Institute of Population Health Data Science, University of Liverpool, Liverpool, United Kingdom.
Department of Orthopaedic and Trauma Surgery, Liverpool University Teaching Hospital Trust, Liverpool, United Kingdom.
J Acquir Immune Defic Syndr. 2021 Aug 15;87(5):1214-1220. doi: 10.1097/QAI.0000000000002720.
HIV reduces bone mineral density, mineralization, and turnover and may impair fracture healing.
This prospective cohort study in South Africa investigated whether HIV infection was associated with impaired fracture healing after trauma.
All adults with acute tibia and femur fractures who underwent intermedullary (IM) nailing for fracture fixation between September 2017 and December 2018, at 2 tertiary hospitals, were followed up for a minimum of 12 months postoperatively. The primary outcome was delayed bone union at 6 months (defined by the radiological union scoring system for the tibia score <9), and the secondary outcome was nonunion (defined as radiological union scoring system for the tibia score <9) at 9 months. Multivariable logistic regression models were constructed to investigate the associations between HIV status and impaired fracture healing.
In total, 358 participants, who underwent 395 IM nailings, were enrolled in the study and followed up for 12 months. Seventy-one of the 358 (19.8%) participants were HIV-positive [83/395 (21%) IM nailings]. HIV was not associated with delayed fracture healing after IM nailing of the tibia or femur (multivariable odds ratio: 1.06; 95% confidence interval: 0.50 to 2.22). HIV-positive participants had a statistically significant lower odds ratio of nonunion compared with HIV-negative participants (multivariable odds ratio: 0.17; 95% confidence interval: 0.01 to 0.92).
Fractures sustained in HIV-positive individuals can undergo surgical fixation as effectively as those in HIV-negative individuals, with no increased risk of delayed union or nonunion.
HIV 会降低骨密度、矿化和周转率，并可能影响骨折愈合。
本前瞻性队列研究在南非调查了 HIV 感染是否与创伤后骨折愈合受损有关。
2017 年 9 月至 2018 年 12 月，在 2 家 3 级医院接受髓内（IM）钉内固定治疗急性胫骨和股骨骨折的所有成年人，术后至少随访 12 个月。主要结局为 6 个月时延迟骨愈合（定义为胫骨放射学愈合评分系统<9），次要结局为 9 个月时非愈合（定义为胫骨放射学愈合评分系统<9）。构建多变量逻辑回归模型，以研究 HIV 状态与骨折愈合受损之间的关系。
共有 358 名参与者（395 例接受 IM 钉内固定）入组并随访 12 个月。358 名参与者中有 71 名（19.8%）为 HIV 阳性[395 例 IM 钉内固定中 83 例（21%）]。HIV 与胫骨或股骨 IM 钉内固定后延迟骨折愈合无关（多变量比值比：1.06；95%置信区间：0.50 至 2.22）。与 HIV 阴性参与者相比，HIV 阳性参与者的非愈合比值比有统计学意义降低（多变量比值比：0.17；95%置信区间：0.01 至 0.92）。
HIV 阳性个体发生的骨折可以像 HIV 阴性个体一样有效地接受手术固定，不会增加延迟愈合或不愈合的风险。
