ABSTRACT
Objective To investigate the effect of perioperative treatment and protection in human immunodeficiency virus (HIV) infected patients with osteoporotic vertebral compression fracture by percutaneous kyphoplasty (PKP).Methods From February 2010 to December 2015,206 cases with osteoporotic vertebral compression fracture treated by PKP were admitted,including 13 HIV infected patients.Blood routine,biochemical indexes,liver and kidney function,blood coagulation function,immune index and preoperative nutritional status were detected before operation.Highly active antiretroviral therapy (HAART),reasonable antibiotics,nutritional and immune support were given to the HIV infected patients.Standardized operation process and meticulous operative manipulation were applied during operation.The prevention of occupational exposure protection standardization process was strictly enforced.The postoperative complications,improvement of immune function and nutritional status,vertebral height,VAS,ODI and exposure occupation of medical personnel were observed.Results All 13 HIV infected patients had successful operations,without bone cement leakage and toxic reaction.One patient had perficial infection and the others had operative incisionprimary healing.There was no death.The levels of vertebral height,VAS scores and ODI scores were significantly improved after intervention and at the end of follow-up (P ＜ 0.05),but there were no significant differences between after the intervention and at the end of follow-up (P ＞ 0.05).Eleven malnutrition patients with HIV infected were received nutritional and immune support,and the levels of CD4 +,ALB and Hb were significantly improved:(289.00 ± 54.29) × 106./L vs.(237.25 ± 72.70) × 106/L,(38.04 ± 5.17) g/L vs.(33.73 ± 7.16) g/L,(112.87 ± 15.54) g/L vs.(100.68 ± 18.95) g/L,P ＜ 0.05.The levels of PLT and WBC had no significantly change (P ＞ 0.05).Two medical personnel had occupational exposure,and none had HIV infection.Conclusions Perioperative adjuvant treatment in HIV infected patients with osteoporotic vertebral compression fracture can achieve satisfactory outcomes.Strict implementation of protective standardization process should be focused.
ABSTRACT
Objective To observe the effect of perioperative treatment on complications in human immunodeficiency virus positive patients undergoing spinal surgery, and summarize effective perioperative management to make these patients to get better treatment. Methods Forty-eight HIV positive patients (experimental group) and 79 HIV negative patients (control group) undergoing spinal surgery from November 2010 to March 2016 were retrospectively reviewed. The two groups were comparable in age, gender, type of spinal surgery and basic diseases. Nutritional support and the uses of antibiotics and blood transfusion were strengthened in patients of experimental group. Immunomodulatory drugs, the treatment with HAART and occupational protection were also used in patients of experimental group. The patients in control group only received conventional perioperative treatment. Wound healing, opportunistic infection, the failure of internal fixation and death after the operation was observed. The perioperative treatment methods were summarized. Chi square test was used in comparison of the rate and P < 0.05 was considered statistically significant. Results Surgery was successfully completed in all patients in experimental group and control group. Two cases (4.2%) in experimental group and 4 cases(5.1%) in control group showed delayed healing of incisions. All incisions were healed after debridement and no incision infection happened. CD4+T lymphocyte count of 2 cases in the experimental group was in stage 3. Among them, 1 patient underwent emergency surgery and opportunistic infection appeared after the operation. The other patients for elective surgery took operation when CD4+T lymphocyte counts were adjusted to 2 and no complications appeared. The two groups had no internal fixation failure cases and deaths. Conclusions HIV positive patients with spinal diseases are special patients. HIV positive patients with spinal surgery can reduce complications, and achieve good clinical curative effect by reasonable preoperative assessment, optimization of perioperative treatment, proper type of operation and active prevention of opportunistic infections after surgery.