Talaat Miriam B, Kowaleski Michael P, Boudrieau Randy J
Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA.
Vet Surg. 2006 Dec;35(8):729-39. doi: 10.1111/j.1532-950X.2006.00217.x.
To describe a surgical technique, and outcome, for treatment of cranial cruciate ligament (CrCL) deficient stifle joints with excessive tibial plateau angle (TPA) by combined tibial plateau leveling osteotomy and cranial closing wedge osteotomy (TPLO/CCWO).
Retrospective clinical study.
Fifteen client-owned dogs (18 stifle joints).
Medical records of dogs that had TPLO/CCWO were reviewed. Pre- and postoperative TPA, CCWO technique, method of fixation and complications were recorded. In-hospital re-evaluation of limb function and length of time to radiographic healing was reviewed. Long-term outcome was assessed by owner telephone interview.
Mean pre- and postoperative TPA was 42 degrees and 8 degrees, respectively. The Slocum biradial saw was used to create the CCWO in 4 stifle joints (mean postoperative TPA, 16 degrees) and a sagittal saw was used in 14 stifle joints (mean postoperative TPA, 5 degrees). Postoperative surgical complications were documented in 77.8% of cases; including patellar tendon thickening (61.1%), and implant loosening or breakage (27.8%), seroma formation (11.1%), and local irritation (11.1%). A second surgical procedure was performed in one-third of cases primarily to retrieve implants. Mean time to documented radiographic healing was 18 weeks. Final in-hospital re-evaluation of limb function (mean, 23 weeks postoperatively) was recorded as no lameness in 73.3% and mild lameness in 26.7%. All interviewed owners were satisfied with outcome and 90.9% reported marked improvement or a return to preinjury status.
Long-term clinical outcome of TPLO/CCWO was very good in dogs with excessive TPA, with high owner satisfaction. Longer healing times and a higher complication rate were observed compared with TPLO alone.
TPLO/CCWO of the tibia in stifle joints with excessive TPA allows for full correction of the TPA to 5 degrees without eliminating buttress support of the tibial tuberosity.
描述一种通过联合胫骨平台平整截骨术和颅侧闭合楔形截骨术（TPLO/CCWO）治疗胫骨平台角（TPA）过大且颅侧十字韧带（CrCL）缺失的 stifle 关节的手术技术及结果。
回顾性临床研究。
15 只客户拥有的犬（18 个 stifle 关节）。
回顾接受 TPLO/CCWO 手术的犬的病历。记录术前和术后的 TPA、CCWO 技术、固定方法及并发症。回顾住院期间肢体功能的重新评估情况以及影像学愈合所需时间。通过主人电话访谈评估长期结果。
术前和术后 TPA 的平均值分别为 42 度和 8 度。4 个 stifle 关节使用 Slocum 双桡锯进行 CCWO（术后 TPA 平均值为 16 度），14 个 stifle 关节使用矢状锯（术后 TPA 平均值为 5 度）。77.8%的病例记录了术后手术并发症；包括髌腱增厚（61.1%）、植入物松动或断裂（27.8%）、血清肿形成（11.1%）和局部刺激（11.1%）。三分之一的病例进行了二次手术，主要目的是取出植入物。影像学愈合记录的平均时间为 18 周。住院期间肢体功能的最终重新评估（平均术后 23 周）显示，73.3%的犬无跛行，26.7%的犬有轻度跛行。所有接受访谈的主人对结果满意，90.9%的主人报告有显著改善或恢复到受伤前状态。
对于 TPA 过大的犬，TPLO/CCWO 的长期临床结果非常好，主人满意度高。与单纯 TPLO 相比，观察到愈合时间更长且并发症发生率更高。
对于 TPA 过大的 stifle 关节，胫骨的 TPLO/CCWO 可将 TPA 完全矫正至 5 度，同时不消除胫骨结节的支撑作用。
