| 王 杰,张耀申,赵昌松,张 强.后路减压椎间植骨融合术治疗伴HIV感染老年腰椎退行性疾病患者的疗效分析[J].中国脊柱脊髓杂志,2023,(7):631-638. |
| 后路减压椎间植骨融合术治疗伴HIV感染老年腰椎退行性疾病患者的疗效分析 |
| 中文关键词: 腰椎退行性疾病 HIV感染 老年 后路减压椎间植骨融合 疗效 |
| 中文摘要: |
| 【摘要】 目的：探讨后路减压椎间植骨融合术治疗伴人类免疫缺陷病毒（human immunodeficiency virus，HIV）感染老年腰椎退行性疾病患者的疗效。方法：回顾性分析2015年1月～2021年10月因腰椎退行性疾病于首都医科大学附属北京地坛医院骨科接受后路减压椎间植骨融合术治疗的25例老年（≥65岁）HIV感染者（HIV组）的临床资料，选取同一时期因腰椎退行性疾病接受后路减压椎间植骨融合术治疗的35例年龄、性别、症状持续时间、退行性疾病类型、合并基础疾病种类及严重程度、减压类型、融合类型与HIV组相匹配的老年非HIV感染者作为非HIV组，比较HIV组与非HIV组术前腰椎骨密度、CD4+ T淋巴细胞计数、CD4+ T淋巴细胞计数/CD8+T淋巴细胞计数、体重指数（body mass index，BMI）、白蛋白、血红蛋白、合并感染疾病情况；两组均予以围术期规范化处理及出院后长期健康管理，观察两组患者术前及术后6个月、12个月的腰腿痛视觉模拟评分（visual analogue scale，VAS）、腰椎Oswestry功能障碍指数（Oswestry disability index，ODI）、腰椎日本骨科协会（Japanese Orthopaedic Association，JOA）评分及植骨融合情况；统计术中及术后并发症情况；统计HIV组患者术前及术后6个月、12个月髋部骨密度变化情况。结果：两组患者均手术顺利，HIV组手术时间147.16±6.58min，术中出血量319.16±26.84ml；非HIV组手术时间145.31±9.77min，出血量309.69±24.43ml。HIV组患者术前腰椎骨密度、CD4+ T淋巴细胞计数、CD4+ T淋巴细胞计数/CD8+ T淋巴细胞计数、BMI、白蛋白、血红蛋白均显著低于非HIV组（P＜0.05），HIV组合并感染疾病（乙型病毒性肝炎、丙型病毒性肝炎、梅毒）例数显著高于非HIV组（P＜0.05）。两组患者术前及术后6个月、12个月的VAS、ODI及JOA评分呈持续好转趋势（P＜0.05）；HIV组术前和术后6个月VAS、ODI及JOA评分明显高于非HIV组（P＜0.05），术后12个月VAS、ODI及JOA评分组间比较差异无统计学意义（P＞0.05）。HIV组患者髋部骨密度术前、术后6个月、术后12个月呈持续上升趋势（P＜0.05）。HIV组随访19.38±3.62个月（12～30个月），非HIV组随访22.89±4.12个月（12～36个月），两组随访时间比较差异无统计学意义（P＞0.05）。两组患者末次随访时腰椎均获骨性融合；均无硬脊膜撕裂、手术部位感染、机会性感染、内固定松动等手术相关并发症。结论：合并HIV感染的老年腰椎退行性疾病患者腰椎骨密度低、免疫力低、营养状态差、合并多种感染疾病（乙型病毒性肝炎、丙型病毒性肝炎、梅毒）；在围手术期规范化处理及出院后长期健康管理的基础上，后路减压椎间植骨融合术是此类人群一种安全有效的治疗方法。 |
Efficacy analysis of posterior decompression and interbody fusion in the treatment of lumbar degenerative diseases in elderly patients with HIV infection |
| 英文关键词:Lumbar degenerative diseases Human immunodeficiency virus Elderly Posterior decompression and interbody fusion Curative effect |
| 英文摘要: |
| 【Abstract】 Objectives: To explore the efficacy of posterior decompression and interbody fusion in the treatment of lumbar degenerative diseases in elderly patients with human immunodeficiency virus(HIV) infection. Methods: The clinical data of 25 elderly patients(≥65 years old) with HIV infection who were treated with posterior decompression and interbody fusion(as HIV group) in the Department of Orthopedics, Beijing Ditan Hospital affiliated to Capital Medical University from January 2015 to October 2021 were retrospectively analyzed. Another 35 cases of elderly non-HIV infected patients who received posterior decompression and interbody fusion for lumbar degenerative diseases in the same period and were matched with HIV group in age, sex, duration of symptoms, type of degenerative disease, type and severity of underlying diseases, fusion type, and decompression type, were selected as the non-HIV group. Lumbar bone mineral density(BMD), CD4+ T lymphocyte count, CD4+ T lymphocyte count/CD8+ T lymphocyte count, body mass index(BMI), albumin, hemoglobin and co-infection were compared between HIV group and non-HIV group before operation. Both groups were given perioperative standardized management and long-term health management after discharge. Visual analogue scale(VAS) of low back and leg pain, lumbar Oswestry disability index(ODI), Japanese Orthopaedic Association(JOA) score of lumbar spine, and bone graft fusion were observed before operation and at 6 months and 12 months postoperatively. Intraoperative and postoperative complications were collected. The changes of hip BMD between before operation and at 6 months and 12 months postoperatively in HIV group were counted. Results: Both groups of patients underwent surgery smoothly, with an operative time of 147.16±6.58min and a bleeding volume of 319.16±26.84ml in HIV group, and an operative time of 145.31±9.77min and a bleeding volume of 309.69±24.43ml in non-HIV group. The lumbar BMD, CD4+ T lymphocyte count, CD4+ T lymphocyte count/CD8+ T lymphocyte count, BMI, albumin and hemoglobin in HIV group were significantly lower than those in non-HIV group before operation(P<0.05). The number of patients with infection(hepatitis B, hepatitis C, and syphilis) in HIV group was significantly higher than that in non-HIV group(P<0.05). The VAS, ODI and JOA scores of both groups showed continuous improvement at 6 months and 12 months postoperatively than before operation(P＜0.05). The VAS, ODI and JOA scores in HIV group were significantly higher than those in non-HIV group before operation and at 6 months postoperatively(P＜0.05), while no significant differences was found between the two groups at 12 months postoperatively(P＞0.05). The BMD of hip in HIV group increased continuously at 6 months and 12 months postoperatively than before operation(P＜0.05). HIV group was followed up for 19.38±3.62 months(12-30 months), and non-HIV group was followed up for 22.89±4.12 months(12-36 months), with no significant difference between the two groups(P>0.05). Bony fusion of lumbar vertebra was achieved in both groups at the last follow-up, and there were no intraoperative and postoperative complications such as dural tear, surgical site infection, opportunistic infection or internal fixation loosening related ones. Conclusions: Elderly patients with lumbar degenerative diseases complicated with HIV infection have low lumbar BMD, poor immunity and nutritional status, and multiple infectious diseases (hepatitis B, hepatitis C, syphilis); Posterior decompression and interbody fusion is a safe and effective treatment for such population on the basis of perioperative standardized management and long-term health management after discharge. |
| 投稿时间：2022-09-08 修订日期：2023-04-19 |
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