PDF(Pubmed)
Abstract：
UNASSIGNED: Avascular necrosis (AVN), also known as osteonecrosis, refers to the death of bone tissue due to the lack of blood supply. Osteonecrosis in HIV can be a complication of the ART\'s or the disease itself.
METHODS: 47 years old male, HIV positive for 10 years on Antiretroviral-therapy had gradual onset of bilateral hip pain for 6 months, progressively and sharp in nature, aggravated by movement and relieved by resting with reduced range of movement, wheel chair dependent 2 months. No history of fever, cough, night sweats or weight loss. No history of trauma, steroid use or hormonal therapy and no history of alcohol intake. On Examination he had bilateral inguinal and hip tenderness, pain on movement, with reduced flexion and extension of the hip. His viral-load was 27copies/ml of blood. Complete blood count was unremarkable. Serum lipid panel had no evidence of hypertriglyceridemia. He was diagnosed with bilateral femoral heads Avascular-necrosis. Bilateral ceramic with polyethylene liner uncemented total hip arthroplasty was done. No complications observed, in 6 months of follow up he had Harris hip score of 90 and he had returned to his activities without hip pain complaints/complications.
CONCLUSIONS: The management of AVN is usually total hip arthroplasty, but other surgical treatment includes, hemiarthroplasty, core-decompression and girdle stone arthroplasty, the latter has poor outcomes in-terms of quality of life.
CONCLUSIONS: Understanding causes and mechanism of AVN is crucial for effective management and treatment, particularly when addressing cases such as in our patient with HIV induced osteonecrosis of both femoral heads, surgical treatment should aid on relieving pain and improving patient\'s quality of life.
METHODS: 47 years old male, HIV positive for 10 years on Antiretroviral-therapy had gradual onset of bilateral hip pain for 6 months, progressively and sharp in nature, aggravated by movement and relieved by resting with reduced range of movement, wheel chair dependent 2 months. No history of fever, cough, night sweats or weight loss. No history of trauma, steroid use or hormonal therapy and no history of alcohol intake. On Examination he had bilateral inguinal and hip tenderness, pain on movement, with reduced flexion and extension of the hip. His viral-load was 27copies/ml of blood. Complete blood count was unremarkable. Serum lipid panel had no evidence of hypertriglyceridemia. He was diagnosed with bilateral femoral heads Avascular-necrosis. Bilateral ceramic with polyethylene liner uncemented total hip arthroplasty was done. No complications observed, in 6 months of follow up he had Harris hip score of 90 and he had returned to his activities without hip pain complaints/complications.
CONCLUSIONS: The management of AVN is usually total hip arthroplasty, but other surgical treatment includes, hemiarthroplasty, core-decompression and girdle stone arthroplasty, the latter has poor outcomes in-terms of quality of life.
CONCLUSIONS: Understanding causes and mechanism of AVN is crucial for effective management and treatment, particularly when addressing cases such as in our patient with HIV induced osteonecrosis of both femoral heads, surgical treatment should aid on relieving pain and improving patient\'s quality of life.
摘要：
■血管坏死（AVN），也被称为骨坏死，是指由于缺乏血液供应而导致的骨组织死亡。HIV中的骨坏死可能是ART或疾病本身的并发症。
方法：47岁男性，抗逆转录病毒治疗10年HIV阳性后，双侧髋部疼痛逐渐发作6个月，本质上是渐进和尖锐的，因运动而加重，因运动范围减小而休息而缓解，轮椅依赖2个月。无发热史,咳嗽,夜间出汗或体重减轻。没有外伤史,使用类固醇或激素治疗，无饮酒史。经检查，他有双侧腹股沟和髋部压痛，运动时的疼痛，髋部屈曲和伸展减少。他的病毒载量是27拷贝/毫升血液。全血细胞计数并不显著。血清脂质小组没有高甘油三酯血症的证据。他被诊断为双侧股骨头缺血性坏死。进行双侧陶瓷和聚乙烯衬里的非骨水泥全髋关节置换术。未观察到并发症,在6个月的随访中,他的Harris髋关节评分为90分,他恢复了活动,没有髋关节疼痛主诉/并发症.
结论：AVN的治疗通常是全髋关节置换术，但是其他手术治疗包括，半髋关节置换术,核心减压和带结石关节成形术，就生活质量而言，后者的结局较差。
结论：了解AVN的原因和机制对于有效管理和治疗至关重要，特别是当处理病例，如在我们的病人与艾滋病毒诱导的股骨头坏死，手术治疗应有助于减轻疼痛，提高患者的生活质量。
方法：47岁男性，抗逆转录病毒治疗10年HIV阳性后，双侧髋部疼痛逐渐发作6个月，本质上是渐进和尖锐的，因运动而加重，因运动范围减小而休息而缓解，轮椅依赖2个月。无发热史,咳嗽,夜间出汗或体重减轻。没有外伤史,使用类固醇或激素治疗，无饮酒史。经检查，他有双侧腹股沟和髋部压痛，运动时的疼痛，髋部屈曲和伸展减少。他的病毒载量是27拷贝/毫升血液。全血细胞计数并不显著。血清脂质小组没有高甘油三酯血症的证据。他被诊断为双侧股骨头缺血性坏死。进行双侧陶瓷和聚乙烯衬里的非骨水泥全髋关节置换术。未观察到并发症,在6个月的随访中,他的Harris髋关节评分为90分,他恢复了活动,没有髋关节疼痛主诉/并发症.
结论：AVN的治疗通常是全髋关节置换术，但是其他手术治疗包括，半髋关节置换术,核心减压和带结石关节成形术，就生活质量而言，后者的结局较差。
结论：了解AVN的原因和机制对于有效管理和治疗至关重要，特别是当处理病例，如在我们的病人与艾滋病毒诱导的股骨头坏死，手术治疗应有助于减轻疼痛，提高患者的生活质量。
