Christie B A, Baumann K, Kurth M H
Hemophilia & Thrombosis Center, University of Minnesota Medical Center, Fairview, and Department of Pediatric Haemotology and Oncology, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN 55455, USA.
Haemophilia. 2006 Sep;12(5):526-30. doi: 10.1111/j.1365-2516.2006.01316.x.
Venous access devices (VADs) have been used in some individuals with haemophilia to facilitate infusions of factor concentrates. Studies have reported complications of infection and thrombosis with VADs but there have been no studies looking at the potential effect that VADs may have on growth of the upper extremities in children with haemophilia. We hypothesize that there could be potential growth discrepancies in upper extremities in children with VADs related to changes in blood flow to the extremity caused by the VADs.
This study was a cohort descriptive comparative study to determine if VAD use correlated to discrepancies in upper extremity limb measurement data. A multivariate analysis compared limb measurements with VAD use, bleeding, clotting, infections, surgeries, chest wall collateral patterns and magnetic resonance venogram results.
A total of 59 children with haemophilia participated (36 subjects with VADs, 23 subjects without). Overall, in subjects with VADs the non-VAD side was found to be shorter and measured less in girth than the VAD side. These differences did not reach statistical significance except bicep/tricep girth in the 11-15 age group. There was no correlation found between duration of VAD placement and subject age vs. length and girth measurements. When comparing subjects with VADs to those without VADs, no differences in measurements were seen. Differences in girth were measured between dominant hand and non-dominant hand in all subjects indicating that the dominant hand arm was larger. Reproducibility of this data may be hampered by limitations of sample size, subject homogeneity and variability in bleeding history between subject groups.
静脉通路装置（VADs）已被用于一些血友病患者，以方便输注凝血因子浓缩剂。研究报告了VADs的感染和血栓形成并发症，但尚无研究探讨VADs对血友病儿童上肢生长可能产生的影响。我们假设，与VADs导致的上肢血流变化相关，使用VADs的儿童上肢可能存在生长差异。
本研究是一项队列描述性比较研究，以确定VADs的使用是否与上肢测量数据的差异相关。多变量分析将肢体测量结果与VADs的使用、出血、凝血、感染、手术、胸壁侧支模式和磁共振静脉造影结果进行了比较。
共有59名血友病儿童参与研究（36名使用VADs的受试者，23名未使用的受试者）。总体而言，在使用VADs的受试者中，发现非VAD侧比VAD侧更短，周长测量值更小。除了11 - 15岁年龄组的二头肌/三头肌周长外，这些差异未达到统计学意义。未发现VAD放置时间与受试者年龄与长度和周长测量值之间存在相关性。将使用VADs的受试者与未使用VADs的受试者进行比较时，未发现测量值有差异。在所有受试者中，测量了优势手和非优势手之间的周长差异，表明优势手臂更大。样本量的限制、受试者的同质性以及受试者组之间出血史的变异性可能会妨碍这些数据的可重复性。
