Preis M, Bailey T, Jacxsens M, Barg A
Department of Orthopaedics Aukammklinik, Wiesbaden, Germany.
Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.
Haemophilia. 2017 Jul;23(4):e301-e309. doi: 10.1111/hae.13200. Epub 2017 Mar 17.
There are two general surgical approaches for operative treatment of end-stage haemophilic ankle arthropathy: ankle arthrodesis and total ankle replacement (TAR).
The aim of this study was to determine intraoperative and postoperative complications and evaluate the mid-term clinical and radiographic outcomes of TAR in patients with haemophilic arthropathy.
Fourteen patients with a mean age of 51.4 ± 10.2 years (range = 32.9-63.7) were treated for end-stage haemophilic ankle arthropathy. Nine procedures were primary arthroplasties, five procedures were conversions of painful ankle arthrodesis to TAR. The mean duration of follow-up was 5.8 ± 2.3 years (range = 2.0-9.2). Component stability and alignment was assessed with weight-bearing radiographs. Clinical assessment was performed.
One patient sustained an intraoperative medial malleolar fracture. In two patients, delayed wound healing was observed. In one patient, open arthrolysis was performed due to painful arthrofibrosis. Both components were neutrally aligned. Visual analogue scale (VAS) significantly decreased from 8.5 ± 0.9 (range = 8-10) to 1.3 ± 1.6 (range = 0-6). Significant functional improvement including range of motion (ROM) and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was observed. The summarized components of the SF-36 physical and mental outcomes score significantly improved at the latest follow-up. Complication rates and clinical/radiographic outcomes were comparable in patients with primary TAR and conversion of ankle arthrodesis to TAR.
The mid-term results following TAR or a conversion procedure in patients with haemophilic arthropathy are encouraging. However, for postoperative success, access to an experienced, multidisciplinary team including a haematologist is mandatory.
终末期血友病性踝关节病的手术治疗有两种常见的外科手术方法：踝关节融合术和全踝关节置换术（TAR）。
本研究的目的是确定全踝关节置换术治疗血友病性关节病患者的术中及术后并发症，并评估其中期临床和影像学结果。
14例平均年龄为51.4±10.2岁（范围=32.9 - 63.7岁）的患者接受了终末期血友病性踝关节病的治疗。9例手术为初次关节置换术，5例手术为将疼痛性踝关节融合术转换为全踝关节置换术。平均随访时间为5.8±2.3年（范围=2.0 - 9.2年）。通过负重X线片评估假体稳定性和对线情况。进行临床评估。
1例患者术中发生内踝骨折。2例患者出现伤口愈合延迟。1例患者因疼痛性关节纤维性变进行了开放性关节松解术。两个假体均呈中性对线。视觉模拟评分（VAS）从8.5±0.9（范围=8 - 10）显著降至1.3±1.6（范围=0 - 6）。观察到包括活动范围（ROM）和美国矫形足踝协会（AOFAS）后足评分在内的显著功能改善。在最近一次随访时，SF - 36身体和心理结果评分的综合指标显著改善。初次全踝关节置换术患者和踝关节融合术转换为全踝关节置换术患者的并发症发生率及临床/影像学结果具有可比性。
血友病性关节病患者接受全踝关节置换术或转换手术的中期结果令人鼓舞。然而，为了术后取得成功，必须有一个经验丰富的多学科团队，包括血液科医生。
