Rodriguez-Merchan E Carlos
Department of Orthopaedic Surgery, La Paz University Hospital-IdiPaz, Paseo de la Castellana 261, 28046-Madrid, Spain.
Arch Bone Jt Surg. 2022 Feb;10(2):129-134. doi: 10.22038/abjs.2020.47865.2366.
There are several manners to take care of the hemophilic ankle in the initial phases of degeneration of the articular cartilage, in the event that hematologic prophylaxis is unsuccessful in accomplishing no bleeds. Some of these are nonoperative, with which management must start. These are Physical and Rehabilitation Medicine protocols and the utilization of orthoses (patellar tendon bearing). When these are unsuccessful, more aggressive types of treatment can be utilized, such as radiosynovectomy and some surgical operations (open or arthroscopic removal of anterior osteophyte of the distal part of the tibia, arthroscopic ankle debridement). Nonetheless, in the late phases of degeneration of the articular cartilage (advanced arthropathy), the solely options are surgical: ankle fusion or total ankle arthroplasty. The review of the literature has shown that the percentage of consolidation is between 90% and 100%, and that the percentage of postoperative infection is between 0% and 10%%. When the Ilizarov external fixator is utilized for ankle fusion, the percentage of pin tract infection is around 14%. Ankle fusion is a secure surgical technique that meliorates articular pain and improves the quality of life of hemophilic patients.
在关节软骨退变的初始阶段，如果血液学预防未能成功避免出血，有几种方法可以处理血友病性踝关节。其中一些是非手术方法，治疗必须从这些方法开始。这些方法包括物理和康复医学方案以及矫形器（髌腱承重）的使用。当这些方法不成功时，可以采用更积极的治疗方式，如放射性滑膜切除术和一些外科手术（开放或关节镜下切除胫骨远端前部骨赘、关节镜下踝关节清创术）。然而，在关节软骨退变的晚期（晚期关节病），唯一的选择是手术：踝关节融合或全踝关节置换。文献综述表明，融合成功率在90%至100%之间，术后感染率在0%至10%之间。当使用伊里扎洛夫外固定器进行踝关节融合时，针道感染率约为14%。踝关节融合是一种安全的外科技术，可减轻关节疼痛并改善血友病患者的生活质量。
