소형견에서 전 십자인대 단열의 치료를 위한 경골 고평부 평탄 골절단술의 평가 Tibial Plateau Leveling Osteotomy for Treatment of Naturally Occurring Cranial Cruciate Ligament Rupture in Small Breed Dogs - Case Series원문보기
본 연구는 소형견에서 전 십자인대 단열에서 경골 고평부 평탄 골절단술로 치료된 증례의 예후와 수술적 기법에 대해 보고하고자 한다. 5 kg 미만의 7 마리의 성견에서 편측 전 십자인대 단열에서의 경골 고평부 평탄 골절단술을 이용한 증례를 본 연구에서 이용하였다. 임상적 관찰, 파행 지수, 관절의 운동 범위, 대퇴 둘래 길이를 측정하고 수술 후 부작용에 대해 기록하였다. 모든 환자에서 수술 후 1주에 파행 지수 1을 8주 이후에는 파행 지수 0를 보여 주었다. 수술한 다리의 펴짐각은 다른 쪽 정상 다리와 비교하여 4주에 98.11%로 8주에 99.07%로 12주에 98.73%로 측정되었고 굽힘각은 4주에 98.07%로 8주에 95.88%로 12주에 96.35%로 측정되었다. 수술 후 대퇴 둘레 길이는 다른쪽 정상 다리와 비교하여 4주에 92.95%를 8주에 93.68%를 12주에 95.44%를 보여 주었다. 우리가 수술 한 결과는 이전에 보고된 대형견에서 경골 고평부 평탄 골절단술의 이용 결과들과 비교하여 나쁘지 않은 결과를 보여 주었다. 본 증례를 바탕으로 대형견에서와 같이 소형견에서도 경골 고평부 평탄 골절단술이 전 십자인대 단열에서 성공적으로 사용될 수 있다고 사료된다.
본 연구는 소형견에서 전 십자인대 단열에서 경골 고평부 평탄 골절단술로 치료된 증례의 예후와 수술적 기법에 대해 보고하고자 한다. 5 kg 미만의 7 마리의 성견에서 편측 전 십자인대 단열에서의 경골 고평부 평탄 골절단술을 이용한 증례를 본 연구에서 이용하였다. 임상적 관찰, 파행 지수, 관절의 운동 범위, 대퇴 둘래 길이를 측정하고 수술 후 부작용에 대해 기록하였다. 모든 환자에서 수술 후 1주에 파행 지수 1을 8주 이후에는 파행 지수 0를 보여 주었다. 수술한 다리의 펴짐각은 다른 쪽 정상 다리와 비교하여 4주에 98.11%로 8주에 99.07%로 12주에 98.73%로 측정되었고 굽힘각은 4주에 98.07%로 8주에 95.88%로 12주에 96.35%로 측정되었다. 수술 후 대퇴 둘레 길이는 다른쪽 정상 다리와 비교하여 4주에 92.95%를 8주에 93.68%를 12주에 95.44%를 보여 주었다. 우리가 수술 한 결과는 이전에 보고된 대형견에서 경골 고평부 평탄 골절단술의 이용 결과들과 비교하여 나쁘지 않은 결과를 보여 주었다. 본 증례를 바탕으로 대형견에서와 같이 소형견에서도 경골 고평부 평탄 골절단술이 전 십자인대 단열에서 성공적으로 사용될 수 있다고 사료된다.
This study describes a surgical technique and evaluates the clinical outcomes in small breed dogs with cranial cruciate ligament rupture (CCLR) treated with tibial plateau leveling osteotomy (TPLO). Seven skeletally mature dogs weighing less than 15 kg underwent unilateral TPLO to stabilize the stif...
This study describes a surgical technique and evaluates the clinical outcomes in small breed dogs with cranial cruciate ligament rupture (CCLR) treated with tibial plateau leveling osteotomy (TPLO). Seven skeletally mature dogs weighing less than 15 kg underwent unilateral TPLO to stabilize the stifle joint with CCLR. Clinical evaluation was performed via visual lameness score, range of motion (ROM), and thigh girth circumference (TC). Postoperative complications were recorded. All patients reached a grade 1 score at 1 week and grade 0 at 8 weeks postoperatively. The mean operated limb extension angle was 98.11%, 99.07%, and 98.73% of the mean extension angle of the contralateral limb at 4 weeks, 8 weeks, and 12 weeks postoperatively, respectively. The mean operated limb flexion angle was 98.07%, 95.88%, and 96.35% of the mean flexion angle of the contralateral limb at 4 weeks, 8 weeks, and 12 weeks postoperatively, respectively. The mean TC of the operated limb was 92.95%, 93.68%, and 95.44% of the mean TC of the normal limb at 4 weeks, 8 weeks, and 12 weeks postoperatively, respectively. Our outcomes for TPLO in small breed dogs are not worse than those previously reported for large breed dogs. Based on the result in the present study, CCLR in small dogs can be successfully managed with TPLO, as done in large breed dogs.
This study describes a surgical technique and evaluates the clinical outcomes in small breed dogs with cranial cruciate ligament rupture (CCLR) treated with tibial plateau leveling osteotomy (TPLO). Seven skeletally mature dogs weighing less than 15 kg underwent unilateral TPLO to stabilize the stifle joint with CCLR. Clinical evaluation was performed via visual lameness score, range of motion (ROM), and thigh girth circumference (TC). Postoperative complications were recorded. All patients reached a grade 1 score at 1 week and grade 0 at 8 weeks postoperatively. The mean operated limb extension angle was 98.11%, 99.07%, and 98.73% of the mean extension angle of the contralateral limb at 4 weeks, 8 weeks, and 12 weeks postoperatively, respectively. The mean operated limb flexion angle was 98.07%, 95.88%, and 96.35% of the mean flexion angle of the contralateral limb at 4 weeks, 8 weeks, and 12 weeks postoperatively, respectively. The mean TC of the operated limb was 92.95%, 93.68%, and 95.44% of the mean TC of the normal limb at 4 weeks, 8 weeks, and 12 weeks postoperatively, respectively. Our outcomes for TPLO in small breed dogs are not worse than those previously reported for large breed dogs. Based on the result in the present study, CCLR in small dogs can be successfully managed with TPLO, as done in large breed dogs.
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가설 설정
Our purpose in this study was to describe the surgical technique in terms of those difficulties with small dogs and evaluate the outcomes of TPLO for the stabilization of CCLR in small dogs. Our hypothesis was that TPLO in small breed dogs would provide results for visual lameness score, stifle range of motion, and thigh girth circumference comparable to TPLO in large breed dogs and superior to ECR in small breed dogs.
제안 방법
Analgesia and antibiotics were provided in all cases with meloxicam (Medicox [0.1 mg/kg], Myungmoon Pharm Cl. LTD, Kyonggi-do, South Korea), tramadol (2 mg/kg two times daily, TRIDOL SOLUBLE TAB®, Grunenthal GmbH, Germany) given orally for 2 weeks, and cephalexin (15 mg/kg two times daily, Methilexin Inj®, Union Korea Pharm, Korea) for 1 week orally.
The surgical procedures for the treatment of CCLR in the present study were as follows. First, a thorough exploration of the stifle joint was performed using arthroscopy. Remnants of the injured cruciate ligament were identified and removed with grasping forceps.
Follow-up evaluation included 4, 8, 12, and 24 weeks reevaluation with visual lameness score, ROM, TC, and radiograph. Three patients had only 12 weeks of follow-up evaluation because their surgery happened less than 24 weeks before our analysis.
Although many studies have evaluated outcomes of TPLO in large breed dogs (3,6,17), few studies have assessed its results in small breed dogs, which present some technical difficulties to TPLO. Our purpose in this study was to describe the surgical technique in terms of those difficulties with small dogs and evaluate the outcomes of TPLO for the stabilization of CCLR in small dogs. Our hypothesis was that TPLO in small breed dogs would provide results for visual lameness score, stifle range of motion, and thigh girth circumference comparable to TPLO in large breed dogs and superior to ECR in small breed dogs.
The medical records were reviewed for breed, age, weight, sex, body condition score, limb affected, history of lameness, previous medications, method and result of surgery, and condition of the affected limb in the postoperative period. Physical examination, visual lameness score, thigh girth circumference (TC) measurement, measurement of stifle range of motion (ROM), and radiographic examination were performed.
Dogs were excluded if they didn’t meet the inclusion criteria or had a neurologic dysfunction. The medical records were reviewed for breed, age, weight, sex, body condition score, limb affected, history of lameness, previous medications, method and result of surgery, and condition of the affected limb in the postoperative period. Physical examination, visual lameness score, thigh girth circumference (TC) measurement, measurement of stifle range of motion (ROM), and radiographic examination were performed.
The surgical plan was performed using a digital templating software program (OrthoView Vet Orthopedic Digital Planning: OrthoView LLC, USA). A TPLO saw blade of appropriate size for each patient was located on the scaled radiographic image and positioned with being centering the saw over the intercondylar eminence (13).
대상 데이터
Dogs were included in the present study if they had hind limb lameness resulting from CCLR, weighed less than 15 kg, and were treated with TPLO at Chonbuk Animal Medical Center between August 2013 and May 2014. Dogs were excluded if they didn’t meet the inclusion criteria or had a neurologic dysfunction.
All of our patients showed higher percentage of ROM than previous reports and none of them lost more than 10º of ROM in extension or flexion.
In conclusion, technical difficulties associated with the size of small breed dogs can be overcome using arthroscopy and precise osteotomy with saw blade location determined using three measuring distances instead of two. Our outcomes of evaluation for TPLO in small breed dogs are not worse than those previously reported for large breed dogs.
In this retrospective study, all dogs presented their operated limb with a mean 5.56% decrease in TC, 1.27% decrease in extension, and 3.65% decrease in flexion at 12 weeks postoperatively. None were lame 4 weeks postoperatively.
The status of the cranial cruciate ligament included 5 complete CCLR (71.43%), 1 partial tear (14.29%), and 1 stretched ligament (14.29%). Conditions of medial meniscus included 3 no damage (42.
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