Ribbans W J, Giangrande P, Beeton K
Department of Orthopaedics, Northampton General Hospital, United Kingdom.
Clin Orthop Relat Res. 1997 Oct(343):12-8.
Acute hemarthroses are probably the most frequent type of bleeding in the patient with hemophilia. Delayed and/or inadequate treatment can trigger a series of pathologic changes within the joint leading to a painful and disabling arthropathy. Despite the advent of prophylactic treatment with factor concentrates, the majority of patients in the world have no access to even on demand factor replacement. Care for all patients involves a team approach led by the hematologist but including input from orthopaedic surgeons and physiotherapists. Optimal treatment involves a combination of factor replacement, rest, ice, and supervised rehabilitation. In certain cases, joint aspiration may be considered. In developing countries, where factor concentrates are in short supply, such bleeding episodes usually are treated by physical means alone or with the addition of cryoprecipitate or fresh frozen plasma. After successful resolution of such episodes by whatever means, the events leading to the bleeding episode and its subsequent management should be considered within the setting of the treating unit. Such debriefings should aim to provide counsel regarding any appropriate lifestyle modifications and, where necessary, treatment should be arranged to minimize the risk of additional episodes.
急性关节积血可能是血友病患者最常见的出血类型。延迟治疗和/或治疗不当会引发关节内一系列病理变化，导致疼痛性和致残性关节病。尽管出现了使用凝血因子浓缩物的预防性治疗，但世界上大多数患者甚至无法获得按需凝血因子替代治疗。对所有患者的护理采用由血液科医生牵头的团队方法，但也包括骨科医生和物理治疗师的意见。最佳治疗方法包括凝血因子替代、休息、冰敷和有监督的康复治疗相结合。在某些情况下，可考虑关节穿刺抽吸。在凝血因子浓缩物供应短缺的发展中国家，此类出血事件通常仅通过物理方法治疗，或加用冷沉淀或新鲜冰冻血浆。无论通过何种方式成功解决此类事件后，都应在治疗单位的环境中考虑导致出血事件的原因及其后续管理。此类总结汇报应旨在就任何适当的生活方式调整提供建议，必要时应安排治疗以尽量降低再次发生出血事件的风险。
