The Application Value Of High Frequency Ultrasound In The Evaluation Of Children With Hemophilia A Joint Disease

Objective:To investigate the application value of high-frequency ultrasound in the evaluation of children with type A hemophilia joint disease.Method:1.Collect 22 cases of Hemophilia A children aged 18 or below from the First Affiliated Hospital of Hunan Normal University(Hunan Provincial People's Hospital)from January 2017 to February 2018 as a case group;At the same time,15 normal male child volunteers were included as a control group;the case group was divided into 6-year-old and 7-18-year-old groups according to age,according to the severity of hemophilia,the patients were divided into three groups:light,medium and heavy.Detailed records of all subjects' basic information and medical history,including age,height,hemophilia type,number of affected joints,and total number of joint hemorrhages.2.Ultrasound examinations of all six joints(bilateral elbows,knees,and ankles)were performed on all subjects by two sonographers to observe the joint lesions,and according to China's "Ultrasound Diagnostic Application of Hemophilia Osteoarthropathy" Consensus(2017)scored.At the same time,two rehabilitation specialists evaluated the joints of the same six joints in the same patient and scored according to the Hemophilia Joint Health Score(HJHS)scale.3.Comparison of age,height,weight and body mass index between case group and control group;ultrasound scores of abnormal joints in the case group were compared with hemophilia type,age,body mass index,and total number of joint hemorrhages.According to the ultrasound scores of all joints in the case group and the clinical hemophilia joint health scores,the correlation and consistency of the two assessment methods for joint lesion detection were analyzed.Result:l.In the case group,22 children with hemophilia A were male,including 9 in the 6-year-old group,13 in the 7-18-year-old group,3 in the light-weight group,6 in the middle-type group,and 13 in the heavy-duty group.The average age is 6.55±4.18 years old.The total number of joint hemorrhages ranges from 0 to 180 times.There was no significant difference in gender,age,height and weight between the case group and the control group.2.A total of 132 joints were included in the case group and 90 joints were included in the control group.In the case group,the range of abnormal scores of ultrasound was(1 to 11)points,0 points was normal,and 29 abnormal joints were detected by high-frequency ultrasonography(22.0%).Among them,there were 9 in the 6-year-old group,20 in the 7-18-year-old group,3 in the light-weight group,8 in the middle-type group,and 18 in the heavy-duty group;The ultrasound score of the control group was 0 points.In the case group,the clinical hemophilia joint abnormality score ranged from 1 to 18 points,and the normal score was 0 points.A total of 23 abnormal joints(17.4%)were detected in clinical joint evaluation.The clinical score of the control group was 0 points.Seven of the 29 joints with abnormal ultrasound evaluation in the case group were normal in the clinical joint assessment.3.The hemophilia joint lesions detected by ultrasound included joint effusion,synovial thickening,synovial vascular hyperplasia,hemosiderin deposition,cartilage changes,and subchondral bone changes.It was 12.9%(17/132),17.4%(23/132),12.9%(17/132),12.9%(17/132),10.6%(14/132),1.5%(2/132).4.The ultrasonic score of abnormal joints detected by ultrasound was positively correlated with the total number of joint hemorrhages in children with hemophilia A(P<0.01),and was not significantly related to the age and body mass index of children(P>0.05).5.Ultrasound scores of abnormal joints detected in children with A-type hemophilia in the<7 year age group and 7-18 year-old age group were significantly different(t = 3.386,P<0.01).6.There was no significant difference in ultrasound scores of abnormal joints detected by ultrasonography in children with mild,intermediate and severe hemophilia A(F=0.328,P=0.723).7.There was a positive correlation bet.ween high-frequency ultrasound scores and clinical hemophilia joint health scores(HJHS)in 132 joints of children with hemophilia A in the case group(r=0.857,P<0.01).8.The high-frequency ultrasound evaluation and clinical hemophilia joint health evaluation were consistent in the diagnosis of children with type A hemophilia arthropathy in the case group,and the difference was not statistically significant(P>0.05),and the degree of consistency was excellent.The kvalue is 0.809.Conclusion:1.High-frequency ultrasound can effectively detect children with type A hemophilic arthropathy soft tissue lesions and joint cartilage and bone lesions.2.There is a significant positive correlation between high-frequency ultrasound joint scores and clinical hemophilia joint health scores;The two assessment methods have excellent consistency in the diagnosis of children with hemophilia A joint disease,and ultrasound can find the joint arteries with negative evaluation of clinical joints,which can provide visualization,objective imaging evidence for clinical.