AIDS患者股骨颈骨折关节置换的围手术期治疗

Perioperative Treatment of Femoral Neck Fracture Joint Replacement in AIDS Patients

目的研究正在高效联合抗反转录病毒治疗(highly active antiretroviral therapy,HAART)治疗AIDS患者因不同因素引起的股骨颈骨折人工髋关节置换手术治疗效果及并发症分析,为AIDS患者股骨颈骨折手术治疗的术前评估、手术治疗效果及并发症的预防提供可靠的参考依据。方法分析2015年6月—2019年6月期间河南省传染病医院收治的正在HAART治疗152例因不同因素(摔倒跌伤、交通事故伤、高处坠落伤、非暴力伤)引起的股骨颈骨折AIDS患者,进行人工全髋关节置换术治疗,观察术后关节活动功能及并发症发生情况,回顾性分析所有患者的随访资料。结果入组AIDS患者共152例,均采取围手术期规范化处理,均采取标准的人工全髋关节置换术。术后随访平均12个月,术后离床活动时间平均为(2±1.5)天,优良率97.4%。无关节假体松动及断裂出现,未发现症状性静脉血栓发生,97例患者出现围手术期血红蛋白(Hb)与出血量、输血量等预算明显不一致,称之为不对称性贫血,21例出现低蛋白血症及电解质紊乱,出现3例血培养均为大肠埃希氏菌菌血症,3例出现肺部感染(1例为流感嗜血杆菌、2例为肺炎克雷伯杆菌),而无切口感染,依据临床经验和药物敏感性试验,给予敏感抗菌药物抗感染治疗,均得到完全治愈,所有患者术后疼痛迅速消失,关节功能迅速恢复,均恢复正常的日常生活及工作。结论AIDS患者股骨颈骨折人工全髋关节置换手术治疗取得满意的疗效,安全有效,重视和加强AIDS患者骨科围手术期处理,积极采取有效措施,使患者机体内环境接近正常状态,降低围手术期严重并发症,才能保障AIDS患者围手术期安全。

Objective To study the effect and complication analysis of hip arthroplasty for femoral neck fracture caused by different factors in HAART treatment of AIDS patients,so as to provide a reliable reference for the preoperative evaluation of femoral neck fracture treatment,the effect of surgical treatment and the prevention of complications in AIDS patients.Methods in June 2015-June 2019 are HAART infectious disease hospitals in henan province during the period of treatment of 152 cases with different factors(fall falls,traffic accident injury,high falling injury,non-violent)in patients with femoral neck fracture caused by AIDS,artificial total hip replacement therapy,by the same physician butcher,24 to 48 hours after patients from the bed,1,3,6 and 12 months after review,observe the joint activity function and postoperative complications.Follow-up data of all patients were retrospectively analyzed.Results A total of 152 patients were treated with HAART for AIDS,all of whom were treated with standardized perioperative management and standard total hip replacement.The average postoperative follow-up was 12 months,and the average postoperative out-of-bed activity time was(2±1.5)days,with an excellent and good rate of 97.4%.No symptomatic venous thrombosis was found,and no incision infection and AIDS infection-related complications were found.97 patients had perioperative hemoglobin(Hb)that was significantly inconsistent with the blood loss volume and blood transfusion budget,which was called asymmetric anemia.21 patients had hypoproteinemia and electrolyte imbalances.3 cases had blood cultures of Escherichia coli bacteremia,and 3 cases had lung infection(1 case was Haemophilus influenzae and 2 cases were Klebsiella pneumoniae),but there was no incision infection,according to clinical practice.Empirical and drug susceptibility tests,and anti-infective therapy with sensitive antimicrobial drugs,were completely cured.Postoperative pain of all patients disappeared rapidly,joint function recovered rapidly,and normal daily life and work were resumed.Conclusion Total hip arthroplasty for patients with AIDS combined with femoral neck fracture is safe and effective.Appropriate joint prosthesis should be selected according to the patients'own conditions,standardized surgical procedures,strict aseptic operation,satisfactory efficacy,fewer complications,and total hip arthroplasty.