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犬跗关节不稳手术稳定后的短期和长期预后

Short and long-term outcome following surgical stabilization of tarsocrural instability in dogs.

作者信息

Beever Lee J, Kulendra Elvin R, Meeson Richard L

机构信息

Richard Meeson MA VetMB, MVetMed, DECVS, FHEA, MRCVS, Lecturer in Orthopaedic Surgery, The Royal Veterinary College, Queen Mother Hospital for Animals, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA, United Kingdom, Phone: +44 1707 666 366, E-mail:

出版信息

Vet Comp Orthop Traumatol. 2016;29(2):142-8. doi: 10.3415/VCOT-15-05-0083. Epub 2016 Feb 5.

Abstract

OBJECTIVES

To evaluate the outcome and complications following surgical stabilization of canine tarsocrural luxations.

METHODS

Medical records of dogs which were surgically treated for tarsocrural joint instability between February 2007 and June 2014 were reviewed. Surgical technique, complications and long-term outcome (via questionnaire and Canine Brief Pain Inventory) were assessed.

RESULTS

Twenty-four dogs (26 joints) were included. All injuries were traumatic. All joints had associated fractures; malleolar in 21/26 limbs (13/26 medial). Eight joints had internal fracture fixation and transarticular external skeletal fixator, six had external fixator alone, four had prosthetic ligaments with external fixator, and four had prosthetic ligaments with external coaptation. Two joints had pantarsal arthrodesis and two primary ligament repair. Complications occurred in 24/26 limbs giving 45 distinct complications; 16 were minor, 29 major, and 31 complications were external fixator associated. Prosthetic ligaments were significantly associated with major complications (p = 0.017); five out of eight required subsequent removal between 105-1006 days. Cost was significantly associated with major complications (p = 0.017) and soft tissue wounds (p = 0.03). Long-term lameness was seen in nine of 14 dogs. There was no association between pain severity (p = 0.3) and pain interference scores (p = 0.198) when comparing stabilization methods.

CLINICAL SIGNIFICANCE

Complications are common; however many are external fixator related. Prosthetic ligaments are significantly associated with major complications. Regardless of technique, a degree of ongoing lameness is likely.

摘要

目的

评估犬跗关节脱位手术固定后的结果及并发症。

方法

回顾2007年2月至2014年6月间因跗关节不稳定接受手术治疗的犬只的病历。评估手术技术、并发症及长期结果(通过问卷调查和犬简短疼痛量表)。

结果

纳入24只犬(26个关节)。所有损伤均为外伤性。所有关节均伴有骨折;21/26条肢体有踝关节骨折(13/26条肢体为内侧)。8个关节采用内固定和跨关节外固定支架,6个关节仅采用外固定支架,4个关节采用人工韧带联合外固定支架,4个关节采用人工韧带联合外部固定包扎。2个关节进行了跗关节融合术,2个关节进行了一期韧带修复。24/26条肢体出现并发症,共45种不同并发症;16种为轻微并发症,29种为严重并发症,31种并发症与外固定支架相关。人工韧带与严重并发症显著相关(p = 0.017);8个中有5个在105 - 1006天内需要后续取出。费用与严重并发症(p = 0.017)和软组织伤口(p = 0.03)显著相关。14只犬中有9只出现长期跛行。比较固定方法时,疼痛严重程度(p = 0.3)和疼痛干扰评分(p = 0.198)之间无相关性。

临床意义

并发症很常见;然而许多与外固定支架有关。人工韧带与严重并发症显著相关。无论采用何种技术,都可能会有一定程度的持续跛行。

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