生物型人工全髋关节置换术治疗HIV感染者股骨头缺血性坏死

Treatment of avascular necrosis of femoral head in patients with human immunodeficiency virus infection by cementless total hip arthroplasty

目的探讨采用生物型人工全髋关节置换术治疗HIV感染者股骨头缺血性坏死的疗效。方法回顾分析2014年2月—2017年1月,采用生物型人工全髋关节置换术治疗的22例(35髋)股骨头缺血性坏死的HIV感染者(阳性组)临床资料,以同期治疗的33例(43髋)未感染HIV患者(阴性组)作为对照。阳性组患者年龄、性别、双侧股骨头缺血性坏死发生率以及股骨头缺血性坏死病程比较,差异均有统计学意义(P<0.05);股骨头缺血性坏死分期比较,差异无统计学意义(P>0.05)。记录两组患者手术时间、术中出血量、输血率、术后并发症及住院时间。随访期间髋关节功能采用Harris评分评价,复查髋关节正侧位X线片观察假体位置。结果阳性组随访时间13～24个月,平均20.2个月;阴性组为14～25个月,平均21.6个月。阴性组手术时间较阳性组明显缩短(t=3.677,P=0.001);但两组术中出血量、输血率及住院时间比较,差异无统计学意义(P>0.05)。两组患者术前及术后1、3、6、12个月Harris评分比较,差异均无统计学意义(P>0.05)。阳性组术中及术后均未发生职业暴露,住院期间出现切口浅表感染2例、肺部感染1例;阴性组出现切口浅表感染1例、下肢静脉血栓形成1例,均经对症处理后痊愈。两组随访期间无患者死亡,未出现假体松动、下沉。结论生物型人工全髋关节置换术是一种治疗HIV感染者股骨头缺血性坏死的安全、有效方法。

Objective To investigate the effectiveness of cementless total hip arthroplasty (THA) in treatment ofavascular necrosis of the femoral head (ANFH) in patients with human immunodeficiency virus (HIV) infection.Methods The clinical data of 22 patients (35 hips) with HIV infection and ANFH (positive group), who were treatedwith cementless THA between February 2014 and January 2017, was retrospectively analyzed. Tirty-three cases (43 hips)without HIV infection, who were treated with cementless THA during the same period, were collected as control (negativegroup). There were significant differences in the age, gender, incidence of bilateral ANFH, and disease duration between2 groups (P<0.05). There was no significant difference in the Ficat stage of ANFH between 2 groups (P>0.05). Theoperation time, intraoperative blood loss, rate of blood transfusion, postoperative complications, and hospitalization timewere recorded. The hip joint function was evaluated by Harris score and X-ray film was performed to observe the positionof the prosthesis. Results The follow-up time was 13-24 months (mean, 20.2 months) in positive group and 14-25months (mean, 21.6 months) in negative group. The operation time of negative group was significantly shorter than thatof positive group (t=3.677, P=0.001). However, there was no significant difference in intraoperative blood loss, rate ofblood transfusion, and hospitalization time between 2 groups (P>0.05). There was no significant difference in Harris scorebetween 2 groups before operation and at 1, 3, 6, and 12 months after operation (P>0.05). There were 2 cases of superficialinfection of incision and 1 case of pulmonary infection during hospitalization in positive group, and 1 case of superficialinfection of incision and 1 case of venous thrombosis of lower extremity in negative group. No death or loosening andsinking of the prosthesis occurred in both groups during follow-up. Conclusion Cementless THA is a safe and effectivemethod for ANFH in patients with HIV infection.