Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KULeuven, Heverlee, Belgium.
Service D'hématologie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium.
Haemophilia. 2020 Sep;26(5):907-915. doi: 10.1111/hae.14128. Epub 2020 Aug 7.
To compare foot joint kinetics and energetics in male paediatric boys with and without blood-induced ankle joint destruction to these of matched control groups.
A cross-sectional study was conducted in which 3D gait analysis data were collected from thirty-five male children (6-21 years) with severe or moderate haemophilia and twenty-six typically developing boys. Structural integrity of the tarsal foot joints of all haemophilic patients was assessed using the IPSG-MRI scale. All participants walked barefoot while adopting a physiological gait pattern. Three subgroups were created based on the IPSG-MRI scores: a group with no joint involvement (HealthyHaemo), with uni- or bilaterally involvement (PathoHaemo) and with only unilaterally involvement (Haemo_Unilateral_Patho).
The PathoHaemo group presented a significant lower Lisfranc peak dorsiflexion angular velocity (34.7°/s vs 71.4°/s, P = .000, Cohen d = 1.31) and a significantly higher Lisfranc peak plantarflexion angular velocity (-130.5°/s vs -51.8°/s, P = .000, Cohen d = 0.98) compared to the control group. The Haemo_Unilateral_Patho side had a significant higher Chopart peak dorsiflexion angular velocity compared to the Haemo_Unilateral_Healthy side (41.7°/s vs 31.9°/s, P = .002, Cohen d = 1.16).
No evidence for mild and severe gait deviations could be demonstrated. Internal moments, used as a surrogate measure of joint loading, quantified by the multi-segment foot model were found to be similar within the three subanalyses. We suggest that the ongoing musculoskeletal development in children compensates for structural damage to the ankle joint.
比较伴有和不伴有血源性踝关节破坏的男性儿科男孩的足部关节动力学和能量学，以及这些与匹配对照组的比较。
进行了一项横断面研究，其中从 35 名患有严重或中度血友病的男性儿童（6-21 岁）和 26 名典型发育男孩中收集了 3D 步态分析数据。所有血友病患者的跗骨足部关节的结构完整性均使用 IPSG-MRI 量表进行评估。所有参与者赤脚行走，采用生理步态模式。根据 IPSG-MRI 评分创建了三个亚组：无关节受累组（HealthyHaemo）、单侧或双侧受累组（PathoHaemo）和仅单侧受累组（Haemo_Unilateral_Patho）。
PathoHaemo 组的 Lisfranc 峰值背屈角速度明显较低（34.7°/s 比 71.4°/s，P=.000，Cohen d=1.31），而 Lisfranc 峰值跖屈角速度明显较高（-130.5°/s 比-51.8°/s，P=.000，Cohen d=0.98）与对照组相比。Haemo_Unilateral_Patho 侧的 Chopart 峰值背屈角速度明显高于 Haemo_Unilateral_Healthy 侧（41.7°/s 比 31.9°/s，P=.002，Cohen d=1.16）。
没有证据表明存在轻度和重度步态偏差。使用多节段足部模型量化的作为关节负荷替代测量的内部力矩在三个亚分析中发现相似。我们认为，儿童持续的肌肉骨骼发育可以代偿踝关节的结构损伤。
