Rodriguez-Merchan E Carlos
Consultant Orthopedic Surgeon, Department of Orthopedics and Hemophilia Unit, La Paz University Hospital, and Associate Professor of Orthopedics, Autonoma University, Madrid, Spain.
Semin Hematol. 2008 Apr;45(2 Suppl 1):S58-63. doi: 10.1053/j.seminhematol.2008.03.005.
Hematologists are of the opinion that orthopedic surgeons will eventually not be required in the clinical management of patients with hemophilia. Although such a belief is indicative of a strong desire to end the orthopedic complications associated with hemophilia, this has yet to become reality. Current knowledge and appropriate prophylactic treatment have the potential to reduce the level of orthopedic problems affecting hemophilia patients, but optimal therapy cannot be implemented globally. The Spanish Health System places no restrictions on the treatment of patients with hemophilia, and consequently children with this condition have better musculoskeletal status than their counterparts of 30 years ago. Unfortunately, older patients continue to present with severe articular deformities that require the intervention of an orthopedic surgeon. This article considers surgical techniques used to address orthopedic problems associated with hemophilia, and reviews procedures frequently performed in Spanish clinics. These include arthrocenteses, radioactive synoviortheses, arthroscopic synovectomies and articular debridements, tendon lengthening, alignment osteotomies, joint arthroplasties, opening of compartment syndromes, and removal of pseudotumors.
血液学家认为，在血友病患者的临床管理中，最终将不再需要骨科医生。尽管这种观点表明了人们强烈希望消除与血友病相关的骨科并发症，但这尚未成为现实。目前的知识和适当的预防性治疗有可能降低影响血友病患者的骨科问题的发生率，但最佳治疗方案无法在全球范围内实施。西班牙医疗系统对血友病患者的治疗没有限制，因此患有这种疾病的儿童的肌肉骨骼状况比30年前的同龄人更好。不幸的是，老年患者仍然存在严重的关节畸形，需要骨科医生进行干预。本文探讨了用于解决与血友病相关的骨科问题的手术技术，并回顾了西班牙诊所经常进行的手术程序。这些手术包括关节穿刺、放射性滑膜切除术、关节镜下滑膜切除术和关节清创术、肌腱延长术、对线截骨术、关节置换术、骨筋膜室综合征切开减压术以及假肿瘤切除术。
