微创医学

目的探讨成年HIV/AIDS患者行全髋关节置换术（THA）的临床特征和近期治疗效果。方法回顾病历，总结分析年龄≥18岁且行THA的HIV/AIDS患者的围术期临床数据及预后。结果共31例患者接受了38例次THA，均选择外侧或后外侧入路通过非骨水泥型髋关节假体进行手术。手术中位时间为173 min，术中出血量中位数为800 mL，引流管留置中位时间为6 d，抗生素使用中位时间为7 d，术后并发肺部感染患者的抗生素中位使用时间为15 d，住院中位时间为24 d。与术前相比，术后第1天CD4+T淋巴细胞计数降低（P＜0.05），而术后第7天的CD4+T淋巴细胞计数差异无统计学意义（P＞0.05）。术后第12周，患者的Harris髋关节评分较术前高，而VAS评分较术前低（均P＜0.05）。切口甲级愈合35例次、乙级愈合3例次。术后并发肺部感染18例（1例病情加重后死亡），贫血14例，低白蛋白血症16例，电解质紊乱13例，肝功能损害6例，下肢静脉血栓3例，脱位3例。术后第12周返院复查，未发现假体周围感染或松动，失访4例。结论成年HIV/AIDS患者行THA治疗的近期效果良好，且手术可造成CD4+T淋巴细胞水平暂时性下降，但术后并发症发生风险较高，尤其是肺部感染，对成年HIV/AIDS患者行THA应严格把握手术指征，个体化选择手术方案。

ObjectiveTo investigate the clinical characteristics and short-term therapeutic effect of total hip arthroplasty (THA) in adult patients with HIV/AIDS. MethodsThe medical records were reviewed, and the perioperative clinical data and prognosis of HIV/AIDS patients aged ≥18 years who underwent THA were summarized and analyzed. ResultsA total of 31 patients underwent 38 times of THA with cementless hip prostheses via lateral or posterolateral approach. The median operation time was 173 minutes, the median intraoperative blood loss was 800 mL, the median indwelling time of drainage tube was 6 days, the median antibiotic use time was 7 days, the median antibiotic use time of patients complicated with postoperative pulmonary infection was 15 days, and the median hospitalization time was 24 days. Compared with before operation, CD4+ T lymphocyte counts decreased on the first day after operation (P＜0.05), while there was no statistically significant difference in CD4+ T lymphocyte counts on the 7th day after operation (P＞0.05). After 12 weeks of operation, the Harris hip score was higher, while the VAS score was lower as compared with before operation (all P＜0.05). Thirty-five cases had grade A wound healing and three cases had grade B wound healing. There were 18 cases complicated with postoperative pulmonary infection (1 case died after aggravation), 14 cases with anemia, 16 cases with hypoalbuminemia, 13 cases with electrolyte disturbance, 6 cases with liver function impairment, 3 cases with venous thrombosis of lower extremity and 3 cases with dislocation. When reexamination in hospital was conducted on the 12th week after operation, no infection or loosening around the prosthesis was found, whereas 4 patients were lost to follow-up. ConclusionThe short-term effect of THA in treating adult patients with HIV/AIDS is good, and the operation can cause the temporary decrease of CD4+ T cells levels; however, the risk of postoperative complications is high, especially the pulmonary infection. THA on adult patients with HIV/AIDS should strictly grasp the surgical indications and select the surgical scheme individually.