Mersey Deanery Orthopaedic Training Programme, Orthopaedic Department, Royal Liverpool University Hospital, Prescot Street, L7 8XP Liverpool, UK.
Bone Joint J. 2013 Dec;95-B(12):1703-7. doi: 10.1302/0301-620X.95B12.32083.
We compared early post-operative rates of wound infection in HIV-positive and -negative patients presenting with open tibial fractures managed with surgical fixation. The wounds of 84 patients (85 fractures), 28 of whom were HIV positive and 56 were HIV negative, were assessed for signs of infection using the ASEPIS wound score. There were 19 women and 65 men with a mean age of 34.8 years. A total of 57 fractures (17 HIV-positive, 40 HIV-negative) treated with external fixation were also assessed using the Checkett score for pin-site infection. The remaining 28 fractures were treated with internal fixation. No significant difference in early post-operative wound infection between the two groups of patients was found (10.7% (n = 3) vs 19.6% (n = 11); relative risk (RR) 0.55 (95% confidence interval (CI) 0.17 to 1.8); p = 0.32). There was also no significant difference in pin-site infection rates (17.6% (n = 3) vs 12.5% (n = 5); RR 1.62 (95% CI 0.44 to 6.07); p = 0.47). The study does not support the hypothesis that HIV significantly increases the rate of early wound or pin-site infection in open tibial fractures. We would therefore suggest that a patient's HIV status should not alter the management of open tibial fractures in patients who have a CD4 count > 350 cells/μl.
我们比较了接受手术固定治疗的开放性胫骨骨折的 HIV 阳性和阴性患者的术后早期伤口感染率。使用 ASEPIS 伤口评分评估了 84 名患者（85 处骨折）的伤口是否有感染迹象，其中 28 名 HIV 阳性，56 名 HIV 阴性。共有 19 名女性和 65 名男性，平均年龄为 34.8 岁。还使用 Checkett 针道感染评分评估了 57 处（17 处 HIV 阳性，40 处 HIV 阴性）接受外固定治疗的骨折。其余 28 处骨折采用内固定治疗。两组患者的术后早期伤口感染率无显著差异（10.7%（n=3）与 19.6%（n=11）；相对风险（RR）0.55（95%置信区间（CI）0.17 至 1.8）；p=0.32）。针道感染率也无显著差异（17.6%（n=3）与 12.5%（n=5）；RR 1.62（95%CI 0.44 至 6.07）；p=0.47）。本研究不支持 HIV 显著增加开放性胫骨骨折早期伤口或针道感染率的假设。因此，我们建议，对于 CD4 计数>350 个/μl 的患者，HIV 状态不应改变开放性胫骨骨折的治疗方案。
