Ramanath Sharath Kittanakere, Shah Rahul Hemant
Department of Orthopaedics, Ramaiah Medical College & Hospitals, Bengaluru, Karnataka, India.
J Orthop Case Rep. 2018 Sep-Oct;8(5):75-77. doi: 10.13107/jocr.2250-0685.1220.
Antiretroviral drugs are known to cause osteoporosis making the bones susceptible to fracture. Osteoporotic fractures are majorly seen in the vertebral bodies. Pathological fractures need to be fixed without much delay to start mobilization of the patients.
The present case describes a 72-year-old male who was diagnosed to be human immunodeficiency virus-positive 11 months back for which the patient was on a combination of antiretroviral therapy for 11 months. The patient was a farmer by occupation. The patient presented to us with left sided hip pain for1 week with no history of trauma or fall. The patient was able to walk approximately 100m with the help of a height adjustable walker. However, activities such as squatting and sitting cross-legged were restricted for1 week. Radiographic examination revealed a fracture of the left neck of the femur. The patient was evaluated for metastasis the investigations for which were negative. Bipolar hemiarthroplasty of the hip was done since radiographically and intraoperatively no changes were noted in the acetabulum which would have changed the plan to total hip replacement. Following the surgery, patient started walking full-weight bearing from the very next day after surgery.
This case concludes the potential of antiretroviral drugs such as abacavir, lamivudine and efavirenz to cause pathological fractures which has never been described in literature before.
已知抗逆转录病毒药物会导致骨质疏松，使骨骼易发生骨折。骨质疏松性骨折主要见于椎体。病理性骨折需要尽快固定，以便患者开始活动。
本病例描述了一名72岁男性，11个月前被诊断为人类免疫缺陷病毒阳性，为此患者接受了11个月的抗逆转录病毒联合治疗。患者职业为农民。患者因左侧髋部疼痛1周前来就诊，无外伤或跌倒史。患者借助可调节高度的助行器能够行走约100米。然而，诸如蹲坐和盘腿坐之类的活动受限1周。影像学检查显示左股骨颈骨折。对患者进行了转移检查，结果为阴性。由于影像学和术中检查发现髋臼无变化，不会改变全髋关节置换计划，因此对该患者实施了双极半髋关节置换术。术后第二天，患者即开始完全负重行走。
本病例证实了阿巴卡韦、拉米夫定和依非韦伦等抗逆转录病毒药物导致病理性骨折的可能性，这在以前的文献中从未有过描述。
