Chung So-Won, Seo Young-Jae, You Chur Woo, Chun Tong-Jin, Jung Kang-Jae, Kim Jae-Hyung
Department of Physical Medicine and Rehabilitation, Hemophilia Treatment Center of Eulji University Hospital, Eulji University School of Medicine, #95, Dunsanse-Ro, Seo-Gu, Daejeon, 302-799 Republic of Korea.
Department of Pediatrics, Hemophilia Treatment Center of Eulji University Hospital, Eulji University School of Medicine, #95, Dunsanse-Ro, Seo-Gu, Daejeon, 302-799 Republic of Korea.
Indian J Hematol Blood Transfus. 2017 Sep;33(3):380-388. doi: 10.1007/s12288-016-0717-4. Epub 2016 Aug 18.
Hemophilic arthropathy (HA) can be diagnosed by a number of imaging studies. However, it is difficult with conventional radiography to find soft tissue structures around joints, and ultrasonography has limited effectiveness in evaluating internal bony structures. We attempt to determine whether a combination of ultrasonography for soft tissue around joints and conventional radiography for bony structures can be used as a cost-effective imaging tool for evaluating HA and whether it reflects the functional status of hemophilic patients. Thirty-six males (median age 16.5 years; severe 34, mild 2) with hemophilia were recruited. We evaluated the severity of HA using combined imaging score that consisted of modified Petterson X-ray score (mPXS) and the modified ultrasonographic score (mUS). Joint impairment was clinically assesses using the World Federation of Hemophilia-Physical Examination (WFH-PE) scale and the Hemophilic joint health score (HJHS). We assessed the Hemophilia activities list (HAL) for the functional level. We performed a comparative analysis between the combined imaging score and the joint impairment scores as well as the functional scores. The mean mUS was 4.97 ± 3.99 points, and the mean mPXS was 2.85 ± 2.91 points; the combined imaging score was 7.83 ± 6.31 points. The combined imaging score was significantly correlated with the HJHS ( = 0.006) and WFH-PE scores ( = 0.019) as well as the HAL score ( = 0.002). A combination of conventional radiological and ultrasongraphic study might ultimately impact the optimal evaluation of joint impairment and functional status in hemophilic patients.
血友病性关节病（HA）可通过多种影像学检查来诊断。然而，传统X线摄影很难发现关节周围的软组织结构，而超声检查在评估关节内部骨骼结构方面效果有限。我们试图确定关节周围软组织超声检查与骨骼结构传统X线摄影相结合是否可作为一种经济有效的影像学工具来评估HA，以及它是否能反映血友病患者的功能状态。招募了36名男性血友病患者（中位年龄16.5岁；重度34例，轻度2例）。我们使用由改良的彼得森X线评分（mPXS）和改良的超声评分（mUS）组成的联合影像评分来评估HA的严重程度。使用世界血友病联盟体格检查（WFH-PE）量表和血友病关节健康评分（HJHS）对关节损伤进行临床评估。我们评估血友病活动清单（HAL）以确定功能水平。我们对联合影像评分与关节损伤评分以及功能评分进行了比较分析。平均mUS为4.97±3.99分，平均mPXS为2.85±2.91分；联合影像评分为7.83±6.31分。联合影像评分与HJHS（P = 0.006）、WFH-PE评分（P = 0.019）以及HAL评分（P = 0.002）显著相关。传统放射学和超声检查相结合可能最终影响对血友病患者关节损伤和功能状态的最佳评估。
