围手术期处理对HIV阳性骨折患者术后并发症的影响

目的探讨应用围手术期处理对HIV阳性骨折患者术后并发症的影响。方法2010年1月到2014年2月，本研究收集49例骨科HIV阳性合并闭合性骨折患者（治疗组）及68例HIV阴性闭合性骨折患者（对照组）的临床资料，两组患者均给予钢板螺钉、髓内钉或椎弓根钉内固定；治疗组通过围手术期应用营养支持、免疫调节药物、高效抗逆转录病毒治疗、合理应用抗菌药物以及术中精细操作规范手术程序等处理；观察组仅给予一般围手术期处理。观察两组患者术后骨科并发症、HIV／AIDS并发症、骨折愈合情况及其治疗前后白细胞、血红蛋白和CD4^＋T淋巴细胞等变化进行比较分析，并分析总结围手术期处理方法。结果49例HIV阳性患者中四肢骨折36例（占73．46％），脊柱椎体压缩性骨折10例（20．41％），多发骨折3例（6．12％）。给予早期切开复位钢板螺钉内固定手术治疗的患者39例（占79．59％）；带锁髓内钉固定术治疗7例（14．29％）；脊柱骨折行切开复位减压植骨融合椎弓根钉内固定术10例（占20．41％）。经过特殊围手术期治疗方法，除1例患者伤口延迟愈合不良，其余全部患者伤口均一期愈合，无伤口感染。发生机会性感染1例，无骨感染，无术后死亡、无其他严重骨科并发症（如肺栓塞、骨不愈合或慢性骨髓炎等）。对照组患者术后仅3例切口延迟愈合，无切口感染、骨感染，无术后死亡及严重骨科并发症。治疗组（15例营养不良患者）予营养支持、免疫调节治疗前、后CD4^＋T淋巴细胞、血红蛋白等相比较差异具有统计学意义（P均〈0．05）。结论对HIV阳性闭合性骨折患者，通过合理术前评估、优化围手术期处理措及适当的手术方式可以显著减少并发症的发生，本组患者均取得良好的临床疗效。

The effect of perioperative management on HIV infected patients with fractures

Objective To investigate the postoperative complications of HIV infected patients with fractures by means of perioperative management. Methods From January 2010 to February 2014, a total of 49 HIV positive patients with closed fractures and 68 controls with HIV negative were admitted and treated with nails, pedicle screws and intramedullary nail fixation. HIV positive patients were treated with nutritional support, immunomodulatory drugs, highly active antiretroviral therapy, reasonable application of antibiotics and intraoperative standard procedures, while the patients in control group were given the general perioperative treatment. Fracture healing, complications, HIV/AIDS complications, white blood cell, hemoglobin and CD4＋ T lymphocytes pre- and post-operatively were observed, respectively. The managements were summarized. Results There were 36 （73.46%） cases among 49 cases were limb fractures, 30 （61.22%） cases were limb fractures, 10 （20.41%） cases were spinal vertebral compression fractures, 3 （6.12%） cases were multiple complex fractures. There were 39 （79.59%） cases received early open reduction and plate screw internal fixation operation, 10 （20.41%） cases of spinal fractures underwent open reduction and decompression, bone graft fusion and pedicle screw fixation. There were 7 （14.29%） cases received interlocking intramedullary nail fixation. Through optimal perioperative treatment, all the cases had primary healing except for one case of patients with delayed wound healing. There was no wound infection, opportunistic infection, bone infection, postoperative death, fatal HIV/AIDS related complications and severe complications （such as pulmonary embolism, nonunion, chronic osteomyelitis）. There were only 3 cases of delayed healing of incision. No wound infection, bone infection, operative mortality and severe complications was observed in control group. There was significant difference in Hb and CD4＋ T lymphocytes between perioperative and postoperation management （