| Objective To investigate the status of joint function in patients with hemophilia,to understand the characteristics and trends of hemophilia arthritis,and to analyze the progression factors of hemophilic arthritis.In order to improve the understanding of the characteristics of hemophilic arthritis,and evaluate the short-term efficacy of surgical interventions.It providesa theoretical basis for the treatment and management of hemophilic arthritis.Methods 1.According to the previous literature on hemophilic arthritis,under the guidance of experts in the field of epidemiological investigation,the investigation items were determined,and a rating scale was selected to produce a "clinic for hemophilic arthritis" for this study;2.Clinical study on the effect of coagulation factors on the functional status of hemophilia patients on an as-needed basis: Basic information acquisition,joint function assessment,and life status analysis of 210 hemophilia patients diagnosed and treated in the First Center of Tianjin,according to hemophilia joint health assessment The scores of the joints were scored in the table and finally summarized in the “Hemophilia Arthritis Questionnaire” used in this study.The joint function status of 196 patients with hemophilia treated on an on-demand basis was analyzed.The Spearman correlation coefficient was used to analyze the joint status.Correlation with quality of life of patients;3.93 cases of intermediate hemophilia(FVIII: C/FIX: C: 1~5%)and 96 patients with severe hemophilia(FVIII: C/FIX: C: <1%)According to the age of the patients,they were divided into 7 subgroups,<10 year old group,10-20 year old group,20-30 year old group,30-40 year old group,40-50 year old group,50-60 year old group,> 60 year old group.The patient’s joints were counted for the involvement of hemophilic arthritis.Hemophilia joint health evaluation form was used to assess the main joint functional status of the patient’s limbs;4.Analysis of the development factors of hemophilic arthritis: According to the literature review and communication with hemophilia experts,a survey project was developed to correlate the joint health status with multiple hemophilia arthritis related items,and at the same time,the joint function Each item was correlated with different factors,and used according to different types of independent variables: ordered logistic regression analysis,binary logistic regression analysis,multiple linear regression analysis;5.The short-term efficacy analysis was performed on patients treated at the First Central Hospital of Tianjin.The patients undergoing P32 radiosurgical synovectomy and knee joint replacement undergo regular follow-up: Follow-up items for patients undergoing P32 radiation synovectomy are specifically: the number of annual joint hemorrhage before and after treatment,the degree of joint motion,and the time for delayed knee joint replacement;Follow-up of patients undergoing joint replacement surgery was performed to review the short-term treatment outcomes.Specific items included: joint mobility,imaging review,and the US hospital for special surgery knee score(HSS).Result 1.A total of 210 cases of hemophilia patients were collected in this study.Among them,196 patients with hemophilia were treated on an as-needed basis.The average age was 27.81(2-73)years.A total of 184(96.43%)cases of hemophilia were reported.Disease B totaled 5(3.57%)cases.The proportion of affected joints without involvement,one joint involvement,and joint involvement of two or more persons accounted for 3.57%,11.72%,and 84.71%,respectively.The incidence rates of elbow joint,knee joint,and ankle joint were 71.93% and 80.61%,respectively.82.91%;the incidence of joint involvement was 61.60%,72.40% and 80.73% in patients with mild,intermediate and severe hemophilia respectively;the average hemophilia joint health assessment scores for intermediate and severe hemophilia were 23.59±17.02 points respectively.26.69±17.68 points,no statistical difference(P>0.05).There was a negative correlation between joint function and quality of life in patients with hemophilia(r=0.676).2.The mean hemophilia joint health assessment score of the intermediate hemophilia patients was 18.00(26.00),and the average hemophilia joint health assessment score of the severe hemophiliacs was 22.00(31.00).There was no statistically significant difference between the two groups.(P=0.319).In hemophilia patients aged 20 to 30 years,the average number of severe hemophilia patients was 28.78±18.26,and the average hemophilia joint health assessment score for intermediate hemophiliacs was 13.00(14.00),which was statistically significant(Z=-2.127,P=0.033).There were significant differences in the knee joint HJHS between the 10 to 20-year-old group and the 20 to 30-year-old group(Z10~20=-2.710,P10~20=0.007,Z20~30=-2.384 P20~30=0.017).There was no significant difference in the scores and heavy weights of intermediate hemophilia patients at the age(P>0.05).3.The age of the patient is an important influence on the elbow,ankle and knee.Ankle joint function status is also related to whether the target joint(P<0.01);elbow joint function status is also related to the number of bleeding(P<0.01).The effects of BMI,hemophilia level,treatment on time,and regular physical therapy did not have statistical significance for hemophilia joint function status(P<0.01).4.P32 radiation synovectomy had significant effect in reducing articular hemorrhage and VAS in the follow-up period of 12 months.The effect of reducing the number of articular hemorrhage was significant at the follow-up of 24 months.The effect on the degree of joint motion needs further verification.TKA surgery can be safely performed under the protection of a complete clotting factor replacement program.TKA can be safely performed under the protection of a complete coagulation factor replacement program for TKA surgery.TKA can effectively improve the lower extremities force line,VAS,joint mobility,corrected flexion deformity and HSS score.Conclusion This study used hemophilia joint function as the research object in hemophilia patients to analyze the characteristics of each hemophilia joint and the function of joints in patients with hemophilia.The incidence of known hemophilic arthritis and its influencing factors were analyzed..The incidence of joint involvement was high in patients with hemophilia,and at least one joint was involved in patients over 10 years of age.Most of the patients had multiple joint involvement and impaired joint function,which affected the daily behavior of patients.The status of hemorrhage treatment in intermediate hemophilia patients was poor.The combination of on-demand treatment and prevention and treatment can effectively reduce joint bleeding,effectively guarantee the functional status of hemophilia patients,and improve the quality of life of patients.The incidence of haemophilic arthritis is related to multiple factors,and it is necessary to work together in many ways to avoid the disease.Delaying the development of arthritis and reducing the number of joint bleeding plays an important role.Keeping the treatment at a high level is the key to the prevention of haemophilic arthritis,and it is also the key to ensuring the joint status of hemophiliacs.P32 radiosurgery synovectomy is an effective surgical treatment to reduce the number of joint hemorrhages.P32 radiation synovectomy can be used as a treatment method in the short-term repeated bleeding of the joints,but its therapeutic effect on the target joint remains to be further verified.TKA surgery can be safely performed under the protection of a complete clotting factor replacement program.TKA can effectively improve the motion of joints in patients with hemophilia and correct the lower limbs.The incidence of periprosthetic infection and aseptic prosthesis loosening is further observed during long-term follow-up. |
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