Brower Barry E, Kowaleski Michael P, Peruski Ann M, Pozzi Antonio, Dyce Jonathan, Johnson Kenneth A, Boudrieau Randy J
Michael P. Kowaleski, DVM, Diplomate ACVS/ECVS, Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, 200 Westboro Road, North Grafton, MA 01536, USA, Phone: +1 508 887 4659, E-mail:
Vet Comp Orthop Traumatol. 2017 Jan 16;30(1):20-27. doi: 10.3415/VCOT-16-07-0103. Epub 2016 Dec 9.
To describe a cohort of dogs with medial patellar luxation managed with a distal femoral lateral closing wedge ostectomy (DFO) as a component of comprehensive treatment, and to report radiographic and long-term clinical outcome of this technique.
Medical records of dogs that had a lateral closing wedge DFO as part of management of medial patellar luxation at three veterinary teaching hospitals were reviewed. Surgical reports as well as the preoperative, postoperative, and follow-up radiographs were reviewed. The anatomical lateral distal femoral angle (aLDFA) was determined. Long-term clinical outcome was assessed by telephone interview with the owner.
A lateral closing wedge DFO was performed on 66 limbs. The mean pre- and postoperative aLDFA was 107.6° ± 5.8° and 94.1° ± 4.2°, respectively. Cranial cruciate ligament disease was identified in 28/66 affected limbs. Tibial angular deformity, torsional deformity, or both was identified in nine of the 66 limbs. Ostectomy healing was confirmed radiographically in 51/66 limbs. The mean time to union was 73 ± 37 days. All patellae were in the normal position and stable. Complications included infection (2/51), fixation failure (1/51), delayed healing (2/51), and persistent lameness (1/51).
In this cohort of cases, DFO was a highly successful and repeatable component of surgical treatment for dogs with medial patellar luxation associated with femoral varus. This study also provides more evidence of the high rate of concurrent cranial cruciate ligament disease in cases of medial patellar luxation complicated by femoral varus, and supports an association between stifle instability and medial patellar luxation.
描述一组采用股骨远端外侧闭合楔形截骨术（DFO）作为综合治疗一部分来处理内侧髌骨脱位的犬只，并报告该技术的放射学和长期临床结果。
回顾了三家兽医教学医院将外侧闭合楔形DFO作为内侧髌骨脱位治疗一部分的犬只病历。查阅了手术报告以及术前、术后和随访的X光片。测定了解剖学上的股骨远端外侧角（aLDFA）。通过与犬主电话访谈评估长期临床结果。
对66条肢体实施了外侧闭合楔形DFO。术前和术后aLDFA的平均值分别为107.6°±5.8°和94.1°±4.2°。在66条患肢中有28条发现了前交叉韧带疾病。66条肢体中有9条发现了胫骨角畸形、扭转畸形或两者皆有。66条肢体中有51条经X光片证实截骨愈合。平均愈合时间为73±37天。所有髌骨均处于正常位置且稳定。并发症包括感染（2/51）、固定失败（1/51）、愈合延迟（2/51）和持续跛行（1/51）。
在这组病例中，DFO是治疗与股骨内翻相关的内侧髌骨脱位犬只手术治疗中一项非常成功且可重复的组成部分。本研究还提供了更多证据，证明在合并股骨内翻的内侧髌骨脱位病例中并发前交叉韧带疾病的发生率很高，并支持膝关节不稳定与内侧髌骨脱位之间的关联。
