Graham Simon Matthew, Maqungo Sithombo, Laubscher Maritz, Ferreira Nando, Held Michael, Harrison William James, Simpson A Hamish, MacPherson Peter, Lalloo David G
Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Liverpool Orthopaedic and Trauma Service, Liverpool University Teaching Hospital Trust, Liverpool, UK.
OTA Int. 2023 Mar 16;6(2):e251. doi: 10.1097/OI9.0000000000000251. eCollection 2023 Jun.
Human immunodeficiency virus (HIV) infection has been suggested to be associated with an increased risk of the development of nonunion after a fracture. This prospective matched case-control study in South Africa investigated common risk factors, including HIV status, that influence the development of a nonunion after a femur or tibia fracture.
Adult participants (cases) with established nonunions of the femur or tibia shaft were recruited over a 16-month period, between December 2017 and April 2019. They were matched for (1) age; (2) sex; (3) fracture site; and (4) fracture management type, with "control" participants who progressed to fracture union within 6 months of injury. All participants were tested for HIV. Multivariable logistic regression models were constructed to investigate associations between known risk factors for the development of nonunion and impaired fracture healing.
A total of 57 cases were matched with 57 "control" participants (44/57 male, 77.2% vs. 13/57 female, 22.8%, median age 36 years). HIV status was not associated with the development of nonunion after the management of tibia and femur fractures, on both univariate (odds ratio, 0.40; confidence interval, 0.10-1.32; = 0.151) or multivariable (odds ratio, 0.86; confidence interval, 0.18-3.73; = 0.831) analysis. No other confounding factors were shown to have any statistically significant impact on the odds of developing nonunion in this study cohort.
This study demonstrates that HIV does not seem to increase the risk of the development of nonunion and HIV-positive individuals who sustain a fracture can be managed in the same manner as those who are HIV negative.
有人提出，人类免疫缺陷病毒（HIV）感染与骨折后骨不连发生风险增加有关。这项在南非开展的前瞻性配对病例对照研究，调查了包括HIV感染状况在内的、影响股骨或胫骨骨折后骨不连发生的常见风险因素。
在2017年12月至2019年4月的16个月期间，招募了患有股骨或胫骨干已确诊骨不连的成年参与者（病例组）。将他们与在受伤后6个月内骨折愈合的“对照”参与者，按照（1）年龄；（2）性别；（3）骨折部位；以及（4）骨折治疗类型进行配对。对所有参与者进行HIV检测。构建多变量逻辑回归模型，以研究已知的骨不连发生风险因素与骨折愈合受损之间的关联。
共57例病例与57名“对照”参与者配对（44/57为男性，占77.2%，13/57为女性，占22.8%，中位年龄36岁）。在单变量分析（比值比，0.40；置信区间，0.10 - 1.32；P = 0.151）或多变量分析（比值比，0.86；置信区间，0.18 - 3.73；P = 0.831）中，HIV感染状况与胫骨干和股骨干骨折治疗后骨不连的发生均无关联。在本研究队列中，未发现其他混杂因素对骨不连发生几率有任何统计学上的显著影响。
本研究表明，HIV似乎不会增加骨不连发生风险，骨折的HIV阳性个体与HIV阴性个体可采用相同方式进行治疗。
