血友病足踝部病變的外科治療_《中國修復重建外科雜志》

作者：

張凌漢 , 翁習生 , 邱貴興 , 高鵬 , 錢文偉 , 王以朋

中國醫學科學院北京協和醫學院北京協和醫院骨科（北京，100730）;

關鍵詞：

血友病足踝部病變關節融合術跟腱延長術圍術期處理

DOI：

10.7507/1002-1892.20130036

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目的探討外科治療血友病足踝部病變圍術期處理方法、術式選擇及療效。方法1998年6月－2012年2月，收治血友病足踝部病變男性患者10例（12足）。年齡13～41歲，平均22.6歲。其中甲型血友病9例（11足），乙型血友病1例（1足）。單足受累8例，雙足2例；左側3足，右側9足。病程5～84個月，平均32.2個月。術前根據美國矯形足踝協會（AOFAS）評分為（43.2 ± 21.1）分，簡明健康調查量表（SF-36量表）評分總分為（45.4 ± 20.0）分。入院后給予凝血因子2 000～3 500 U行預試驗，圍術期行凝血因子替代方案治療。行踝關節融合術4例（4足），單純跟腱延長/肌腱轉移術7例（8足）；其中1例左足行單純跟腱延長術，右足行踝關節融合術。結果手術時間65～265 min，平均141.1 min；除1例術中出血400 mL、術中回輸200 mL自體血外，其余患者出血量均 lt; 50 mL，圍術期均未輸血。患者切口均Ⅰ期愈合，術后無感染、下肢深靜脈血栓形成、神經損傷等并發癥發生。患者均獲隨訪，隨訪時間6個月～14年3個月，中位時間22個月。行踝關節融合術患者末次隨訪時X線片檢查示踝關節完全融合。術后6個月及末次隨訪時，AOFAS評分分別為（78.8 ± 14.7）分和（75.8 ± 14.5）分， SF-36量表評分總分分別為（76.6 ± 13.1）分和（75.5 ± 13.2）分，兩指標與術前比較，差異均有統計學意義（P lt; 0.05）；術后6個月與末次隨訪時比較，差異均無統計學意義（P gt; 0.05）。結論對于血友病足踝部病變患者，手術治療可以緩解足踝部疼痛，改善功能。術前行凝血因子預試驗，圍手術期行凝血因子替代方案，可降低術后大出血發生率。

引用本文： 張凌漢,翁習生,邱貴興,高鵬,錢文偉,王以朋. 血友病足踝部病變的外科治療. 中國修復重建外科雜志, 2013, 27(2): 160-163. doi: 10.7507/1002-1892.20130036 復制

1.	Forsyth AL, Giangrande P, Hay CR. Difficult clinical challenges in haemophilia: international experiential perspectives. Haemophilia, 2012, 18 Suppl 5: 39-45.
2.	Samantha CM. Prothrombin complex concentrates: a brief review. Eur J Anaesthesiol, 2008, 25(10): 784-789.
3.	Gamble JG, Bellah J, Rinsky LA, et al. Arthropathy of the ankle in haemophilia. J Bone Joint Surg (Am), 1991, 73(7): 1008-1015.
4.	Tsukamoto S, Tanaka Y, Matsuda T, et al. Arthroscopic ankle arthrodesis for hemophilic arthropathy: two cases report. Foot (Edinb), 2011, 21(2): 103-105.
5.	丁秋蘭, 王學鋒, 王鴻利, 等. 血友病A的替代治療. 臨床血液學雜志, 2010, 23(1): 51-52.
6.	丁秋蘭, 王學鋒, 王鴻利, 等. 血友病B的替代治療. 臨床血液學雜志, 2010, 23(1): 52.
7.	李其一, 郭文娟, 仉建國. 血友病乙患者脊柱后凸矯形手術圍手術期處理. 中國骨與關節外科, 2011, 4(3): 256-260.
8.	高增鑫, 邱貴興, 翁習生, 等. 關節成形術治療血友病性關節病. 中華外科雜志, 2008, 46(11): 809-812.
9.	黃省利, 賀西京, 李浩鵬, 等. 血友病性骨關節病4例. 中國骨傷, 2005, 18(2): 121-122.
10.	閔重函, 張洪美. 踝關節置換治療血友病性關節炎的短期臨床療效觀察. 中國骨傷, 2009, 22(6): 428-431.
11.	Pasta G, Forsyth A, Merchan CR, et al. Orthopaedic management of haemophilia arthropathy of the ankle. Haemophilia, 2008, 14 Suppl 3: 170-176.
12.	Van Meegeren ME, Van Veghel K, De Kleijn P, et al. Joint distraction results in clinical and structural improvement of haemophilic ankle arthropathy: a series of three cases. Haemophilia, 2012, 18(5): 810-817.
13.	Hahn ME, Wright ES, Segal AD, et al. Comparative gait analysis of ankle arthrodesis and arthroplasty: initial findings of a prospective study. Foot Ankle Int, 2012, 33(4): 282-289.
14.	Barg A, Elsner A, Hefti D, et al. Haemophilic arthropathy of the ankle treated by total ankle replacement: a case series. Haemophilia, 2010, 16(4): 647-655.
15.	Queen RM, De Biassio JC, Butler RJ, et al. J. Leonard Goldner Award 2011: changes in pain, function, and gait mechanics two years following total ankle arthroplasty performed with two modern fixed-bearing prostheses. Foot Ankle Int, 2012, 33(7): 535-542.
16.	Panotopoulos J, Hanslik-Schnabel B, Wanivenhaus A, et al. Outcome of surgical concepts in haemophilic arthropathy of the hindfoot. Haemophilia, 2005, 11(5): 468-471.
17.	Rodriguez-Merchan EC. Orthopaedic surgery of haemophilia in the 21st century: an overview. Haemophilia, 2002, 8(3): 360-368.
18.	Bossard D, Carrillon Y, Stieltjes N, et al. Management of haemophilic arthropathy. Haemophilia, 2008, 14 Suppl 4: 11-19.
19.	Silva M, Luck JV Jr. Long-term results of primary total knee replacement in patients with hemophilia. J Bone Joint Surg (Am), 2005, 87(1): 85-91.
20.	Ketz J, Myerson M, Sanders R. The salvage of complex hindfoot problems with use of a custom talar total ankle prosthesis. J Bone Joint Surg (Am), 2012, 94(13): 1194-1200.

1. Forsyth AL, Giangrande P, Hay CR. Difficult clinical challenges in haemophilia: international experiential perspectives. Haemophilia, 2012, 18 Suppl 5: 39-45.
2. Samantha CM. Prothrombin complex concentrates: a brief review. Eur J Anaesthesiol, 2008, 25(10): 784-789.
3. Gamble JG, Bellah J, Rinsky LA, et al. Arthropathy of the ankle in haemophilia. J Bone Joint Surg (Am), 1991, 73(7): 1008-1015.
4. Tsukamoto S, Tanaka Y, Matsuda T, et al. Arthroscopic ankle arthrodesis for hemophilic arthropathy: two cases report. Foot (Edinb), 2011, 21(2): 103-105.
5. 丁秋蘭, 王學鋒, 王鴻利, 等. 血友病A的替代治療. 臨床血液學雜志, 2010, 23(1): 51-52.
6. 丁秋蘭, 王學鋒, 王鴻利, 等. 血友病B的替代治療. 臨床血液學雜志, 2010, 23(1): 52.
7. 李其一, 郭文娟, 仉建國. 血友病乙患者脊柱后凸矯形手術圍手術期處理. 中國骨與關節外科, 2011, 4(3): 256-260.
8. 高增鑫, 邱貴興, 翁習生, 等. 關節成形術治療血友病性關節病. 中華外科雜志, 2008, 46(11): 809-812.
9. 黃省利, 賀西京, 李浩鵬, 等. 血友病性骨關節病4例. 中國骨傷, 2005, 18(2): 121-122.
10. 閔重函, 張洪美. 踝關節置換治療血友病性關節炎的短期臨床療效觀察. 中國骨傷, 2009, 22(6): 428-431.
11. Pasta G, Forsyth A, Merchan CR, et al. Orthopaedic management of haemophilia arthropathy of the ankle. Haemophilia, 2008, 14 Suppl 3: 170-176.
12. Van Meegeren ME, Van Veghel K, De Kleijn P, et al. Joint distraction results in clinical and structural improvement of haemophilic ankle arthropathy: a series of three cases. Haemophilia, 2012, 18(5): 810-817.
13. Hahn ME, Wright ES, Segal AD, et al. Comparative gait analysis of ankle arthrodesis and arthroplasty: initial findings of a prospective study. Foot Ankle Int, 2012, 33(4): 282-289.
14. Barg A, Elsner A, Hefti D, et al. Haemophilic arthropathy of the ankle treated by total ankle replacement: a case series. Haemophilia, 2010, 16(4): 647-655.
15. Queen RM, De Biassio JC, Butler RJ, et al. J. Leonard Goldner Award 2011: changes in pain, function, and gait mechanics two years following total ankle arthroplasty performed with two modern fixed-bearing prostheses. Foot Ankle Int, 2012, 33(7): 535-542.
16. Panotopoulos J, Hanslik-Schnabel B, Wanivenhaus A, et al. Outcome of surgical concepts in haemophilic arthropathy of the hindfoot. Haemophilia, 2005, 11(5): 468-471.
17. Rodriguez-Merchan EC. Orthopaedic surgery of haemophilia in the 21st century: an overview. Haemophilia, 2002, 8(3): 360-368.
18. Bossard D, Carrillon Y, Stieltjes N, et al. Management of haemophilic arthropathy. Haemophilia, 2008, 14 Suppl 4: 11-19.
19. Silva M, Luck JV Jr. Long-term results of primary total knee replacement in patients with hemophilia. J Bone Joint Surg (Am), 2005, 87(1): 85-91.
20. Ketz J, Myerson M, Sanders R. The salvage of complex hindfoot problems with use of a custom talar total ankle prosthesis. J Bone Joint Surg (Am), 2012, 94(13): 1194-1200.

《中國修復重建外科雜志》

血友病足踝部病變的外科治療

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血友病足踝部病變的外科治療

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