Levet T, Martens A, Devisscher L, Duchateau L, Bogaert L, Vlaminck L
Department of Large Animal Surgery and Anaesthesiology, Ghent University, Salisburylaan 133, B-9820 Merelbeke, Belgium.
Equine Vet J. 2009 Jan;41(1):18-23. doi: 10.2746/042516408x343046.
There is a lack of evidence-based data on the prevalence, outcome and risk factors of distal limb cast sores, and no objective tool has been described for the early detection of cast sores.
To investigate the prevalence, location, outcome and risk factors of cast sores after application of a distal limb cast and to determine whether static thermography of the cast is a valuable tool for the assessment of sores.
A prospective study was conducted on horses treated with a distal limb cast. At each cast removal, cast sores were graded as superficial sores (SS), deep dermal sores (DS) or full thickness skin ulcerations (FS). In several cases, a thermographic evaluation of the cast was performed immediately prior to removal and differences in temperature (AT) between the coolest point of the cast and 2 cast regions predisposed for sore development (dorsoproximal mc/mtIII and palmar/plantar fetlock) were calculated.
Mean +/- s.d. total casting time of 70 horses was 31 +/- 18 days. Overall, 57 legs (81%) developed at least SS. Twenty-four legs (34%) ultimately developed DS and one horse had an FS. Multivariable analysis showed that the severity of sores was positively associated with increasing age (OR: 1.111, P = 0.028), a normal (vs. swollen) limb (OR: 3387, P = 0.023) and an increase in total casting time (OR per week: 1.363, P = 0.002). The thermographic evaluation (35 casts) revealed that the severity of sores was positively associated with increasing deltaT (OR: 2.100, P = 0.0005). The optimal cut-off values for the presence of SS and DS were set at, respectively, deltaT = 23 and 43 degrees C.
Distal limb cast is a safe coaptation technique with increasing risk of developing sores with time. Thermography is a valuable and rapid clinical tool to monitor the development of cast sores.
目前缺乏关于远端肢体石膏压疮的患病率、转归及危险因素的循证数据，且尚无用于早期检测石膏压疮的客观工具。
调查远端肢体石膏固定后压疮的患病率、部位、转归及危险因素，并确定石膏的静态热成像是否为评估压疮的有效工具。
对接受远端肢体石膏固定治疗的马匹进行前瞻性研究。每次拆除石膏时，将石膏压疮分为浅表性压疮（SS）、深部真皮压疮（DS）或全层皮肤溃疡（FS）。在某些病例中，拆除石膏前立即对石膏进行热成像评估，并计算石膏最凉点与2个易发生压疮部位（背近端掌骨/跖骨III和掌侧/跖侧系关节）之间的温度差（ΔT）。
70匹马的平均±标准差总石膏固定时间为31±18天。总体而言，57条腿（81%）至少发生了浅表性压疮。24条腿（34%）最终发展为深部真皮压疮，1匹马发生了全层皮肤溃疡。多变量分析显示，压疮严重程度与年龄增加（比值比：1.111，P = 0.028）、肢体正常（与肿胀相比）（比值比：3387，P = 0.023）及总石膏固定时间增加（每周比值比：1.363，P = 0.002）呈正相关。热成像评估（35个石膏）显示，压疮严重程度与ΔT增加呈正相关（比值比：2.100，P = 0.0005）。浅表性压疮和深部真皮压疮存在的最佳截断值分别设定为ΔT = 23和43℃。
远端肢体石膏固定是一种安全的固定技术，但随着时间推移发生压疮的风险增加。热成像是监测石膏压疮发展的一种有价值且快速的临床工具。
