HIV阳性骨折患者手术切口愈合情况的临床分析

Healing status of surgical incisions in human immunodeficiency virus-positive patients with fractures

目的 观察人类免疫缺陷病毒（HIV）阳性骨折患者手术切口愈合的情况,探讨切口愈合不良的相关因素、处理及预防措施.方法 回顾性分析2010年6月至2013年10月在首都医科大学附属北京地坛医院骨科治疗的61例HIV阳性骨折患者的临床资料,统计分析切口愈合不良（红肿、渗出、裂开、感染、血肿、脂肪液化等）发生率、影响因素、治疗及结果.结果 61例HIV阳性骨折患者中手术切口愈合良好50例,愈合不良者11例,其中红肿10例,渗出8例,裂开3例,感染2例,血肿1例,脂肪液化2例,延迟愈合2例.给予相应处理后均愈合良好,随访无远期感染及死亡.HIV阳性和HIV阴性患者的切口感染率的差异无统计学意义（2/61比1/60,P＞0.05）,愈合不良率的差异有统计学意义（11/61比5/60,P＜0.05）.其中,切口愈合不良的危险因素包括：年龄大、体质指数低、血清白蛋白低、血红蛋白低、总淋巴细胞计数低、CD4＋T淋巴细胞计数低、HIV感染临床分期高、手术时间长、急诊手术和切口污染.结论 HIV阳性骨折患者大多数手术切口愈合良好,少数切口愈合不良.切口愈合不良是多种因素作用的结果,如果早期发现这些问题并给予及时而恰当的治疗,切口均能良好愈合.

Objective To observe the healing status of surgical incisions in human immunodeficiency virus （HIV）-positive patients with fractures and explore the factors related with poor wound healing,treatment and preventive measures.Methods Retrospective analyses were performed for the clinical data of 61 HIV-positive patients with fractures.And the influencing factors,treatment and outcomes of poor wound healing were analyzed.Results Among them,the healing status was good （n =50） and poor （n =11）.And the outcomes included redness （n =10）,oozing （n=8）,split （n =3）,infection （n =2）,hematoma （n =1）,fat liquefaction （n =2） and delayed healing （n =2）.All healed well after treatment.There was no infection or death during the follow-up period.Compared with HIV-negative patients,it was not statistically significant in wound infection.However,poor healing rates were significantly different （P ＜ 0.05）.The risk factors included advanced age,low body mass index,low albumin,low hemoglobin,low total lymphocyte count,low CD4 ＋ T lymphocyte count,high HIV infection clinical stage,long operative duration,emergency surgery and incision contamination.Conclusion In HIV-positive patients with fractures,the healing of surgical incision is generally good.However few have poor wound healing due to multiple factors.If poor healing is identified early and handled timely and correctly,good healing ensues.