Treatment of Quadriceps Contracture with Femoral Shortening Ostectomy, Rectus Femoris Muscle Transposition and Dynamic Stifle Flexion Apparatus in a Dog원문보기
Roh, Yoon-Ho
(College of Veterinary Medicine, Chungnam National University)
,
Choi, Min-Ho
(College of Veterinary Medicine, Chungnam National University)
,
Lee, Je-Hun
(College of Veterinary Medicine, Chungnam National University)
,
Mok Jeong, Seong
(College of Veterinary Medicine, Chungnam National University)
,
Lee, HaeBeom
(College of Veterinary Medicine, Chungnam National University)
A 13-month-old, 3.3 kg castrated male Shih-tzu presented with right hindlimb lameness. The physical examination revealed atrophy of the right thigh muscles, hyperextension of the stifle joint and external torsion of the tibia. On the radiographic examination, patella alta and genu recurvatum were ob...
A 13-month-old, 3.3 kg castrated male Shih-tzu presented with right hindlimb lameness. The physical examination revealed atrophy of the right thigh muscles, hyperextension of the stifle joint and external torsion of the tibia. On the radiographic examination, patella alta and genu recurvatum were observed. A biapical deformity of the tibia and external torsion of the distal tibia were detected by computed tomography (CT). A three-dimensional (3D) printed bone model was designed and constructed for the preoperative plan prior to surgery. Rectus femoris muscle transposition, femoral shortening ostectomy and open wedge osteotomy of the distal tibia were performed using hybrid external skele/t0al fixation (hybrid-ESF). A dynamic stifle flexion apparatus was used to prevent recurrence of a quadriceps contracture (QC). Intense physiotherapy was administered postoperatively. The dog began to use the affected limb one week after surgery. Functional improvement in the affected limb was observed, and full weight-bearing was possible at 3 months after surgery. Union of the osteotomy lines was observed at 3 months, and the stifle joint was fully movable at 7 months after surgery. Regarding the treatments for QC, these methods may be excellent candidates, as they do not lead to severe damage to the limb or amputation.
A 13-month-old, 3.3 kg castrated male Shih-tzu presented with right hindlimb lameness. The physical examination revealed atrophy of the right thigh muscles, hyperextension of the stifle joint and external torsion of the tibia. On the radiographic examination, patella alta and genu recurvatum were observed. A biapical deformity of the tibia and external torsion of the distal tibia were detected by computed tomography (CT). A three-dimensional (3D) printed bone model was designed and constructed for the preoperative plan prior to surgery. Rectus femoris muscle transposition, femoral shortening ostectomy and open wedge osteotomy of the distal tibia were performed using hybrid external skele/t0al fixation (hybrid-ESF). A dynamic stifle flexion apparatus was used to prevent recurrence of a quadriceps contracture (QC). Intense physiotherapy was administered postoperatively. The dog began to use the affected limb one week after surgery. Functional improvement in the affected limb was observed, and full weight-bearing was possible at 3 months after surgery. Union of the osteotomy lines was observed at 3 months, and the stifle joint was fully movable at 7 months after surgery. Regarding the treatments for QC, these methods may be excellent candidates, as they do not lead to severe damage to the limb or amputation.
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문제 정의
This report demonstrates that femoral shortening osteotomy and rectus femoris transposition are suitable treatment options for QC in dogs.
This report describes the successful outcomes of surgical treatment involving femoral shortening ostectomy, rectus femoris transposition, and a dynamic stifle flexion apparatus in patients with quadriceps contracture. Short- and long-term clinical outcomes are reported.
제안 방법
Therefore, the technique described in this paper cannot be recommended as a first line of treatment but should be reserved for cases in which function of the limb can be partially restored. Additional research needs to be conducted to establish more detailed guidelines for quadriceps contracture treatment.
Although the treatment options depend on the severity of the disease, salvage techniques such as arthrodesis or amputation are indicated for the nonfunctional limb (10,11). For the case presented here, rectus femoris muscle transposition and femoral shortening ostectomy were performed. These techniques have the advantages of yielding minimal damage to muscles and restoring stifle joint flexion.
In a previous report, normal gait was maintained when the femoral length was reduced by as much as 20% (17). The aim of surgery is to restore the function of the limb by releasing the contracted limb rather than reconstructing the anatomic shape of the bone, thus promoting weight bearing of the patient.
Intense physiotherapy was performed postoperatively. The goal was to improve the range of motion of the stifle joint, decrease the fibrotic change in the muscles.
In the radiographic examinations, patella alta, medial patella luxation and coxofemoral subluxation or luxation are detected in most patients, and genu recurvatum is observed in extreme cases (3,8). The reported treatment options include conservative management or surgery. Although early detection and restoration of mobility through physiotherapy are considered the gold standard for the treatment of QC, surgical correction may be required in progressive cases.
대상 데이터
A 13-month-old, 3.3 kg castrated male Shih-tzu presented at Chungnam National University Veterinary Medicine Teaching Hospital with intermittent right hindlimb nonweight bearing lameness and hyperextension of the stifle joint. Hyperextension of the right stifle commenced after dystocia with posterior presentation at birth.
성능/효과
At 7 months, the thigh girth measurement improved from 74% to 84% on the affected limb compared to the contralateral limb [Table 1], and the ROM of the stifle joint improved (80º in flexion and 204º in extension).
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