Harris Karen P, Langley-Hobbs Sorrel J
Department of Veterinary Medicine, Cambridge Veterinary School, University of Cambridge, Cambridge, CB3 0ES, England.
J Am Vet Med Assoc. 2013 Dec 15;243(12):1746-50. doi: 10.2460/javma.243.12.1746.
A 6-year-old neutered female mixed-breed dog was evaluated because of a 6-week history of left forelimb lameness that varied in severity.
Radiography revealed expansile and lytic changes of the left accessory carpal bone (ACB). Results of histologic evaluation of ACB core biopsy specimens indicated areas of bone necrosis. The entire left ACB was excised and submitted for histologic evaluation; results confirmed a diagnosis of idiopathic ischemic necrosis.
Left pancarpal arthrodesis was performed to treat carpal hyperextension and persistent lameness. The dog had an excellent functional outcome with no other problems related to the carpus until its death 4 years later, further decreasing suspicion that the problem was attributable to an undetected neoplasm or bacterial or fungal osteomyelitis.
The radiographic and histologic findings for the dog of this report were similar to previously reported findings for dogs with ischemic femoral head necrosis and humans with ischemic carpal (pisiform or lunate bone) necrosis. The etiology of the ischemic ACB necrosis in this dog was not determined. To the authors' knowledge, this is the first report of a dog with idiopathic ischemic ACB necrosis. Idiopathic ischemic necrosis should be included as a differential diagnosis for dogs with lameness and destructive and expansile ACB radiographic lesions. An excellent functional outcome may be attained by means of ACB excision and pancarpal arthrodesis.
一只6岁已绝育的雌性混种犬因左前肢跛行6周前来评估，跛行严重程度不一。
X线摄影显示左副腕骨（ACB）有膨胀性和溶解性改变。ACB核心活检标本的组织学评估结果显示存在骨坏死区域。切除了整个左ACB并送去做组织学评估；结果证实诊断为特发性缺血性坏死。
进行了左全腕关节固定术以治疗腕关节过度伸展和持续跛行。这只狗功能恢复良好，直到4年后死亡，腕关节未出现其他问题，这进一步降低了怀疑该问题是由未检测到的肿瘤或细菌或真菌性骨髓炎引起的可能性。
本报告中这只狗的X线摄影和组织学检查结果与先前报道的患有缺血性股骨头坏死的犬以及患有缺血性腕骨（豌豆骨或月骨）坏死的人类的检查结果相似。这只狗缺血性ACB坏死的病因尚未确定。据作者所知，这是首例关于特发性缺血性ACB坏死犬的报告。特发性缺血性坏死应作为跛行且ACB有破坏性和膨胀性X线摄影病变的犬的鉴别诊断之一。通过ACB切除和全腕关节固定术可获得良好的功能结果。
