Watts Ashlee E, Fortier Lisa A, Nixon Alan J, Ducharme Norm G
Cornell University Hospital for Animals, Cornell University, Ithaca, NY 14853, USA.
Vet Surg. 2010 Feb;39(2):244-53. doi: 10.1111/j.1532-950X.2009.00627.x.
To report a technique for laser-facilitated, minimally invasive proximal interphalangeal joint (PIJ) arthrodesis in horses.
Case series.
Horses (n=6); 5 thoracic and 2 pelvic limb PIJ.
PIJ osteoarthritis (OA) diagnosis was confirmed by radiography. A diode laser was used to apply 2000 J of energy to the joint followed by insertion of 3 parallel 5.5 mm screws in lag fashion through stab incisions to achieve PIJ arthrodesis. After anesthetic recovery, limbs were maintained in bandages (n=2) or bandage casts (5) for 3 weeks. Horses were allowed exercise or turnout by 3 months.
Three horses (4 limbs) were sound throughout follow-up (6-18 months). One horse remained lame the 1st month, another had mild lameness at pasture at 6 weeks, and another had persistent low-grade lameness and delayed joint fusion (1 year). Within 6 months, 5 horses were sound, 4 had radiographic evidence of successful joint fusion, and 5 had returned to intended use.
Diode laser-facilitated, 3 parallel screw arthrodesis for PIJ OA costs less and is associated with less pain compared with standard, open PIJ arthrodesis using 3 parallel screws inserted in lag fashion.
In horses with advanced PIJ OA, this technique appears to be a viable alternative for PIJ arthrodesis. Further study including characterization of the effects of the laser, ideal case selection indications, and optimal laser dose is indicated before this technique is recommended for routine PIJ arthrodesis.
报告一种用于马近端指间关节(PIJ)激光辅助微创关节固定术的技术。
病例系列。
马(n = 6);5个胸肢和2个盆肢的PIJ。
通过X线摄影确诊PIJ骨关节炎(OA)。使用二极管激光向关节施加2000焦耳能量,然后通过小切口以拉力方式插入3根平行的5.5毫米螺钉以实现PIJ关节固定。麻醉恢复后,肢体用绷带(n = 2)或石膏绷带(5)固定3周。3个月后允许马运动或放牧。
3匹马(4个肢体)在整个随访期间(6 - 18个月)均无跛行。1匹马在第1个月仍有跛行,另一匹马在6周时在牧场有轻度跛行,另一匹马有持续性轻度跛行和关节融合延迟(1年)。6个月内,5匹马无跛行,4匹马有影像学证据表明关节融合成功,5匹马恢复到预期用途。
与使用拉力方式插入3根平行螺钉的标准开放性PIJ关节固定术相比,二极管激光辅助的用于PIJ OA的3根平行螺钉关节固定术成本更低且疼痛更少。
在患有晚期PIJ OA的马中,该技术似乎是PIJ关节固定术的一种可行替代方法。在推荐该技术用于常规PIJ关节固定术之前,需要进一步研究,包括激光效果的特征、理想病例选择指征和最佳激光剂量。