艾滋病患者药物性骨梗死的诊断与治疗  

Diagnosis and treatment of drug-induced bone infarction in AIDS patients

作　　者：宋宏阁 刘维高 张磊[1] SONG Hongge;LIU Weigao;ZHANG Lei(Department of Orthopaedics,Zhengzhou Sixth People's Hospital,Zhengzhou,Henan 450015,China)

机构地区：[1]河南省传染病医院(郑州市第六人民医院)骨科,河南450015

出　　处：《中国骨与关节损伤杂志》2024年第11期1142-1145,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的分析获得性免疫缺陷综合症(Acquired immunodeficiency syndrome,AIDS)患者高效联合抗逆转录病毒疗法(Highlyactive antiretroviral therapy,HAART)治疗引发药物性骨梗死的诊断及手术治疗效果。方法回顾性分析自2017-03-2021-03于笔者所在医院采用手术治疗的114例长期HAART治疗的AIDS骨梗死。所有患者术前临床、影像学检查及穿刺活检查证实诊断。手术方式为骨开窗减压病灶清除打压植骨术,将髓腔骨梗死病灶完全清除,同种异体骨打压填塞,不进行任何内固定,不放置引流管。术后随访并于术后1、3、6、12、24个月复查X线片、CT及MRI检查,了解患者疼痛缓解、病灶植骨区骨质愈合及肢体功能恢复情况。结果MRI诊断骨梗死特异性及敏感性均较高,结合穿刺活检,诊断率达100%。114例均随访24个月,其中2例术后3~6个月时因暴力性受伤在手术部位发生骨折,其余112例术后9~24个月植骨区骨质愈合,疼痛症状全部消失,肢体功能完全恢复,回归正常日常生活及工作。结论艾滋病患者长期服用抗病毒药物引起药物性骨梗死,MRI为首选无创检查方法,骨开窗打压植骨术具有创伤小、手术时间短、恢复快等优点,为骨梗死的治疗提供了一种疗效可靠的方法。Objective To analyze the diagnosis and surgical outcomes of drug-induced bone infarction triggered by highly ac-tive antiretroviral therapy(HAART)treatment in patients with acquired immunodeficiency syndrome(AIDS).Methods A retro-spective analysis of 114 cases of long-term HAART-treated AIDS bone infarcts treated with surgery from March 2017 to March 2021 at the author's hospital was performed.The diagnosis was confirmed by preoperative clinical and imaging examinations and puncture biopsy in all patients.The surgical approach was bone opening and decompression lesion removal and compression bone grafting,in which the medullary bone infarct lesion was completely removed,and the homologous allograft bone was com-pressed and filled without any internal fixation or placement of drains.Postoperative follow-up and review of radiographs,CT and MRI examinations at 1,3,6,12 and 24 months after surgery were performed to find out the patients'pain relief,bone healing in the focal implant area and limb function recovery.Results The specificity and sensitivity of MRI in diagnosing bone infarction were high,and combined with puncture biopsy,the diagnostic rate reached 100%.One hundred and fourteen cases were followed up for 24 months,of which 2 cases suffered fracture at the surgical site due to violent injuries at 3-6 months after surgery,and the rest of the 112 cases experienced bone healing at the implanted area 9-24 months after surgery,and the pain symptoms disappeared,and the limb function completely recovered,and returned to the normal daily life and work.Conclusion For drug-induced bone infarction caused by long-term use of antiretroviral drugs in patients with AIDS,MRI is the preferred noninvasive examination method,and bone opening and compression bone grafting has the advantages of less trauma,shorter surgical time,and quicker recovery,which provides a therapeutic and reliable treatment method for bone infarction.

关 键 词：获得性免疫缺陷综合症 抗病毒药物 高效联合抗逆转录病毒疗法 骨梗死 

分 类 号：R681[医药卫生—骨科学]