Department of Orthopedics and Traumatology, Ege University School of Medicine, Izmir, Turkey.
Kastamonu Research and Training Hospital, Kastamonu, Turkey.
Haemophilia. 2024 Mar;30(2):531-537. doi: 10.1111/hae.14952. Epub 2024 Feb 13.
Knees affected by haemophilic arthropathy exhibit distinct differences in both bone morphology and soft tissue behaviour. This study aims to analyse the morphological characteristics of the distal femur and patellofemoral joint in patients with haemophilia in comparison to normal healthy population.
Study was conducted as pair-matched case-control study with 43 individuals in both the haemophilia group and the control group. Patellar luxation, patellar tilt (PT), length of the patella in both axis (pAP, pML), depth and angle of trochlear sulcus (SD, SA), lateral trochlear inclination (LTI), medial and lateral femoral facet length (mFL, LFL), intercondylar depth (ID), transepicondylar axis (TEA) and lateral condyle length (LCL) were assessed on knee MRI. Correlation between Pettersson score and measured variables were also analysed.
PT was medial sided in 10 (23.2%) cases in haemophilic group. Mean values of pAP, pML, PT were significantly lower in haemophilia group (p < .001, p: .007, p = .001 respectively). There were no significant changes in SA (p = .628), SD (p = .340), LTI (p = .685), LFL (p = .241) and MFC-LFC (p = .770) whilst mFL was significantly longer in haemophilia group (p = .009). ID (p < .001), TEA (p = .007) and LCL (p = .001) were all shorter in haemophilia group. Pettersson score was inversely correlated with pAP, pML, ID, TEA, LCL, pML/SA and ID/LCL.
Morphological changes in haemophilic arthropathy involve a smaller and medially-tilted patella, narrowed lateral condyle and transepicondylar axis, combined with reduced intercondylar depth. These alterations must keep in mind especially in pre- and intraoperative assessments for arthroplasty procedures.
受血友病性关节病影响的膝关节在骨骼形态和软组织行为上都有明显的差异。本研究旨在分析血友病患者与正常健康人群相比，其股骨远端和髌股关节的形态特征。
本研究为病例对照配对研究，血友病组和对照组各 43 人。评估膝关节 MRI 上的髌骨脱位、髌骨倾斜（PT）、髌骨在两个轴上的长度（pAP、pML）、滑车沟的深度和角度（SD、SA）、外侧滑车倾斜度（LTI）、股骨内、外侧关节面长度（mFL、LFL）、髁间深度（ID）、髁间轴（TEA）和外侧髁长度（LCL）。还分析了 Pettersson 评分与测量变量之间的相关性。
血友病组中有 10 例（23.2%）出现髌骨内侧倾斜。在血友病组中，pAP、pML、PT 的平均值明显较低（p<0.001，p：0.007，p=0.001 分别）。SA（p=0.628）、SD（p=0.340）、LTI（p=0.685）、LFL（p=0.241）和 MFC-LFC（p=0.770）无明显变化，而 mFL 在血友病组中明显较长（p=0.009）。ID（p<0.001）、TEA（p=0.007）和 LCL（p=0.001）在血友病组中均较短。Pettersson 评分与 pAP、pML、ID、TEA、LCL、pML/SA 和 ID/LCL 呈负相关。
血友病性关节病的形态变化涉及较小的、内侧倾斜的髌骨、变窄的外侧髁和髁间轴，以及减少的髁间深度。这些改变在进行关节置换术的术前和术中评估时必须牢记在心。
