Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KU Leuven, Heverlee, Belgium.
Department of Physical Medicine, Clinical Motion Analysis Laboratorium (CMAL), University Hospitals Leuven, Pellenberg, Belgium.
J Orthop Res. 2020 Nov;38(11):2419-2428. doi: 10.1002/jor.24715. Epub 2020 May 22.
Ankle cartilage damage due to repeated joint bleeds often leads to altered gait in adult patients with hemophilia. It is therefore of clinical importance to develop an understanding of the biomechanical gait features in hemophilia patients with and without blood-induced cartilage damage and age-matched control subjects. We recruited a control group (n = 17), patients with hemophilia (PwH) without blood-induced ankle cartilage damage (PwH_ , n = 5) and PwH with severe blood-induced ankle cartilage damage (PwH_ , n = 19). We collected three-dimensional gait analysis data with following outcome variables in the ankle, Chopart and the first metatarsophalangeal (MTP 1) joints: range of motion (ROM) during stance phase, peak joint moment and powers. Biomechanical loading (BW) was quantified as the joint reaction forces using inverse dynamic analysis. Loading rate (BW/s) and impulse (BW*s) were calculated between 50% and 70% of stance phase. All biomechanical variables of the ankle joint were significantly lowered in the PwH_ group compared with both the control subjects and the PwH_ group. No compensatory biomechanical function was observed in other foot joints. An ankle loading rate of 2.64 ± 0.83 BW/s was observed in the control group, which was significantly higher than 1.75 ± 0.43 BW/s (P = .049) and 1.22 ± 0.59 BW/s (P < .001) in respectively the PwH_ group and PwH_ group. Patients with severe blood-induced cartilage damage demonstrated a (mal)adaptive gait strategy as they experience difficulties to properly unload the ankle cartilage during walking.
由于关节反复出血导致的踝关节软骨损伤常常导致成年血友病患者的步态发生改变。因此，了解无血源性软骨损伤和有血源性软骨损伤的血友病患者以及年龄匹配的对照组患者的生物力学步态特征具有重要的临床意义。我们招募了一个对照组（n=17）、无血源性踝关节软骨损伤的血友病患者（PwH_，n=5）和有严重血源性踝关节软骨损伤的血友病患者（PwH_，n=19）。我们采集了三维步态分析数据，踝关节、Chopart 和第一跖趾关节（MTP1）的以下结果变量：站立相的运动范围（ROM）、关节峰值力矩和功率。使用反向动力学分析量化了关节受力（BW）。在站立相的 50%到 70%之间计算了加载率（BW/s）和冲量（BW*s）。与对照组和 PwH_组相比，PwH_组的踝关节所有生物力学变量均显著降低。在其他足部关节未观察到代偿性生物力学功能。对照组的踝关节加载率为 2.64±0.83 BW/s，明显高于 PwH_组的 1.75±0.43 BW/s（P=0.049）和 PwH_组的 1.22±0.59 BW/s（P<0.001）。患有严重血源性软骨损伤的患者在行走时难以正确地从踝关节软骨上卸力，因此表现出（不良）适应性步态策略。
