수컷, 12년령, 2 kg의 푸들견이 오른쪽 앞다리 파행 평가를 위해 내원하였다. 병력 검사에서 교통사고 후 1년 동안 재발성 양측 어깨 관절 탈구를 보이다가 최근 들어 왼쪽 어깨는 유지가 잘 되고 오른쪽 어깨는 탈구가 심해진 것을 확인 하였다. 신체 검사에서 오른쪽 앞다리 파행을 확인 하였고, 방사선 검사에서 상완골 내측 탈구와 상완골과 견갑골의 겹침 현상을 확인 하였다. 수술 중 근위축, 상완 두갈래 근육 톤 감소, 어깨 관절 내측 인대 파열, 어깨 아래근 정지부 파열을 확인 하였다. 상완 두갈래근 변위술을 사용하였으나 수술 7일 후 재탈구를 확인 하였다. 견갑골 어깨 관절 부위에 장착한 두 개의 $2mm{\times}6mm$ 피질용 본 앵커와 상완골 어깨 관절 부위에 장착한 한 개의 $4mm{\times}6mm$ 해면질용 본 앵커를 이용 어깨 관절 내측 인대 복원술을 실시 하였다. 수술 직후 및 6주 후 방사선 검사에서 어깨 관절 탈구를 확인 할 수 없었다. 수술 후 6개월 신체 검사에서 파행은 더 이상 관찰 되지 않았다.
수컷, 12년령, 2 kg의 푸들견이 오른쪽 앞다리 파행 평가를 위해 내원하였다. 병력 검사에서 교통사고 후 1년 동안 재발성 양측 어깨 관절 탈구를 보이다가 최근 들어 왼쪽 어깨는 유지가 잘 되고 오른쪽 어깨는 탈구가 심해진 것을 확인 하였다. 신체 검사에서 오른쪽 앞다리 파행을 확인 하였고, 방사선 검사에서 상완골 내측 탈구와 상완골과 견갑골의 겹침 현상을 확인 하였다. 수술 중 근위축, 상완 두갈래 근육 톤 감소, 어깨 관절 내측 인대 파열, 어깨 아래근 정지부 파열을 확인 하였다. 상완 두갈래근 변위술을 사용하였으나 수술 7일 후 재탈구를 확인 하였다. 견갑골 어깨 관절 부위에 장착한 두 개의 $2mm{\times}6mm$ 피질용 본 앵커와 상완골 어깨 관절 부위에 장착한 한 개의 $4mm{\times}6mm$ 해면질용 본 앵커를 이용 어깨 관절 내측 인대 복원술을 실시 하였다. 수술 직후 및 6주 후 방사선 검사에서 어깨 관절 탈구를 확인 할 수 없었다. 수술 후 6개월 신체 검사에서 파행은 더 이상 관찰 되지 않았다.
A 12-year-old male poodle weighing 2.0 kg presented for evaluation of right thoracic limb lameness. The owner reported that the dog showed recurrent bilateral shoulder joint luxation after a car accident for a year. Recently, the left shoulder joint appeared well maintained, but right shoulder joint...
A 12-year-old male poodle weighing 2.0 kg presented for evaluation of right thoracic limb lameness. The owner reported that the dog showed recurrent bilateral shoulder joint luxation after a car accident for a year. Recently, the left shoulder joint appeared well maintained, but right shoulder joint luxation was exacerbated. On physical examination, the dog showed non-weight bearing lameness on the right thoracic limb. Craniocaudal radiographic views revealed medial displacement of the right humerus. Mediolateral radiographic views revealed overlap of the glenoid cavity and humeral head. Muscle atrophy of the right thoracic limb, reduced biceps brachii muscle tendon tone, a tear of the medial glenohumeral ligament, and a rupture of the subscapularis tendon were identified intraoperatively. Transposition of the biceps muscle tendon was performed. However, at 7 days, there was evidence of right shoulder reluxation on radiographs. The second surgery was performed with two $2mm{\times}6mm$ cortical bone anchors and a $4mm{\times}6mm$ cancellous bone anchor placed in the cortical bone of the distal scapula and the cancellous bone of the proximal humerus respectively. Two scapular bone anchors were then connected with a humeral bone anchor using heavy nylon suture to minimize shoulder abduction range of motion. On radiographs right after surgery and 6 weeks after surgery, the affected limb revealed no evidence of medial shoulder luxation. At 6 months, no evidence of lameness was noted on the right thoracic limb.
A 12-year-old male poodle weighing 2.0 kg presented for evaluation of right thoracic limb lameness. The owner reported that the dog showed recurrent bilateral shoulder joint luxation after a car accident for a year. Recently, the left shoulder joint appeared well maintained, but right shoulder joint luxation was exacerbated. On physical examination, the dog showed non-weight bearing lameness on the right thoracic limb. Craniocaudal radiographic views revealed medial displacement of the right humerus. Mediolateral radiographic views revealed overlap of the glenoid cavity and humeral head. Muscle atrophy of the right thoracic limb, reduced biceps brachii muscle tendon tone, a tear of the medial glenohumeral ligament, and a rupture of the subscapularis tendon were identified intraoperatively. Transposition of the biceps muscle tendon was performed. However, at 7 days, there was evidence of right shoulder reluxation on radiographs. The second surgery was performed with two $2mm{\times}6mm$ cortical bone anchors and a $4mm{\times}6mm$ cancellous bone anchor placed in the cortical bone of the distal scapula and the cancellous bone of the proximal humerus respectively. Two scapular bone anchors were then connected with a humeral bone anchor using heavy nylon suture to minimize shoulder abduction range of motion. On radiographs right after surgery and 6 weeks after surgery, the affected limb revealed no evidence of medial shoulder luxation. At 6 months, no evidence of lameness was noted on the right thoracic limb.
* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.
가설 설정
Intraoperative photograph (A) and suture anchors (B). A: A tear of the medial glenohumeral ligament and a rupture of the subscapularis tendon are identified. B: Cortical (left) and cancellous (right) suture anchors are characterized by a narrow thread and by a relatively thin core and a wide and deep thread, respectively.
제안 방법
Owner was instructed to administer cefalexin (30 mg/kg orally twice daily; Cefacin®, Kyongbo. Co., Ltd, Korea ) for 11 days, firocoxib (5 mg/kg orally once daily; Previcox®; Merial, Frence) for 25 days, and tramadol (3 mg/kg orally twice daily; Tridol®; Yuhan. Co., Ltd, Korea) for 4 days postoperatively.
In addition, indications for each surgical technique are not well outlined. The purpose of this case report is to describe the clinical presentation and successful surgical management by use of a cancellous suture anchor and two cortical suture anchors in a dog with recurrent medial shoulder luxation and recommend indication for surgical management using bone anchors.
성능/효과
In conclusion, this case report described the clinical presentation and successful surgical management by use of three bone anchors in a dog with recurrent medial shoulder luxation. Surgical management using three bone anchors can be recommended in cases where previous surgical treatments fail to provide joint stabilization or in cases where transposition or imbrication of the muscle tendon is not available due to severe muscle atrophy caused by recurrent luxation.
참고문헌 (16)
Anvik JO, Gavin PR. Congenital shoulder luxation in a fox terrier. Can Vet J 1987; 28: 249-250.
Evans HE. Muscles of the thoracic limb. In: Miller's Anatomy of the Dog, 3rd ed. Philadelphia: WB Saunders. 1993: 321-349.
Fossum TW. Disease of the joints. In: Small animal surgery, 3rd ed. St. Louis: Mosby. 2007: 1183-1192.
Jang H, Lee B, Namkung MH, Yoon H, Han H, Kim J, Jeong S. Surgical stabilization of traumatic medial luxation of scapulohumeral joint and scapular fracture in a dog. J Vet Clin 2009; 26: 276-278.
Marcellin-Little DJ, Levine D, Canapp SO. The canine shoulder: selected disorders and their management with physical therapy. Clin Tech Small Anim Pract 2007; 22: 171-182.
Pettitt RA, Clements DN, Guilliard MJ. Stabilisation of medial shoulder instability by imbrications of the subscapularis muscle tendon of insertion. J Small Anim Pract 2007; 48: 626-631.
Post C, Guerrero T, Voss K, Montavon PM. Temporary transarticular stabilization with a locking plate for medial shoulder luxation in a dog. Vet Comp Orthop Traumatol 2008; 21: 166-170.
Rockwood CA, Matsen FA. Biomechanics of the shoulder. In: The shoulder, 2nd ed. Philadelphia: WB Saunders Co. 1998: 233-276.
Sidaway BK, McLaughlin RM, Elder SH, Boyle CR, Silverman EB. Role of the tendons of the biceps brachii and infraspinatus muscles and the medial glenohumeral ligament in the maintenance of passive shoulder joint stability in dogs. Am J Vet Res 2004; 65: 1216-1222.
AI-Helper
※ AI-Helper는 부적절한 답변을 할 수 있습니다.