Bergh Mary Sarah, Rajala-Schultz Päivi, Johnson Kenneth A
Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210-1089, USA.
Vet Surg. 2008 Jun;37(4):374-82. doi: 10.1111/j.1532-950X.2008.00391.x.
To evaluate factors that predispose to tibial tuberosity (TT) fracture after tibial plateau leveling osteotomy (TPLO) in dogs.
Retrospective study.
Dogs (n=182) with cranial cruciate ligament (CCL) rupture undergoing 213 TPLO surgeries.
Medical records and radiographs of 2 groups of dogs that had TPLO surgery (2000-2001, 2004-2005) were evaluated to determine the effect of operative technique and surgeon experience on TT fracture.
TT fracture was diagnosed in 8 dogs (9 TPLO, 4.2% of surgical procedures). Four fractures occurred after unilateral TPLO in 167 dogs (2.4%), 4 fractures occurred after simultaneous bilateral TPLO in 5 dogs (40%), and 1 fracture occurred after staged bilateral TPLO in 36 dogs (2.8%). Simultaneous bilateral TPLO resulted in a 12.4 times higher odds of TT fracture versus unilateral TPLO (P=.046). The mean absolute thickness of the TT after TPLO was less in dogs sustaining TT fractures (7.2 +/- 2.2 mm) than those that did not (10.8 +/- 2.7 mm, P<.0001). The odds of fracture decreased by 37% when the absolute TT width postosteotomy increased by 1 mm (P<.0001). An increase in tibial plateau angle at follow-up versus immediately postoperative was associated with TT fracture (P=.025). Surgeon experience was not associated with TT fracture.
A combination of surgical decision-making and surgical technique play a role in the occurrence of TT fracture after TPLO. Simultaneous bilateral TPLO was associated with a high percentage of TT fracture.
Careful planning of osteotomy positioning is advised while performing TPLO surgery.
评估犬胫骨平台水平截骨术（TPLO）后易导致胫骨结节（TT）骨折的因素。
回顾性研究。
182只患有颅侧交叉韧带（CCL）断裂并接受213次TPLO手术的犬。
评估两组接受TPLO手术的犬（2000 - 2001年、2004 - 2005年）的病历和X光片，以确定手术技术和外科医生经验对TT骨折的影响。
8只犬（9次TPLO手术，占手术例数的4.2%）被诊断为TT骨折。167只犬单侧TPLO术后发生4例骨折（2.4%），5只犬双侧同时TPLO术后发生4例骨折（40%），36只犬分期双侧TPLO术后发生1例骨折（2.8%）。双侧同时TPLO导致TT骨折的几率比单侧TPLO高12.4倍（P = 0.046）。发生TT骨折的犬TPLO术后TT的平均绝对厚度（7.2±2.2毫米）小于未发生骨折的犬（10.8±2.7毫米，P < 0.）。截骨术后TT绝对宽度每增加1毫米，骨折几率降低37%（P < 0.）。随访时胫骨平台角度较术后即刻增加与TT骨折相关（P = 0.025）。外科医生经验与TT骨折无关。
手术决策和手术技术的综合因素在TPLO术后TT骨折的发生中起作用。双侧同时TPLO与TT骨折的高发生率相关。
建议在进行TPLO手术时仔细规划截骨位置。
