Neville-Towle Jack D, Makara Mariano, Johnson Kenneth A, Voss Katja
University Veterinary Teaching Hospital, Sydney, Faculty of Veterinary Science, University of Sydney, Sydney, NSW, 2006, Australia.
BMC Vet Res. 2017 Jan 9;13(1):18. doi: 10.1186/s12917-017-0942-6.
Cranial cruciate ligament insufficiency is a common orthopaedic problem in canine patients. This cadaveric and radiographic study was performed with the aim of determining the effect of proximal translation of the tibial tuberosity during tibial tuberosity advancement (TTA) on patellar position (PP) and patellar ligament angle (PLA).
Disarticulated left hind limb specimens harvested from medium to large breed canine cadavers (n = 6) were used for this study. Limbs were mounted to Plexiglass sheets with the stifle joint fixed in 135° of extension. The quadriceps mechanism was mimicked using an elastic band. Medio-lateral radiographs were obtained pre-osteotomy, after performing TTA without proximal translation of the tibial tuberosity, and after proximal translation of the tibial tuberosity by 3mm and 6mm. Radiographs were blinded to the observer for distance of tibial tuberosity proximalization following radiograph acquisition. Three independent observers recorded PP and PLA (tibial plateau method and common tangent method). Comparisons were made between the stages of proximalization using repeated measures ANOVA. Patellar position was found to be significantly more distal than pre-osteotomy, if the tibial tuberosity was not translated proximally (P = 0.001) and if it was translated proximally by 3mm (P = 0.005). The difference between pre-osteotomy PP and 6mm proximalization was not significant. The PLA was significantly larger if the tibial tuberosity was not translated proximally compared to tibial tuberosity proximalization of 6mm using the tibial plateau and the common tangent methods (P = 0.006 and P = 0.015 respectively).
Proximalizing the tibial tuberosity during TTA helps in maintaining vertical position of the patella in the patellar groove. Proximalization of the tibial tuberosity reduces PLA when compared to TTA without tibial tuberosity proximalization.
颅交叉韧带功能不全是犬类患者常见的骨科问题。本尸体和影像学研究旨在确定胫骨结节前移术（TTA）过程中胫骨结节近端移位对髌骨位置（PP）和髌韧带角度（PLA）的影响。
本研究使用从大中型犬尸体（n = 6）采集的离体左后肢标本。将肢体安装在有机玻璃板上， stifle关节固定在135°伸展位。使用弹性带模拟股四头肌机制。在截骨术前、进行无胫骨结节近端移位的TTA后以及胫骨结节近端移位3mm和6mm后获取内外侧X线片。在获取X线片后，观察者对胫骨结节近端移位的距离进行盲法观察。三名独立观察者记录PP和PLA（胫骨平台法和公切线法）。使用重复测量方差分析对近端移位阶段进行比较。发现如果胫骨结节未向近端移位（P = 0.001）以及如果向近端移位3mm（P = 0.005），髌骨位置比截骨术前明显更靠下。截骨术前PP与6mm近端移位之间的差异不显著。与使用胫骨平台法和公切线法的6mm胫骨结节近端移位相比，如果胫骨结节未向近端移位，PLA明显更大（分别为P = 0.006和P = 0.015）。
在TTA过程中使胫骨结节向近端移位有助于维持髌骨在髌槽中的垂直位置。与无胫骨结节近端移位的TTA相比，胫骨结节近端移位可降低PLA。
