이 연구는 개에서 내측 슬개골 탈구 2도와 3도를 수술적으로 교정한 증례를 활차성형술 적용 여부에 따라 후향적으로 평가한 것이다. 본 후향 연구는 63마리의 개에서 68건의 수술한 케이스를 대상으로 하였으며, 합병증, 회복기간 및 방사선 검사로 퇴행성 관절 변화를 평가하였다. 수술 후 최소 3개월 이상 정기적으로 예후를 평가하였다. 합병증은 총 10.3% (7/68)의 재탈구와 1 케이스에서 경골조면 이식 실패를 확인하였다. 재탈구와 합병증 때문에 재수술을 요하는 경우는 활차성형술을 적용한 군에서는 3케이스(3/47, 6.4%), 활차성형술을 적용하지 않은 군에서는 1케이스(1/21, 4.8%)였다. 활차성형술을 적용하지 않은 군은 적용한 군에 비교하여 회복시간이 유의적으로 짧았고, 방사선 검사상 확인된 퇴행성 관절 변화에서 유의적인 차이를 보였다. 따라서, 2도와 3도의 내측 슬개골 탈구의 경우, 활차성형술을 적용하지 않는 수술방법이 수술적 예후를 향상 시킬 것으로 생각한다.
이 연구는 개에서 내측 슬개골 탈구 2도와 3도를 수술적으로 교정한 증례를 활차성형술 적용 여부에 따라 후향적으로 평가한 것이다. 본 후향 연구는 63마리의 개에서 68건의 수술한 케이스를 대상으로 하였으며, 합병증, 회복기간 및 방사선 검사로 퇴행성 관절 변화를 평가하였다. 수술 후 최소 3개월 이상 정기적으로 예후를 평가하였다. 합병증은 총 10.3% (7/68)의 재탈구와 1 케이스에서 경골조면 이식 실패를 확인하였다. 재탈구와 합병증 때문에 재수술을 요하는 경우는 활차성형술을 적용한 군에서는 3케이스(3/47, 6.4%), 활차성형술을 적용하지 않은 군에서는 1케이스(1/21, 4.8%)였다. 활차성형술을 적용하지 않은 군은 적용한 군에 비교하여 회복시간이 유의적으로 짧았고, 방사선 검사상 확인된 퇴행성 관절 변화에서 유의적인 차이를 보였다. 따라서, 2도와 3도의 내측 슬개골 탈구의 경우, 활차성형술을 적용하지 않는 수술방법이 수술적 예후를 향상 시킬 것으로 생각한다.
We evaluated outcomes of dogs surgically treated for grade 2 or 3 medial patellar luxation (MPL) with and without trochleoplasty. A retrospective study of 63 dogs with grade 2 or 3 MPL surgically treated with or without trochleoplasty was performed. Results of radiographic evaluation were expressed ...
We evaluated outcomes of dogs surgically treated for grade 2 or 3 medial patellar luxation (MPL) with and without trochleoplasty. A retrospective study of 63 dogs with grade 2 or 3 MPL surgically treated with or without trochleoplasty was performed. Results of radiographic evaluation were expressed numerically as degenerative joint disease score and were compared between the groups with and without trochleoplasty. The study included 7 (7/68, 10.3%) cases of reluxation and 1 case of tibial tuberosity transposition implant failure. Reluxation and complications requiring additional surgery were confirmed in 3 cases (3/47, 6.4%) in trochleoplasty group and in 1 case (1/21, 4.8%) in nontrochleoplasty group. The nontrochleoplasty group showed a shorter recovery time than the trochleoplasty group (P < 0.05). There was a significant difference in degenerative joint disease scores over time between the groups, with nontrochleoplasty group having lower scores (P < 0.05). This study suggests that surgical treatment without trochleoplasty results in favorable outcomes compared to treatment with trochleoplasty. It is not mandatory to exclude trochleoplasty when performing surgery for grade 2 or 3 MPL, but we propose that surgical treatment without trochleoplasty is one option when choosing a combination of surgical techniques.
We evaluated outcomes of dogs surgically treated for grade 2 or 3 medial patellar luxation (MPL) with and without trochleoplasty. A retrospective study of 63 dogs with grade 2 or 3 MPL surgically treated with or without trochleoplasty was performed. Results of radiographic evaluation were expressed numerically as degenerative joint disease score and were compared between the groups with and without trochleoplasty. The study included 7 (7/68, 10.3%) cases of reluxation and 1 case of tibial tuberosity transposition implant failure. Reluxation and complications requiring additional surgery were confirmed in 3 cases (3/47, 6.4%) in trochleoplasty group and in 1 case (1/21, 4.8%) in nontrochleoplasty group. The nontrochleoplasty group showed a shorter recovery time than the trochleoplasty group (P < 0.05). There was a significant difference in degenerative joint disease scores over time between the groups, with nontrochleoplasty group having lower scores (P < 0.05). This study suggests that surgical treatment without trochleoplasty results in favorable outcomes compared to treatment with trochleoplasty. It is not mandatory to exclude trochleoplasty when performing surgery for grade 2 or 3 MPL, but we propose that surgical treatment without trochleoplasty is one option when choosing a combination of surgical techniques.
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제안 방법
Preoperative cranio-caudal (A) and medial-lateral (E) radiographs from a representative dog in the trochleoplasty group. Postoperative radiographs taken one (B,F), two (C,G) and three (D,H) month after surgery, showing absolute DJD change of 6 during 3 months.
Preoperative cranio-caudal (A) and medial-lateral (E) radiographs from a representative dog in the non-trochleoplasty group. Postoperative radiographs taken one (B,F), two (C,G) and three (D,H) month after surgery, showing absolute DJD score change of 3 during 3 months.
The scores were calculated as the sum of individual scores (0 through 3) assigned to these 7 radiographic factors, with an individual score of 0 indicating no change in the factor, a score of 1 indicating mild changes, a score of 2 indicating moderate changes, and a score of 3 indicating severe changes. The investigators worked independently when evaluating the DJD scores and were blinded to the medical records of the animals and the scores assigned by the other investigator. The individual scores from the 2 investigators were averaged to obtain the DJD scores used in the statistical analyses.
The purpose of the present study was to identify cases not requiring trochleoplasty and to compare the complications, recovery time, and development of degenerative joint disease (DJD) in dogs treated with and without trochleoplasty.
Two standard radiographic views (craniocaudal and mediolateral) of the operated stifle joints were obtained from each case preoperatively and postoperatively every month for at least 3 months. The radiographic evaluation was expressed numerically as DJD scores, and these were assigned by two investigators. A modification of a previously reported DJD score system based on the criteria of de Rooster and van Bree was used to evaluate the level of OA on each radiograph (4,18).
The scores for the following 7 OA-related factors were used to obtain the DJD score (including osteophyte formation on the proximal and distal edge of the patella, subchondral sclerosis of the femoral trochear groove, osteophyte formation on the lateral and medial fabella, osteophyte formation at the tibial attachment site of the cranial cruciate ligament, subchondral sclerosis or osteophyte formation in the tibial plateau, subchondral sclerosis in the long digital extensor muscle groove, and osteophyte formation on the lateral and medial femoral condyle).
Two standard radiographic views (craniocaudal and mediolateral) of the operated stifle joints were obtained from each case preoperatively and postoperatively every month for at least 3 months. The radiographic evaluation was expressed numerically as DJD scores, and these were assigned by two investigators.
대상 데이터
Mean (SD) DJD scores of the trochleoplasty and nontrochleoplasty group at preoperative and 1st, 2nd, and 3rd month after surgery. Data were available for 36 cases in the trochleoplasty group and 23 cases in the nontrochleoplasty group. There was a significant difference between groups (repeated measures analysis of variance [ANOVA]; P < 0.
Sixty-three small breed dogs were included in this study. The female-to-male ratio was about 1:1.
Dogs had previously undergone surgical treatments for MPL at other animal hospitals were also excluded. The final study comprised 63 dogs.
This study included 7 (7/68 [10.3%]) cases of patellar luxation recurrence and 1 case of patellar reluxation with TTT implant failure. The luxation grade at the time of recurrence was recorded in all the cases.
데이터처리
The DJD scores of the groups surgically treated with and without trochleoplasty 3 months after the surgery were analyzed statistically using the repeated measures analysis of variance [ANOVA] test. In addition, Pearson correlations and paired t-tests were used to assess the degree of agreement between the 2 investigators with respect to the DJD scores. For dogs that had bilateral surgery, data for the first stifle joint operated on were used for all the statistical analyses to avoid violations of the assumption of statistical independence.
The Kruskal-Wallis test and the Mann-Whitney test were used to compare the recovery time depending on the preoperative grade and whether the group had undergone trochleoplasty. The DJD scores of the groups surgically treated with and without trochleoplasty 3 months after the surgery were analyzed statistically using the repeated measures analysis of variance [ANOVA] test. In addition, Pearson correlations and paired t-tests were used to assess the degree of agreement between the 2 investigators with respect to the DJD scores.
이론/모형
Chicago, IL, UDS). The Kruskal-Wallis test and the Mann-Whitney test were used to compare the recovery time depending on the preoperative grade and whether the group had undergone trochleoplasty. The DJD scores of the groups surgically treated with and without trochleoplasty 3 months after the surgery were analyzed statistically using the repeated measures analysis of variance [ANOVA] test.
성능/효과
In the cases where trochleoplasty was not performed, the mean preoperative DJD score was 3.2 ± 0.9, and the mean postoperative scores were 5.1 ± 1.2, 6.3 ± 1.4, and 7.2 ± 1.5 at the 1st, 2nd, and 3rd month after surgery, respectively (Fig 2).
In this study, factors influencing complications after surgery, such as the level of client’s education and the animal’s exercise restriction, may have been well controlled.
Until now, ensuring the alignment of the extensor mechanism and the proper depth of the trochlear groove has been considered important to correct MPL. The findings of this study suggest that surgical treatment without trochleoplasty can result in successful outcomes, especially in grade 2 and 3 MPL, considering postoperative complications, the progression of DJD, and the recovery time. It is not mandatory to exclude trochleoplasty when performing surgery for MPL, but we propose that it is one of the options to be considered when choosing a combination of surgical techniques for better outcomes.
후속연구
In addition, the preoperative depth of the femoral trochlear groove and the damaged area of the trochlear groove after the trochleoplasty performed were not measured. Further research including a longer radiographic follow-up period is needed to confirm whether the progression of OA is substantially affected by trochleoplasty. Furthermore, dogs in such study should be randomly assigned to each group.
In this study, we did not try the surgical procedure without trochleoplasty to the cases whose patella was luxated laterally. Therefore, further research is required to verify if the surgical procedure could be applied to those cases.
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