Singh Harpreet, Kowaleski Michael P, McCarthy Robert J, Boudrieau Randy J
Randy J. Boudrieau DVM, Diplomate ACVS and ECVS, Department of Clinical Sciences, Tufts University School of Veterinary Medicine, 200 Westboro Road, North Grafton, MA 01536, United States, Phone: +1 508 839 7960, E-mail:
Vet Comp Orthop Traumatol. 2016;29(1):53-60. doi: 10.3415/VCOT-15-03-0051. Epub 2015 Oct 29.
Retrospective comparison of dorsolateral (DLA) and ventrolateral (VLA) surgical approaches for treatment of canine sacroiliac luxation using three different radiographic analyses.
Surgical cases with immediate and ≥4 week postoperative radiographs were reviewed (Jan. 2000 to Jan. 2015). Exactness of reduction, screw position, and sacral body screw purchase were assessed with three separate methods: single plane assessment and orthogonal assessment with or without rotational limits.
The reduction index (RI) for DLA and VLA was not significantly different with single plane assessment (p = 0.0789), but it was significantly greater for DLA than VLA with orthogonal assessment, with or without rotational limits (p = 0.0039, p = 0.0146). No differences were observed with screw placement into the intended location (single plane, and orthogonal assessment with or without rotational limits; p = 0.2941, p = 0.4151, p = 0.3550, respectively). No differences were observed between mean screw purchase index (SPI) and the 60% goal for the DLA (p = 0.1303, p = 0.9594, p = 0.7120) or 50% goal for the VLA (p = 0.2224, p = 0.1401, p = 0.2224; single plane, and orthogonal assessment with or without rotational limits). Implant loosening was present in four DLA cases and one VLA case. No differences were observed in the number of cases or number of screws that loosened (p = 0.3483 and p = 0.6873, respectively).
The key factor demonstrated in maintaining screw and fixation stability was correct screw placement within the sacral body, regardless of the surgical approach.
采用三种不同的影像学分析方法，对背外侧（DLA）和腹外侧（VLA）手术入路治疗犬骶髂关节脱位进行回顾性比较。
回顾2000年1月至2015年1月期间有即刻及术后≥4周X线片的手术病例。采用三种不同方法评估复位的准确性、螺钉位置及骶骨体螺钉的把持情况：单平面评估以及有无旋转限制的正交评估。
单平面评估时，DLA和VLA的复位指数（RI）无显著差异（p = 0.0789），但在有无旋转限制的正交评估中，DLA的RI显著高于VLA（p = 0.0039，p = 0.0146）。螺钉置入预期位置方面未观察到差异（单平面及有无旋转限制的正交评估；p分别为0.2941、0.4151、0.3550）。DLA的平均螺钉把持指数（SPI）与60%目标值之间无差异（p = 0.1303，p = 0.9594，p = 0.7120），VLA与50%目标值之间也无差异（p = 0.2224，p = 0.1401，p = 0.2224；单平面及有无旋转限制的正交评估）。4例DLA病例和1例VLA病例出现植入物松动。松动病例数及松动螺钉数均无差异（p分别为0.3483和0.6873）。
无论采用何种手术入路，维持螺钉及固定稳定性的关键因素是将螺钉正确置入骶骨体内。
