Cook James L, Luther Jill K, Beetem Jodi, Karnes Josh, Cook Cristi R
Comparative Orthopaedic Laboratory, University of Missouri, Columbia, MO 65211, USA.
Vet Surg. 2010 Apr;39(3):315-23. doi: 10.1111/j.1532-950X.2010.00658.x. Epub 2010 Mar 19.
To develop and test a novel extracapsular technique, TightRope CCL technique (TR), and compare its 6-month clinical outcomes to tibial plateau leveling osteotomy (TPLO) in dogs with cranial cruciate ligament (CCL) deficiency.
Prospective clinical cohort study.
Medium, large, and giant breed dogs (n=47) with CCL deficiency.
Before clinical use, TR was evaluated by mechanical testing and the surgical technique was developed and evaluated in canine cadavers. For the clinical study, dogs were assigned to either TR (n=24) or TPLO (n=23) groups and the assigned technique performed after arthroscopic assessment and treatment of joint pathology. Postoperative management was standardized for both groups. Outcome measures were performed immediately postoperatively and up to 6 months after surgery and included complication types and rate, subjective measurement of cranial drawer and tibial thrust, subjective assessment of radiographic progression of osteoarthritis (OA), and function using a validated client questionnaire (6 months only).
TR with a fiber tape suture had superior mechanical properties for creep, stiffness, yield load, and load at failure. Duration of anesthesia, total surgical time, and stabilization procedure (TR versus TPLO) were all significantly (P<.001) shorter for TR compared with TPLO. Complications requiring further treatment occurred in 12.5% of TR cases and 17.4% of TPLO cases. No significant differences were noted between groups for cranial tibial thrust, but cranial drawer was significantly (P<.05) lower in TR stifles at all postoperative time points. No significant differences were noted between groups for radiographic OA scores. No statistically or clinically significant differences were noted between TR and TPLO for scores for each of the client questionnaire categories.
TR resulted in 6-month outcomes that were not different than TPLO in terms of radiographic progression of OA and client-evaluated level of function. TR was associated with shorter anesthesia and surgery times as well as a lower complication rate.
The TR technique is safe and effective and can be considered an appropriate surgical option as part of the overall treatment plan for CCL deficiency in dogs.
研发并测试一种新型关节囊外技术——TightRope交叉韧带技术(TR),并将其6个月的临床疗效与用于治疗犬颅侧交叉韧带(CCL)缺损的胫骨平台水平截骨术(TPLO)进行比较。
前瞻性临床队列研究。
患有CCL缺损的中型、大型和巨型犬(n = 47)。
在临床应用前,通过机械测试对TR进行评估,并在犬类尸体上研发和评估手术技术。对于临床研究,将犬分为TR组(n = 24)或TPLO组(n = 23),在关节镜评估和治疗关节病变后实施指定技术。两组术后管理均标准化。术后立即及术后长达6个月进行结果测量,包括并发症类型和发生率、颅侧抽屉试验和胫骨推力的主观测量、骨关节炎(OA)影像学进展的主观评估以及使用经过验证的客户问卷进行功能评估(仅6个月时)。
带纤维带缝线的TR在蠕变、刚度、屈服载荷和破坏载荷方面具有更好的力学性能。与TPLO相比,TR的麻醉持续时间、总手术时间和稳定手术(TR与TPLO)均显著缩短(P <.001)。12.5%的TR病例和17.4%的TPLO病例出现需要进一步治疗的并发症。两组在胫骨颅侧推力方面无显著差异,但在所有术后时间点,TR膝关节的颅侧抽屉试验结果均显著更低(P <.05)。两组在影像学OA评分方面无显著差异。TR和TPLO在客户问卷各分类评分方面,在统计学或临床上均无显著差异。
就OA的影像学进展和客户评估的功能水平而言,TR术后6个月的结果与TPLO无异。TR与更短的麻醉和手术时间以及更低的并发症发生率相关。
TR技术安全有效,可作为犬CCL缺损整体治疗计划的一部分,被视为一种合适的手术选择。