Burns C G, Boudrieau R J
Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA 01536, USA.
Vet Comp Orthop Traumatol. 2008;21(3):250-5.
To describe a modification of the tibial tuberosity advancement (TTA) procedure that required tuberosity advancement in excess of 12 mm for the stabilization of cranial cruciate ligament (CrCL) deficient stifle joints.
Four large breed dogs with CrCL deficient stifle joints (one bilateral) underwent a modified TTA of 15 or 16 mm in order to obtain a patellar tendon angle of 90 degrees to the tibial plateau slope or common tangent between femur and tibia in the extended limb position. The desired TTA was achieved by displacing a 12-mm cage distally; this displacement distance was calculated from two similar triangles formed within the planned osteotomy site. An allogenous cancellous bone block placed proximal to the cage provided buttress support; a corticocancellous allograft filled the remainder of the gap. Tibial tuberosity fixation was performed as previously described.
Healing of the osteotomy defects with incorporation of the cancellous block was observed at a mean of 8.6 weeks postoperatively. Normal return of limb function was reported in all of the dogs except for one dog that underwent revision surgery four months postoperatively for a continued lameness. Technical errors at the time of the original surgical procedure in this dog resulted in insufficient tuberosity advancement; additional advancement was performed, which resolved the lameness.
Results in this series suggest that our modification of the TTA, in order to advance the tuberosity in excess of 12 mm, could be successfully obtained using the currently available implants.
描述一种改良的胫骨结节前移（TTA）手术方法，该方法需要将结节前移超过12毫米，以稳定颅交叉韧带（CrCL）缺失的 stifle 关节。
四只患有 CrCL 缺失 stifle 关节的大型犬（一只双侧患病）接受了15或16毫米的改良 TTA 手术，以便在伸展肢体位置时使髌腱与胫骨平台斜坡或股骨与胫骨之间的公切线形成90度角。通过将一个12毫米的笼子向远端移位来实现所需的 TTA；该移位距离是根据计划截骨部位内形成的两个相似三角形计算得出的。在笼子近端放置一块同种异体松质骨块提供支撑；一块皮质松质骨移植填充剩余的间隙。胫骨结节固定按先前描述的方法进行。
术后平均8.6周观察到截骨缺损愈合并伴有松质骨块融合。除一只犬术后四个月因持续跛行接受翻修手术外，所有犬的肢体功能均恢复正常。这只犬在初次手术时的技术失误导致结节前移不足；进行了额外的前移，解决了跛行问题。
本系列结果表明，我们改良的 TTA 方法，即结节前移超过12毫米，使用现有的植入物可以成功实现。
