Kotela Ireneusz, Żbikowski Piotr, Ambroziak Paweł, Kotela Andrzej, Lorkowski Jacek, Stefańska-Windyga Ewa, Wojdasiewicz Piotr, Latawiec Filip, Windyga Jerzy
Clinical Department of Orthopedics and Traumatology, Central Clinical Hospital of the Ministry of Interior in Warsaw, Poland.
Clinical Department of Hemostatic Disorders and Internal Diseases, Institute of Hematology and Transfusion Medicine in Warsaw, Poland.
Ortop Traumatol Rehabil. 2013 Nov-Dec;15(6):601-16. doi: 10.5604/15093492.1091516.
Spontaneous intraarticular bleeds in congenital coagulation disorders result in early and extensive damage to the joints and periarticular structures. Total arthroplasty is the only effective method of treating these defects. Interim surgical procedures (arthroscopy, osteotomy, etc.) exist that can postpone arthroplasty, especially considering the fact that the condition affects young people. The aim of this paper is to discuss the range of trauma care and orthopedic procedures performed in patients with congenital coagulation disorders. Also presented are early results of joint arthroplasty in these patients.
A total of 168 trauma care and orthopedic procedures were performed in patients with congenital coagulation disorders at the Clinical Department of Orthopedics and Traumatology of the Central Clinical Hospital of the Ministry of Interior in Warsaw in the years 2010-2013. Among them were total arthroplasties (79 arthroplasties of the knee, 30 of the hip, 3 of the ankle and 1 of the elbow), arthroscopies, filling bone cysts with grafts and trauma procedures. The HHS, KSS, AOFAS and MEPS scales were used to evaluate the respective clinical results of hip, knee, ankle and elbow arthroplasty procedures. A VAS was used to evaluate pain intensity. In knee arthroplasty patients, quality of life parameters were evaluated with the WOMAC index.
In patients post hip arthroplasty, HHS scores increased by 50.22 points and VAS scores increased by 6.34 points. An increase of 116.41 points in KSS scores and 6.67 points in VAS scores was recorded in patients after knee arthroplasty. Also, WOMAC scores improved by 53.8 points after surgery. Evaluation of early results of ankle arthroplasty in the AOFAS scale showed a mean improvement of 35.5 points and a 5-point improvement in VAS scores. MEPS scores, used for evaluation of elbow arthroplasty results, improved from 15 to 70 points, with an improvement from 6 to 2 points in VAS scores.
先天性凝血障碍导致的自发性关节内出血会对关节及关节周围结构造成早期广泛损伤。全关节置换术是治疗这些损伤的唯一有效方法。存在一些过渡性手术程序（关节镜检查、截骨术等），可以推迟关节置换术，尤其是考虑到该病影响年轻人这一事实。本文旨在探讨先天性凝血障碍患者的创伤护理和骨科手术范围。还展示了这些患者关节置换术的早期结果。
2010年至2013年期间，华沙内政部中央临床医院骨科与创伤科对先天性凝血障碍患者进行了共168例创伤护理和骨科手术。其中包括全关节置换术（79例膝关节置换术、30例髋关节置换术、3例踝关节置换术和1例肘关节置换术）、关节镜检查、用移植物填充骨囊肿以及创伤手术。采用HHS、KSS、AOFAS和MEPS量表评估髋关节、膝关节、踝关节和肘关节置换手术各自的临床结果。使用视觉模拟评分法（VAS）评估疼痛强度。对于膝关节置换术患者，用WOMAC指数评估生活质量参数。
髋关节置换术后患者的HHS评分增加了50.22分，VAS评分增加了6.34分。膝关节置换术后患者的KSS评分增加了116.41分，VAS评分增加了6.67分。此外，术后WOMAC评分提高了53.8分。在AOFAS量表中对踝关节置换术早期结果的评估显示，平均提高了35.5分，VAS评分提高了5分。用于评估肘关节置换术结果的MEPS评分从15分提高到70分，VAS评分从6分提高到2分。
