Scaturro Dalila, Tomasello Sofia, Caruso Vincenzo, Picone Isabella, Ammendolia Antonio, de Sire Alessandro, Letizia Mauro Giulia
Precision Medicine in the Medical, Surgical and Critical Care Areas, University of Palermo, 90100 Palermo, Italy.
Villa Delle Ginestre, Palermo Provincial Health Authority, 90146 Palermo, Italy.
Life (Basel). 2025 Aug 1;15(8):1217. doi: 10.3390/life15081217.
Haemophilic arthropathy is caused by repeated joint bleeding episodes, primarily affecting knees, ankles and elbows. Conservative options should be considered prior to surgery, as well as postural evaluation, since any functional overload promotes the development of new bleeding. The aim of this study is to verify the use of foot orthoses in combination with postural rehabilitation, assessing the incidence of spontaneous haemarthroses and haematomas. In total, 15 patients were enrolled and randomly divided into two groups: 8 in group A, composed of patients who were prescribed foot orthoses and a 20-session rehabilitation program, and 7 in group B, composed of patients who were instructed to use foot orthoses only. All patients were evaluated at baseline (T0), at 3 months (T1-end of the rehabilitation program), and at 12 months (T2), using the following scales: Functional Independence Score in Haemophilia (FISH), Haemophilia Joint Health Score (HJHS) and Numerical Rating Scale (NRS). During the 12 months between the first and the last assessment, no patient in group A developed hemarthroses or hematomas, while one case of hemarthrosis was recorded in group B. The HJHS improved significantly (≤0.05) in group A at both T1 and T2, while in group B it improved significantly only in T2. As for FISH, it showed significant improvements in both groups at T1 and T2. NRS showed a significant reduction only at T2 in both groups (-value T0-T1 0.3 in group A e 0.8 in group B). No patient reported any adverse effects from the use of orthotic insoles. The combination of postural rehabilitation, the use of foot orthoses and pharmacological prophylaxis could improve functioning and joint status in patients affected by haemophilic arthopathy, delaying or preventing new hemarthroses by improving the distribution of joint loads and the modification of musculoskeletal system's characteristics.
血友病性关节病由反复的关节出血发作引起，主要影响膝关节、踝关节和肘关节。手术前应考虑保守治疗方案以及姿势评估，因为任何功能过载都会促进新出血的发生。本研究的目的是验证足部矫形器与姿势康复相结合的应用效果，评估自发性关节积血和血肿的发生率。总共招募了15名患者并随机分为两组：A组8名患者，接受足部矫形器及为期20节的康复计划；B组7名患者，仅接受使用足部矫形器的指导。所有患者在基线期（T0）、3个月时（T1，康复计划结束时）和12个月时（T2）接受评估，使用以下量表：血友病功能独立性评分（FISH）、血友病关节健康评分（HJHS）和数字评定量表（NRS）。在首次评估和末次评估之间的12个月内，A组没有患者发生关节积血或血肿，而B组记录到1例关节积血。A组在T1和T2时HJHS均有显著改善（≤0.05），而B组仅在T2时有显著改善。至于FISH，两组在T1和T2时均有显著改善。NRS仅在两组的T2时显示出显著降低（A组T0 - T1时p值为0.3，B组为0.8）。没有患者报告使用矫形鞋垫有任何不良反应。姿势康复、足部矫形器的使用和药物预防相结合，可以改善血友病性关节病患者的功能和关节状况，通过改善关节负荷分布和改变肌肉骨骼系统特征来延迟或预防新的关节积血。
