated for a geriatric type A vertebral fracture, 24 with hybrid stabilization, 5 by percutaneous bisegmental, 22 by kyphoplasty stabilization and 13 by percutaneous polysegmental procedures. Furthermore, these 4 groups were also considered with respect to the treatment in geriatric trauma centers (GTC). The 4 forms of treatment achieved a mean remuneration of 11,238.77â¯. For the individual treatment form of kyphoplasty there was an increase in the remuneration of 4276.54â¯, when patients undergo geriatric complex treatment and the remuneration is according to the diagnosis-related groups (DRG) classification I34Z. In the field of operative treatment of geriatric vertebral fractures, the augmentative procedures of kyphoplasty and vertebroplasty are well-established but an injury-related involvement of adjacent spinal segments and continuity fractures are frequent occurrences so that a bisegmental hybrid stabilization is advantageous. In addition, the perioperative stress in hybrid stabilization is only negligibly longer so that hybrid stabilization and geriatric complex treatment can be recommended as the new standard in spinal surgery for the treatment of type A fractures in aged patients.
Asunto(s)
Fracturas por Compresión , Cifoplastia , Fracturas Osteoporóticas/cirugía , Fracturas de la Columna Vertebral/cirugía , Vertebroplastia , Anciano , Alemania , Humanos , Resultado del TratamientoRESUMEN
BACKGROUND: Exercise training is an integral component of the management of patients with asthma and COPD. A training intensity of 60-80% of maximum oxygen uptake (VO(2)max) has been recommended. Instead of ergospirometry measurement of heart rate can be used for training guidance. It is unknown whether the given target can be reached in outpatient training groups with substantial heterogeneity concerning diagnosis, disease severity, and age. METHODS AND PATIENTS: 61 adult patients (m = 15, w = 46; 63 +/- 9 years) with asthma (n = 50) or COPD (n = 11) exercised in groups of ambulant lung sports. An individualized target heart rate was calculated corresponding to an intensity of 60% to 80% of calculated VO(2)max which was equivalent to a heart rate from 97 to 137 beats per minute in the population studied. Heart rate, as a measure of the intensity of charge, was measured continuously with pulse frequency meters. RESULTS: All but one asthma patient exercised in the targeted heart rate range. Patients reached 81 +/- 9% of the training goal of calculated 80% VO(2)max (asthma patients: 79 +/- 9% vs. COPD patients: 88 +/- 9%, p < 0.005) No significant differences regarding training intensities were observed in relation to severity of illness or age. CONCLUSIONS: In outpatient lung sport groups of considerable heterogeneity regarding diagnosis, severity of illness and age, participants reach their individualized heart rate target range. COPD patients were training at a significantly higher relative training intensity. Heart rate is an easy to use parameter for training guidance.