Bladen M, Alderson L, Khair K, Liesner R, Green J, Main E
Haemophilia Centre, Great Ormond St. Hospital, Great Ormond Street, London, UK.
Haemophilia. 2007 Sep;13(5):542-7. doi: 10.1111/j.1365-2516.2007.01429.x.
Development of haemophilic arthropathy has long-term implications for functional mobility in people with haemophilia, but early manifestations are often asymptomatic and difficult to identify. Earlier identification of joint damage may improve outcomes. The aim of this case note review was to determine whether the GAITRite system (electronic pressure sensitive walkway) could identify early changes in gait patterns in boys with haemophilia compared with their peers. Clinic data from medical and physiotherapy notes of boys with severe haemophilia were compared with data from age and leg length-matched controls. Data from two consecutive walks at preferred speed were collected on all participants using the GAITRite system. Clinic assessment notes from 26 boys (aged 7-17 years) with severe haemophilia were identified. Of these, 20 boys had no evidence of joint pathology on assessment and six boys had radiographic evidence of arthropathy. When these data were compared with normal controls, there were statistically significant increases in swing time, stance time, single support and double support in the asymptomatic group (P < 0.01) suggesting subtle early compensatory changes in gait pattern. The children with arthropathy had additional significant differences in their gait compared with matched controls. These differences included normalized velocity, step length, stride length, step time and base of support (P < 0.01). The GAITRite system appears sensitive enough to identify early subtle changes in gait and differentiate between asymptomatic boys with haemophilia and those with arthropathy in comparison with a matched control group. The electronic walkway is an accessible and portable means of providing quantitative gait analysis in the clinical environment. This is an important finding as early identification of gait changes may provide clinicians with the opportunity to intervene with the aim of arresting progression of joint damage.
血友病性关节病的发展对血友病患者的功能活动能力具有长期影响，但早期表现往往没有症状且难以识别。更早地识别关节损伤可能会改善预后。本病例记录回顾的目的是确定GAITRite系统（电子压力感应步道）与同龄人相比，能否识别血友病男孩步态模式的早期变化。将重度血友病男孩的医学和物理治疗记录中的临床数据与年龄和腿长匹配的对照组数据进行比较。使用GAITRite系统收集了所有参与者以首选速度连续两次行走的数据。确定了26名重度血友病男孩（7至17岁）的临床评估记录。其中，20名男孩在评估时没有关节病变的证据，6名男孩有关节病的影像学证据。当将这些数据与正常对照组进行比较时，无症状组的摆动时间、站立时间、单支撑和双支撑在统计学上有显著增加（P < 0.01），表明步态模式存在细微的早期代偿性变化。与匹配的对照组相比，患有关节病的儿童在步态上还有其他显著差异。这些差异包括标准化速度、步长、步幅、步时和支撑面（P < 0.01）。与匹配的对照组相比，GAITRite系统似乎足够敏感，能够识别步态的早期细微变化，并区分无症状的血友病男孩和患有关节病的男孩。电子步道是在临床环境中提供定量步态分析的一种便捷且便携的手段。这是一项重要发现，因为早期识别步态变化可能为临床医生提供干预机会，以阻止关节损伤的进展。
