Wallny T, Brackmann H H, HEss L, Seuser A, Hofmann P, Kraft C N
Department of Orthopaedics, University of Bonn, Germany.
Haemophilia. 2002 Mar;8(2):149-52. doi: 10.1046/j.1365-2516.2002.00593.x.
In view of an increasing tendency in prosthetic management of haemophilic arthropathy, we intended to evaluate the efficacy of corrective osteotomy of the hip, specifically taking long-term clinical and radiographic results into consideration. Eleven hips affected by haemarthropathy in nine patients suffering from severe haemophilia A were treated with an intertrochanteric varus osteotomy. The average follow-up period was 15 small middle dot4 years. The preoperative clinical score of the Advisory Committee of the World Federation of Haemophilia was 5 small middle dot3 points (range 4-7) and the Pettersson score was 6 small middle dot4 points (range 2-10). The average WFH score at follow-up had increased to 3 small middle dot6 points. Seven hips showed clinical improvement, two hips showed a postoperative deterioration while a further two hips remained unchanged. The Petterson score increased to an average of 7 small middle dot7 points. Here the radiographs of six patients indicated postoperative deterioration, three remained unaltered and two showed improvement. Our study cannot conclusively answer whether intertrochanteric varus osteotomy for haemophilic arthropathy of the hip is always a feasible alternative to joint arthroplasty. The decision for or against this procedure must be individually assessed and the patient must be thoroughly informed about the advantages and disadvantages of both procedures.
鉴于血友病性关节病假体治疗的趋势日益增加，我们旨在评估髋部截骨矫正术的疗效，尤其考虑长期临床和影像学结果。对9例重度甲型血友病患者的11个患有关节积血的髋关节进行了转子间内翻截骨术治疗。平均随访期为15.4年。世界血友病联盟咨询委员会术前临床评分为5.3分（范围4 - 7），彼得松评分为6.4分（范围2 - 10）。随访时世界血友病联盟平均评分增至3.6分。7个髋关节临床改善，2个髋关节术后恶化，另有2个髋关节无变化。彼得松评分平均增至7.7分。6例患者的X线片显示术后恶化，3例无变化，2例改善。我们的研究无法最终回答髋部血友病性关节病的转子间内翻截骨术是否始终是关节置换术的可行替代方案。对此手术的决策必须进行个体评估，并且必须让患者充分了解两种手术的优缺点。
