CAJ | 학술논문

目的探讨围手术期辅助治疗措施对骨科人类免疫缺陷病毒(HIV)阳性患者术后伤口愈合的影响.方法 2010年1月至2014年1月,首都医科大学附属北京地坛医院骨科共收集471例骨科手术患者(HIV阳性79例,HIV阴性392例),在48个月内,根据入选标准和排除标准并结合CD4+T淋巴细胞计数,对骨科需手术治疗的患者分为:A组(HIV阳性,CD4＜ 500/ml);B组(HIV阳性,CD4≥ 500/ml);C组(HIV阴性).A组患者给予高效抗逆转录病毒治疗、围手术期合理应用抗生素以及营养支持、调节免疫药物治疗等优化处理措施;B和C组均仅术前给予常规预防性抗生素治疗,分别观察术后伤口愈合情况,比较3组患者伤口感染率.结果包括四肢骨折364例(77.3％),脊柱椎体骨折和腰椎间盘退变性疾患58例(12.3％),13例骨折畸形愈合患者(2.8％),股骨头无菌性坏死患者15例(3.2％)和膝关节骨关节炎患者21例(4.5％).其中给予切开复位钢板螺钉内固定术患者A组23例、B组21例、C组274例,腰椎间融合内固定术患者A组5例、B组6例、C组47例,关节置换术患者A组3例、B组4例、C组8例,带锁髓内钉固定术患者A组7例、B组4例、C组35例,其他手术类型(如皮瓣游离、截骨术等)患者A组3例、B组3例、C组28例.术后伤口感染患者:A组2例(4.9％),B组3例(5.3％)和C组26例(6.6％).3组术后感染率差异无统计学意义(P＞0.05).结论对HIV阳性需骨科手术治疗患者,给予合理规范的围手术期辅助治疗措施(HAART、延长围手术期预防性抗生素以及营养支持、调节免疫药物治疗、严格无菌操作等)可使术后伤口感染接近正常人发生率,提高手术安全性.
목적 탐토위수술기보조치료조시대골과인류면역결함병독(HIV)양성환자술후상구유합적영향.방법 2010년1월지2014년1월,수도의과대학부속북경지단의원골과공수집471례골과수술환자(HIV양성79례,HIV음성392례),재48개월내,근거입선표준화배제표준병결합CD4+T림파세포계수,대골과수수술치료적환자분위:A조(HIV양성,CD4＜ 500/ml);B조(HIV양성,CD4≥ 500/ml);C조(HIV음성).A조환자급여고효항역전록병독치료、위수술기합리응용항생소이급영양지지、조절면역약물치료등우화처리조시;B화C조균부술전급여상규예방성항생소치료,분별관찰술후상구유합정황,비교3조환자상구감염솔.결과 포괄사지골절364례(77.3％),척주추체골절화요추간반퇴변성질환58례(12.3％),13례골절기형유합환자(2.8％),고골두무균성배사환자15례(3.2％)화슬관절골관절염환자21례(4.5％).기중급여절개복위강판라정내고정술환자A조23례、B조21례、C조274례,요추간융합내고정술환자A조5례、B조6례、C조47례,관절치환술환자A조3례、B조4례、C조8례,대쇄수내정고정술환자A조7례、B조4례、C조35례,기타수술류형(여피판유리、절골술등)환자A조3례、B조3례、C조28례.술후상구감염환자:A조2례(4.9％),B조3례(5.3％)화C조26례(6.6％).3조술후감염솔차이무통계학의의(P＞0.05).결론 대HIV양성수골과수술치료환자,급여합리규범적위수술기보조치료조시(HAART、연장위수술기예방성항생소이급영양지지、조절면역약물치료、엄격무균조작등)가사술후상구감염접근정상인발생솔,제고수술안전성.
Objective To observe the early wound healing of orthopedic surgery in human immunodeficiency virus (HIV) carrier patients treated with optimized auxiliary treatments.Methods During a period of 48 months,according to the inclusion and exclusion criteria plus CD4 +T lymphocyte count,the patients scheduled for orthopedic surgery (including HIV positive and negative) were divided into group A (HIV positive,CD4 ＜ 500/ml) with optimized auxiliary treatments,group B (HIV positive,CD4≥500/ml) and group C (HIV negative) on prophylactic antibiotic therapy alone.Wound healing of 3 groups were observed postoperatively.The rates of clinical wound infection were compared among 3 groups.Results A total of 471 cases (n =79,HIV + ; n =392,HIV-) were selected due to fresh fracture (n =544,77.28％),fracture of spine (n =57,12.31％),mal-union (n =13,2.76％),aseptic necrosis (n =15,3.18％) and osteoarthritis (n =21,4.46％).During surgery,early open reduction and plate screw internal fixation (group A,n =23; group B,n =21 ; group C,n =274) ; pedicle screw internal fixation (group A,n =5 ; group B,n =6 ; group C,n =47) ; total joint replacement (group A,n =3 ;group B,n =4 ; group C,n =8) ; interlocking intramedullary nail fixation (group A,n =7 ; group B,n =4; groupC,n=35) and other operations (group A,n=3; group B,n=3; group C,n =28).For infections,2 cases (4.88％) were observed in group A,3 (5.26％) in group B and 26 (6.63％) in group C.The differences were statistically insignificant.Conclusion Reasonable perioperative adjuvant treatments,including use of antibiotic,nutritional supports,immunomodulators and anti-retroviral drugs,are offered to HIV infected patients undergoing orthopedic surgery.Their risks of postoperative wound infection may be controlled.