Lobet S, McCarthy A, Hermans C, Peerlinck K, Matricali G A, Staes F, Deschamps K
Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Computer Assisted Robotic Surgery (CARS), Université catholique de Louvain, Brussels, Belgium.
Cliniques universitaires Saint-Luc, Service d'hématologie, Brussels, Belgium.
Haemophilia. 2017 Jul;23(4):e250-e258. doi: 10.1111/hae.13202. Epub 2017 Mar 17.
Although regular factor replacement can reduce the incidence of joint bleeds and slow down the development of haemophilic arthropathy, the ankle joint remains particularly vulnerable even in children with haemophilia on primary or secondary prophylaxis and is now the primary joint affected. The heterogeneity in the pathoaetiology of haemophilic ankle arthropathy means that the functional consequences of early stage of ankle arthropathy are difficult to define as early morphological and structural changes can be observed in clinically asymptomatic ankles. In this context, understanding biomechanics of the normal and arthritic foot is complex and difficult to quantify unless considering the foot as multiple functional segments using more sophisticated assessment tools such as multisegment foot models. However, this understanding can undoubtedly aid in the analysis of an underlying clinical problem and provide a strategic basis for a more optimal management.
The purpose of this narrative review was firstly to revise information on the anatomy and biomechanics of the foot and ankle. Finally, related biomechanical markers of human motor performance, which are potentially implicated in the development of haemophilic ankle arthropathy, will be discussed based on published literature and expert opinion.
Searches in published literature were limited to the year 2000 onwards.
Although the ankle (tibiotalar joint) is the most commonly affected joint, associated subtalar joint (SJT) involvement is often seen. This would therefore imply that an alternative phraseology might be better.
In this context, the authors propose the use of 'haemophilic tarsal pan-arthropathy' (HTPA) which encompasses both tibiotalar and subtalar joints.
尽管定期进行因子替代治疗可以降低关节出血的发生率，并减缓血友病性关节病的发展，但即使是接受一级或二级预防的血友病患儿，踝关节仍然特别容易受累，且目前是主要受累关节。血友病性踝关节病的病理病因存在异质性，这意味着踝关节病早期的功能后果难以界定，因为在临床无症状的踝关节中也可观察到早期的形态和结构变化。在这种情况下，除非使用多节段足部模型等更复杂的评估工具将足部视为多个功能节段，否则理解正常和患有关节炎的足部的生物力学是复杂且难以量化的。然而，这种理解无疑有助于分析潜在的临床问题，并为更优化的治疗提供战略依据。
本叙述性综述的目的首先是修订有关足踝部解剖学和生物力学的信息。最后，将根据已发表的文献和专家意见，讨论与血友病性踝关节病发展可能相关的人体运动表现的生物力学标志物。
对已发表文献的检索限于2000年以后。
尽管踝关节（胫距关节）是最常受累的关节，但常常也会累及距下关节（SJT）。因此，这意味着使用另一种表述可能会更好。
在这种情况下，作者建议使用“血友病性跗骨全关节病”（HTPA），它涵盖了胫距关节和距下关节。
