Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
Clin Orthop Surg. 2010 Mar;2(1):22-7. doi: 10.4055/cios.2010.2.1.22. Epub 2010 Feb 4.
The number of human immunodeficiency virus (HIV)-infected patients is increasing constantly, and it is well known that there is a significantly high prevalence of osteonecrosis of the femoral head in HIV-infected patients. Therefore, it is important to develop methods that can ensure the safety of both the patients and medical personnel who participate in surgery on HIV-infected patients. Recently, the authors performed 8 procedures on 5 HIV-infected patients. This paper reports our experience.
This study examined the medical records and radiological studies of 5 HIV-infected patients who had undergone surgery around the hip joint from January, 2005 to September, 2007. During the procedures, their mean age was 38.6 years (range, 23 to 53 years) and all were male. Four of them were under an anti-retroviral therapy program. The reasons for the operations were nonunion of the femoral shaft after trauma in two patients and osteonecrosis of both femoral heads in three. One autologous bone grafting, one screw fixation with autologous bone grafting, five total hip replacement arthroplasties, and one multiple drilling were performed. All procedures were carried out according to the guidelines of HIV infection control made by the Korea Centers for Disease Control and Prevention. The mean follow-up period was 16.6 months (range, 4 to 37 months).
The preoperative CD4 count was 130 in one patient, and 200 to 499 in the other 4. The viral loads were 15100 and 420 in two patients, and negative in the other 3. Bony union was achieved in those who had undergone autologous bone grafting. There were significant improvements in both the Harris Hip Score and functional state in those who had total hip replacement arthroplasty. There were no immediate postoperative complications, such as infection. During the follow-up period, one patient died from esophageal variceal bleeding. However, no surgery-related complications were observed in the other 4 patients.
There were no significant complications in HIV-infected patients after the operations around the hip joint when their preoperative immunity was optimal. In addition, the safety of medical personnel can be assured when the operation is performed in line with the guidelines of HIV infection control.
感染人类免疫缺陷病毒（HIV）的患者人数不断增加，众所周知，HIV 感染者中股骨头坏死的患病率明显较高。因此，开发既能保证患者安全又能保证参与 HIV 感染者手术的医务人员安全的方法非常重要。最近，作者对 5 例 HIV 感染患者进行了 8 例髋关节周围手术。本文报告了我们的经验。
本研究回顾性分析了 2005 年 1 月至 2007 年 9 月 5 例 HIV 感染患者髋关节周围手术的病历和影像学资料。手术时，患者平均年龄 38.6 岁（范围 23-53 岁），均为男性。其中 4 例接受抗逆转录病毒治疗。手术原因包括 2 例创伤后股骨干骨折不愈合，3 例股骨头坏死。其中 1 例行自体骨移植，1 例行自体骨移植加螺钉固定，5 例行全髋关节置换术，1 例行多处钻孔。所有手术均按照韩国疾病控制和预防中心制定的 HIV 感染控制指南进行。平均随访时间为 16.6 个月（4-37 个月）。
1 例患者术前 CD4 计数为 130，另 4 例患者为 200-499。2 例患者病毒载量为 15100 和 420，3 例患者病毒载量为阴性。自体骨移植患者获得骨愈合。全髋关节置换术患者的 Harris 髋关节评分和功能状态均有显著改善。术后无感染等即刻并发症。随访期间，1 例患者因食管胃底静脉曲张出血死亡。然而，其他 4 例患者均无手术相关并发症。
当 HIV 感染者术前免疫功能最佳时，髋关节周围手术后无明显并发症。此外，当手术符合 HIV 感染控制指南时，可以保证医务人员的安全。
