Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Spoorwegstraat 12, B-8200 Brugge, Belgium.
Service D'hématologie, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, B-1200 Bruxelles, Belgium.
Int J Environ Res Public Health. 2021 Oct 29;18(21):11405. doi: 10.3390/ijerph182111405.
Ankle joint distraction (AJD) has been described to be a valuable joint-sparing alternative to arthrodesis or arthroplasty; however, clinical endpoints associated to this surgical intervention are lacking. The current case report describes clinical and biomechanical outcome measures of ankle joint distraction in a 14-year-old patient with severe haemophilia A. Because of persistent and incapacitating pain and the poor response to conservative and invasive treatment options, ankle joint distraction was performed in this 14-year-old patient using an external fixator encompassing two Ilizarov full rings in the tibia and a foot ring fixed to the foot by four K-wires. State-of-the-art medical imaging and non-invasive skin marker-based 3D multi-segment foot modelling were performed in a pre- and post-operative stage. From a structural viewpoint, this AJD was a success since it improved and stabilised the osteo-cartilaginous lesions of the ankle. Biomechanical outcome measures associated with the 18-month follow-up were found to be suboptimal, showing an early plantarflexion pattern at the ankle joint during midstance and a tendency towards increased power absorption at the midfoot with peak power absorption being almost two times higher when compared to boys of the same age. From a functional viewpoint, we observed a clear reduction in the patients' physical activities until one year after AJD. Despite these functional and structural improvements, recurrent painful phenomena, including the development of a complex regional pain syndrome (CRPS) and a stress fracture of the third metatarsal bone, were observed which are probably related with the development of recurrent subchondral oedema.
踝关节牵伸 (AJD) 已被描述为一种有价值的关节保留替代关节融合或关节置换的方法；然而，这种手术干预相关的临床终点尚不清楚。本病例报告描述了一名 14 岁重度 A 型血友病患者行踝关节牵伸的临床和生物力学结果。由于持续的、使人丧失能力的疼痛以及对保守和侵入性治疗方案的反应不佳，对这名 14 岁的患者使用包含两个伊里扎洛夫全环的胫骨外固定器和通过四个 K 线固定到脚部的足部环进行了踝关节牵伸。在术前和术后阶段进行了最先进的医学成像和非侵入性皮肤标记 3D 多节段足部建模。从结构的角度来看，这种 AJD 是成功的，因为它改善和稳定了踝关节的骨软骨病变。与 18 个月随访相关的生物力学结果并不理想，在中足期显示出踝关节早期跖屈模式，并且在中足处表现出增加的功率吸收趋势，峰值功率吸收几乎是同龄男孩的两倍。从功能的角度来看，我们观察到患者的身体活动明显减少，直到 AJD 后一年。尽管有这些功能和结构上的改善，但仍观察到反复发作的疼痛现象，包括复杂区域疼痛综合征 (CRPS) 和第三跖骨应力性骨折的发生，这可能与复发性软骨下水肿的发展有关。
