CAJ | 학술논문

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。
목적：탐토응용위수술기처리대HIV양성골절환자술후병발증적영향。방법2010년1월도2014년2월，본연구수집49례골과HIV양성합병폐합성골절환자（치료조）급68례HIV음성폐합성골절환자（대조조）적림상자료，량조환자균급여강판라정、수내정혹추궁근정내고정；치료조통과위수술기응용영양지지、면역조절약물、고효항역전록병독치료、합리응용항균약물이급술중정세조작규범수술정서등처리；관찰조부급여일반위수술기처리。관찰량조환자술후골과병발증、HIV/AIDS병발증、골절유합정황급기치료전후백세포、혈홍단백화CD4+T림파세포등변화진행비교분석，병분석총결위수술기처리방법。결과49례HIV양성환자중사지골절36례（점73.46%），척주추체압축성골절10례（20.41%），다발골절3례（6.12%）。급여조기절개복위강판라정내고정수술치료적환자39례（점79.59%）；대쇄수내정고정술치료7례（14.29%）；척주골절행절개복위감압식골융합추궁근정내고정술10례（점20.41%）。경과특수위수술기치료방법，제1례환자상구연지유합불량，기여전부환자상구균일기유합，무상구감염。발생궤회성감염1례，무골감염，무술후사망、무기타엄중골과병발증（여폐전새、골불유합혹만성골수염등）。대조조환자술후부3례절구연지유합，무절구감염、골감염，무술후사망급엄중골과병발증。치료조（15례영양불량환자）여영양지지、면역조절치료전、후CD4+T림파세포、혈홍단백등상비교차이구유통계학의의（P균＜0.05）。결론대HIV양성폐합성골절환자，통과합리술전평고、우화위수술기처리조급괄당적수술방식가이현저감소병발증적발생，본조환자균취득량호적림상료효。
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 ifxation. 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 ifxation operation, 10 (20.41%) cases of spinal fractures underwent open reduction and decompression, bone graft fusion and pedicle screw ifxation. There were 7 (14.29%) cases received interlocking intramedullary nail ifxation. 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 (P all<0.05). Conclusions Through reasonable preoperative evaluation, optimal perioperative treatment and appropriate operation method could signiifcantly reduce the occurrence of complications and obtain good clinical curative effect of HIV positive patients with closed fracture.