Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KULeuven, Leuven (Heverlee), Belgium.
Division of Podiatry, Institut D'Enseignement, Supérieur Parnasse Deux-Alice, Sint-Lambrechts-Woluwe, Belgium.
Haemophilia. 2018 Jul;24(4):667-674. doi: 10.1111/hae.13484. Epub 2018 Apr 19.
The aim of this study was to determine whether young haemophilic boys with and without MRI-based signs of ankle arthropathy demonstrate reduced balance ability during a transition task with eyes open and eyes closed.
Thirty-four haemophilic bodies and 28 typically developing boys aged 6-20 years participated to this study. Structural integrity of the tarsal foot joints of all haemophilic boys was assessed with MRI. All participants performed a standard transition task from double-leg stance to single-leg stance with eyes open and eyes closed. Comparison of balance features derived from the centre of pressure displacement captured by a single force platform was performed between the different haemophilia subgroups and sex-age-height matched peers.
The haemophilic boys without signs of arthropathy presented only a higher intermediate phase velocity during the eyes closed condition (P = .05). The haemophilic boys with signs of arthropathy had significantly higher displacement after the time to new stability point, and 95% Ellipse Sway Area and Balance Area compared to their matched peers during eyes open test (P < .05). Similar findings were observed during the eyes closed test for the displacement after the time to new stability point and 95% Ellipse Sway Area (P < .05). No significant differences were observed between affected and non-affected side of the unilateral affected patients.
We suggest that the pathophysiological cascade associated with chronic bleeding episodes should not be considered as a "simple" musculoskeletal injury, hence more as a complex neurophysiological dysfunction which may originate both from unilateral and bilateral deterioration of the musculoskeletal system.
本研究旨在确定有无 MRI 踝关节病变征象的年轻血友病男孩在睁眼和闭眼时的过渡任务中是否表现出平衡能力下降。
本研究纳入 34 名血友病患儿和 28 名典型发育男孩，年龄 6-20 岁。所有血友病患儿均行 MRI 评估跗骨关节结构完整性。所有参与者睁眼和闭眼时均从双腿站立转换为单腿站立，完成标准过渡任务。通过单力台获取的压力中心位移来比较不同血友病亚组与性别-年龄-身高匹配的同龄人的平衡特征。
无关节病变征象的血友病患儿仅在闭眼状态下中间相速度较高（P=.05）。有病变征象的血友病患儿在睁眼测试中，与匹配的同龄儿相比，新稳定点时间后的位移、95%椭圆摆动面积和平衡面积明显更高（P<.05）。闭眼测试中，新稳定点时间后的位移和 95%椭圆摆动面积也观察到了类似的结果（P<.05）。单侧病变患者的患侧和非患侧之间未观察到显著差异。
我们认为，与慢性出血事件相关的病理生理级联反应不应被视为“单纯”的肌肉骨骼损伤，因此更应被视为一种复杂的神经生理功能障碍，其可能源自单侧和双侧肌肉骨骼系统的恶化。
