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中华实验和临床感染病杂志(电子版) ›› 2023, Vol. 17 ›› Issue (06) : 423 -430. doi: 10.3877/cma.j.issn.1674-1358.2023.06.011

论著

人类免疫缺陷病毒感染者限期骨折内植物手术并发症的影响因素
叶俊杰1, 胡波涌1,()   
  1. 1. 510440 广州市,广州医科大学附属市八医院骨科
  • 收稿日期:2023-05-29 出版日期:2023-12-15
  • 通信作者: 胡波涌
  • 基金资助:
    广州市卫生健康科技项目(No. 20211A011042)

Influencing factors of complications of implant surgery for fractures within the limited timeframe of patients with human immunodeficiency virus infection

Junjie Ye1, Boyong Hu1,()   

  1. 1. Department of Orthopedics, The Eighth Affiliated Hospital of Guangzhou Medical University, Guangzhou 510440, China
  • Received:2023-05-29 Published:2023-12-15
  • Corresponding author: Boyong Hu
引用本文:

叶俊杰, 胡波涌. 人类免疫缺陷病毒感染者限期骨折内植物手术并发症的影响因素[J/OL]. 中华实验和临床感染病杂志(电子版), 2023, 17(06): 423-430.

Junjie Ye, Boyong Hu. Influencing factors of complications of implant surgery for fractures within the limited timeframe of patients with human immunodeficiency virus infection[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2023, 17(06): 423-430.

目的

探讨人类免疫缺陷病毒(HIV)感染者在围手术期内规范抗病毒治疗,接受限期骨折内植物手术后发生近、远期并发症的影响因素。

方法

选取2018年6月至2021年6月于广州医科大学附属市八医院术前确诊的60例HIV感染者,根据术后有无并发症分为有并发症组和无并发症组。收集围手术期患者基本资料与术后并发症资料。应用二元Logistic回归分析HIV感染者限期骨折内植物手术并发症发生的影响因素;进一步将所筛选出的高危影响因素在发生近期并发症和远期并发症患者中进行比较。

结果

60例HIV感染者术后无并发症组45例,有并发症组15例,其中发生近期并发症12例,远期并发症6例,其中3例近期、远期并发症均有发生。入组患者术前平均CD4+ T淋巴细胞为301.5(158,424)个/μl,术前平均HIV载量为51 405.5(100,42 925)IU/ml;其中术前CD4+ T淋巴细胞≤ 200个/μl患者23例(38.33%),> 200个/μl患者37例(61.67%)。有并发症组和无并发症组患者的骨折部位(χ2 = 7.214、P = 0.027)和手术方式(χ2 = 20.123、P < 0.001)差异均有统计学意义。二元Logistic回归分析显示性别、年龄、骨折部位、ART时间、手术时间、出血量、内植物类型、术前CD4+ T淋巴细胞、术前HIV载量、术前CD4+ T淋巴细胞分组均非HIV感染者限期骨折内植物手术并发症的影响因素(P均> 0.05),而不同手术方式为术后发生并发症的影响因素(常规切口:OR = 0.003、95%CI:0.000~0.133、P = 0.003,扩大切口:OR = 0.086、95%CI:0.008~0.951、P = 0.045)。不同手术方式患者发生近期并发症(χ2 = 11.968、P = 0.003)和远期并发症(χ2 = 8.611、P = 0.013)差异均有统计学意义;近期并发症组患者中微创切口与常规切口(χ2 = 4.866、P = 0.027)、扩大切口(χ2 = 13.067、P < 0.001)的手术方式差异均有统计学意义;远期并发症组患者中微创切口与扩大切口的手术方式差异有统计学意义(χ2 = 9.818、P = 0.002)。

结论

术前高HIV载量与CD4+ T淋巴细胞≤ 200个/μl并非HIV感染者接受Ⅰ类切口限期内植物骨折手术的禁忌证,选择创伤小的手术方式患者的术后并发症发生率更低。

Objective

To investigate on the influencing factors for the occurrence of short-term and long-term complications of human immunodeficiency virus (HIV) infected patients who undergoing implant surgery for fractures within the limited timeframe under standardized antiviral therapy during the perioperative period.

Methods

Total of 60 HIV infected patients who were diagnosed preoperative in the Eighth Affiliated Hospital of Guangzhou Medical University from June 2018 to June 2021 were selected. Based on the occurrence of postoperative complications, 60 patients were divided into group with complications and group without complications. Basic data of patients and data of perioperative complications were collected, respectively. The influencing factors of complications of implant surgery for fractures within the limited timeframe in HIV infected patients were investigated by binary Logistic regression analysis; the screened high-risk influencing factors between patients with short-term and long-term complications were compared furtherly.

Results

Among the 60 patients, there were 45 cases in non-complication group and 15 cases in group with complications; there were 12 cases had short-term complications and 6 cases had long-term complications, among whom 3 cases had both short-term and long-term complications. The average preoperative CD4+ T lymphocyte count of the enrolled patients was 301.5 (158, 424) cells/μl; the average preoperative HIV load was 51 405.5 (100, 429 25) IU/ml, and there were 23 (38.33%) cases with preoperative CD4+ T lymphocyte count ≤ 200 cells/μl, 37 cases (61.67%) with preoperative CD4+ T lymphocyte count > 200 cells/μl. The fracture site (χ2 = 7.214, P = 0.027) and surgical method (χ2 = 20.123, P < 0.001) between patients in two groups were both with significant differences. The binary Logistic regression analysis showed that gender, age, fracture site, ART time, surgical time, bleeding volume, implant type, preoperative CD4+ T lymphocytes, preoperative HIV load and preoperative CD4+ T lymphocyte grouping were not influencing factors for complications of implant surgery for fractures within the limited timeframe in HIV infected patients (all P > 0.05), but different surgical methods were the influencing factor for postoperative complications (conventional incision: OR = 0.003, 95%CI: 0.000-0.133, P = 0.003; expanded incision: OR = 0.086, 95%CI: 0.008-0.951, P = 0.045). The occurrence of short-term complications (χ2 = 11.968, P = 0.003) and long-term complications (χ2 = 8.611, P = 0.013) among patients with different surgical methods were with significant differences. The surgical methods between minimally invasive and conventional incisions (χ2 = 13.067, P < 0.001), as well as minimally invasive and enlarged incisions (χ2 = 4.866, P = 0.027) were statistically significant in patients with short-term complications; the surgical methods between minimally invasive and expanded incisions were statistically significant in patients with long-term complication (χ2 = 9.818, P = 0.002).

Conclusions

Preoperative HIV high load and CD4+ T lymphocytes ≤ 200 cells/μl were not a contraindication for patients with HIV infection undergoing implant surgery for fractures within the limited timeframe through class Ⅰincision. The surgical procedure with minimally invasive incision had a lower incidence of postoperative complications.

表1 入组60例患者围手术期的基本资料
表2 入组患者近期和远期并发症分布
表3 有并发症组和无并发症组患者的临床资料
临床资料 有并发症组(15例) 无并发症组(45例) 统计量 P
性别[例(%)]     χ2 = 0.247 0.619
14(93.33) 40(88.89)    
1(6.67) 5(11.11)    
年龄( ± s,岁) 51.64 ± 14.63 50.60 ± 10.60 t = 0.299 0.767
ART治疗[例(%)]     χ2 = 0.096 0.757
5(33.33) 17(37.78)    
10(66.67) 28(62.22)    
ART时间[例(%)]     χ2 = 0.105 0.949
5(33.33) 17(37.78)    
≤ 1年 2(13.33) 6(13.33)    
> 1年 8(53.33) 22(48.89)    
骨折部位[例(%)]     χ2 = 1.944 0.378
上肢骨折 4(26.67) 8(17.78)    
下肢骨折 9(60.00) 23(51.11)    
躯干骨折 2(13.33) 14(31.11)    
手术方式[例(%)]     χ2 = 20.123 < 0.001
微创切口 1(6.67) 26(57.78)    
常规切口 7(46.67) 17(37.78)    
扩大切口 7(46.67) 2(4.44)    
手术时间[例(%)]     χ2 = 3.411 0.182
≤ 1.5 h 3(20.00) 21(46.67)    
1.5~3 h 8(53.33) 17(37.78)    
> 3 h 4(26.67) 7(15.56)    
出血量[例(%)]     χ2 = 2.174 0.337
≤ 400 ml 7(46.67) 30(66.67)    
400~1 000 ml 7(46.67) 14(31.11)    
> 1 000 ml 1(6.67) 1(2.22)    
内植物类型[例(%)]     χ2 = 1.089 0.297
金属材料/人工生物材料 11(73.33) 40(88.89)    
多种材料 4(26.67) 5(11.11)    
术前病毒载量[M(P25,P75),IU/ml] 355(100.0,25 300.0) 2 420(141.5,45 300.0) U = 283.000 0.347
术前CD4+ T淋巴细胞[M(P25,P75)] 268(126.0,456.0) 311(178.5,387.0) U = 330.500 0.905
术前CD4+ T淋巴细胞分组[例(%)]     χ2 = 0.588 0.443
≤ 200个/μl 7(46.67) 16(35.56)    
> 200个/μl 8(53.33) 29(64.44)    
表4 HIV感染者限期骨折内植物手术并发症影响因素的二元Logistic回归分析
影响因素 回归系数 标准误 Wald χ2 P 95%CI OR
性别            
          Ref
0.639 1.777 0.129 0.719 0.058~61.724 1.895
年龄 0.000 0.050 0.000 0.994 0.908~1.102 1.000
骨折部位            
上肢骨折           Ref
下肢骨折 -1.181 1.653 0.510 0.475 0.012~7.836 0.307
躯干骨折 -0.064 1.349 0.002 0.962 0.067~13.185 0.938
ART时间            
          Ref
≤ 1年 -2.413 1.783 1.832 0.176 0.003~2.948 0.090
> 1年 -1.238 1.890 0.429 0.513 0.007~11.785 0.290
手术方式            
微创切口           Ref
常规切口 -5.970 2.016 8.768 0.003 0.000~0.133 0.003
扩大切口 -2.449 1.224 4.005 0.045 0.008~0.951 0.086
手术时间            
≤ 1.5 h           Ref
1.5~3 h 0.211 2.044 0.011 0.918 0.022~67.798 1.235
> 3 h 1.515 1.585 0.913 0.339 0.204~101.632 4.549
出血量            
≤ 400 ml           Ref
400~1 000 ml -1.663 1.965 0.716 0.397 0.004~8.928 0.190
> 1 000 ml -2.955 2.411 1.503 0.220 0.000~5.872 0.052
植入物类型            
金属材料/人工生物材料           Ref
多种材料 -1.900 1.592 1.425 0.233 0.007~3.386 0.150
术前HIV载量(IU/ml) 0.000 0.000 0.872 0.350 1.000~1.000 1.000
术前CD4+ T淋巴细胞(个/μl) 0.002 0.005 0.244 0.621 0.993~1.012 1.002
术前CD4+ T淋巴细胞分组            
≤ 200个/μl           Ref
> 200个/μl 3.184 2.166 2.160 0.142 0.346~1 685.299 24.134
表5 不同手术方式HIV感染者限期骨折内植物手术近期和远期并发症
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