Brettler D B, Forsberg A D, O'Connell F D, Cederbaum A I, Chaitman A K, Levine P H
Am J Hematol. 1985 Jan;18(1):13-8. doi: 10.1002/ajh.2830180104.
Because there is little available data to demonstrate whether demand therapy is adequate to prevent progression of hemophilic arthropathy, a cohort of 64 patients with severe Hemophilia A (Factor VIII level less than 1%) and no inhibitor were studied with respect to the progression of knee arthropathy over a period of 6 years. Both degree of disease in flexion and extension and progression of disease were rated on an arbitrary scale. At the outset of the study, the majority of knees were either not restricted or mildly restricted as to motion. Of those knees that were not restricted at the outset, 96% remained not restricted. Of the knees that were mildly restricted, only 58% remained stable or improved over the 6 years, and of the knees that were moderately to severely restricted, 75% improved or remained stable. It thus appears that a demand therapy program can maintain normal range of motion in a knee joint. However, if the patient's joint has progressed to mild disease, the ability to maintain or improve the joint with demand therapy appears to be decreased.
由于几乎没有可用数据来证明按需治疗是否足以预防血友病性关节病的进展，因此对一组64例重度甲型血友病（因子VIII水平低于1%）且无抑制剂的患者进行了研究，观察其膝关节病在6年期间的进展情况。屈曲和伸展时的疾病程度以及疾病进展均按任意量表进行评分。在研究开始时，大多数膝关节的活动要么不受限制，要么轻度受限。在那些一开始不受限制的膝关节中，96%仍然不受限制。在那些一开始轻度受限的膝关节中，在6年期间只有58%保持稳定或改善，而在那些中度至重度受限的膝关节中，75%有所改善或保持稳定。因此，按需治疗方案似乎可以维持膝关节的正常活动范围。然而，如果患者的关节已经发展为轻度疾病，按需治疗维持或改善关节的能力似乎会下降。
