Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA.
Vet J. 2013 Apr;196(1):86-91. doi: 10.1016/j.tvjl.2012.08.003. Epub 2012 Sep 16.
Ex vivo studies have been used extensively to investigate the mechanisms of tibial osteotomies but few have explored femorotibial alignment in vivo. The aim of this study was to assess femorotibial joint alignment under static weight-bearing conditions (and subsequent outcome) in dogs treated for cranial cruciate ligament (CrCL) insufficiency with tibial tuberosity advancement (TTA). Twenty-five dogs (30 stifles) with CrCL insufficiency treated by TTA were included. The distance from the origin to insertion of the CrCL (CrCLd) was measured on non-weight-bearing immediate post-operative radiographs and weight-bearing follow-up radiographs. CrCLd values were compared using a paired t test. The relationship between change in CrCLd (ΔCrCLd) and post-operative patellar tendon angle according to the common tangent method (PTACT) was assessed using Pearson's correlation. Outcome was assessed with an owner-completed questionnaire, and peak vertical force (PVF) and vertical impulse (VI) as percentages of bodyweight (BW). Following TTA, 21/30 stifles were persistently subluxated at a follow-up of 18 ± 14 months (mean ± SD). Follow-up weight-bearing CrCLd was greater (P<0.001) than post-operative non-weight-bearing CrCLd, with a mean ΔCrCLd of 5.8 ± 3.4mm (16 ± 10%). Post-operative PTACT was 89 ± 3° and did not correlate with ΔCrCLd (r=0.002, P=0.994). Mean PVF and VI were 65 ± 10% BW and 9±2% BW, respectively. All owners felt TTA provided improvement in lameness. The results indicated that TTA does not normalize sagittal plane femorotibial stability during standing at a PTACT of 90°, but most dogs return to good limb function regardless of femorotibial alignment.
体外研究已广泛用于研究胫骨截骨术的机制，但很少有研究探索体内股胫关节对线。本研究旨在评估接受胫骨结节前移术（TTA）治疗前十字韧带（CrCL）不足的犬在静态负重条件下（及随后的结果）股胫关节对线。纳入 25 只（30 个膝关节）接受 TTA 治疗的 CrCL 不足的犬。在非负重术后即刻和负重随访 X 线片上测量 CrCL 起点到止点的距离（CrCLd）。使用配对 t 检验比较 CrCLd 值。使用 Pearson 相关评估根据公切线法（PTACT）的 CrCLd 变化（ΔCrCLd）与术后髌腱角的关系。使用主人完成的问卷评估结果，并以体重百分比（BW）表示峰值垂直力（PVF）和垂直冲击力（VI）。在 TTA 后，18 ± 14 个月随访时，30 个膝关节中有 21 个持续半脱位。负重随访时的 CrCLd 大于（P<0.001）非负重术后的 CrCLd，平均 ΔCrCLd 为 5.8 ± 3.4mm（16 ± 10%）。术后 PTACT 为 89 ± 3°，与 ΔCrCLd 无相关性（r=0.002，P=0.994）。平均 PVF 和 VI 分别为 65 ± 10% BW 和 9 ± 2% BW。所有主人都认为 TTA 改善了跛行。结果表明，TTA 不能使站立时的胫骨结节前移术达到 90°的矢状面股胫关节稳定性正常化，但大多数犬无论股胫关节对线如何，都能恢复良好的肢体功能。
