Shields Georgette E, Whitcomb Mary Beth, Vaughan Betsy, Wisner Erik R
William R. Pritchard Veterinary Medical Teaching Hospital, University of California, Davis, One Shields Avenue, Davis, CA, 95616.
Department of Surgical and Radiological Sciences, University of California, Davis, One Shields Avenue, Davis, CA, 95616.
Vet Radiol Ultrasound. 2015 Sep-Oct;56(5):466-73. doi: 10.1111/vru.12262. Epub 2015 Apr 27.
Injuries involving the femoral third trochanter are an uncommon but important source of equine lameness; however, clinical localization can be challenging. The purpose of this retrospective study was to describe ultrasonographic and scintigraphic findings in a group of horses with presumed third trochanter injury. Medical records of an equine referral hospital were searched from 2004-2014, and 20 horses met the inclusion criteria. Lesions consistent with third trochanter fracture were identified with ultrasound in 14/20 horses. Onset of lameness was acute (11), insidious (2), or unknown (1). All but one horse was lame at presentation, ranging from Grade 2-4/5. Ultrasound was the primary diagnostic modality in 5/14 horses with fragmentation, while scintigraphic findings of intense (3), moderate (5), and mild (1) increased radiopharmaceutical uptake (IRU) prompted ultrasonographic examinations in 9/14 fractured horses. A nondisplaced fracture was suspected in an additional horse with intense IRU and negative ultrasound findings. In the remaining five horses, imaging findings included only mild IRU. Lameness was localized to other regions in these cases. Six of 12 fractured horses with available outcome data were returned to function after a prolonged rehabilitation of 8-18 months. Scintigraphic findings helped to direct focused ultrasound exams in the majority of fracture cases. Horses with evidence of third trochanter fracture had similar clinical characteristics to that reported for pelvic fractures and authors therefore recommend ultrasonographic examination of both regions, especially when scintigraphy is unavailable. Prognosis for return to function in horses of the current study was less favorable than previously reported.
涉及股骨第三转子的损伤是马跛行的一个罕见但重要的原因；然而，临床定位可能具有挑战性。这项回顾性研究的目的是描述一组疑似第三转子损伤的马匹的超声和闪烁显像结果。检索了一家马转诊医院2004年至2014年的病历，有20匹马符合纳入标准。在20匹马中有14匹通过超声发现了与第三转子骨折相符的病变。跛行的发作是急性的（11例）、隐匿性的（2例）或不明的（1例）。除一匹马外，所有马在就诊时均跛行，跛行程度为2 - 4/5级。在14匹有骨折碎片的马中，5匹以超声作为主要诊断方式，而在14匹骨折马中，9匹因闪烁显像显示放射性药物摄取增加（IRU）强烈（3例）、中度（5例）和轻度（1例）而进行了超声检查。另一匹IRU强烈但超声检查结果为阴性的马被怀疑有未移位骨折。在其余5匹马中，影像学检查结果仅显示轻度IRU。在这些病例中，跛行定位于其他区域。在12匹有骨折且有可用预后数据的马中，6匹经过8 - 18个月的长期康复后恢复了功能。在大多数骨折病例中，闪烁显像结果有助于指导针对性的超声检查。有第三转子骨折证据的马具有与骨盆骨折报道相似的临床特征，因此作者建议对这两个区域进行超声检查，尤其是在无法进行闪烁显像时。本研究中马匹恢复功能的预后比先前报道的要差。
