James D R, Webster N, White J D, Marchevsky A M, Cashmore R G, Havlicek M, Fearnside S, Black A P
a Surgery Department , Small Animal Specialist Hospital , Level 1/1 Richardson Place, North Ryde , NSW , Australia.
b Darkroom Veterinary Imaging , St Georges Crescent , Heatherton , Vic , Australia.
N Z Vet J. 2017 Sep;65(5):270-276. doi: 10.1080/00480169.2017.1345336. Epub 2017 Jul 5.
To objectively compare measures of bone healing, using computed tomography (CT) in dogs following bilateral tibial tuberosity advancement (TTA), between tibiae treated with and without autogenous cancellous bone grafts.
Ten dogs with bilateral cranial cruciate ligament disease requiring surgical stabilisation were prospectively recruited to undergo single-session bilateral TTA, with only one, randomly assigned, tibia receiving bone graft in the osteotomy deficit. Bone healing at the osteotomy site was assessed using CT performed 38-70 days post-operatively. CT images were evaluated using both objective measurements of osseous bridging and subjective evaluation by six radiologists. Repeated measures ANOVA was used to compare the objective outcomes between the grafted and non-grafted tibiae.
The mean percentage of the osteotomy deficit bridged at the lateral cortex was greater in grafted (77.6, SD 35.2%) compared to non-grafted (63.0, SD 36.5%) tibiae (p=0.001), but did not differ at the medial cortex (p=0.1). The mean minimum callus width was greater in grafted (7.2, SD 3.3 mm) compared to non-grafted (3.6, SD 2.9 mm) tibiae (p<0.001). There was no difference in mean attenuation (measured in Hounsfield units) of the callus between grafted and non-grafted tibiae (p=0.5). The grafted tibia was deemed to have superior bone healing in 50/60 subjective assessments made by radiologists.
Superior osseous bridging was detected by CT analysis following TTA using autogenous cancellous bone grafts compared with no graft. This was shown by greater bridging percentage at the lateral cortex and formation of a broader callus. Qualitative assessments made by six radiologists also supported the conclusion that bone healing was improved by use of autogenous cancellous bone graft. CT was a useful method for assessing evidence of bone healing following TTA.
These findings justify the application of autogenous cancellous bone graft to augment healing following TTA in dogs.
使用计算机断层扫描（CT）客观比较双侧胫骨结节前移术（TTA）后犬只胫骨在使用和未使用自体松质骨移植情况下的骨愈合情况。
前瞻性招募10只患有双侧颅交叉韧带疾病需要手术稳定的犬只，进行单次双侧TTA，仅一侧胫骨（随机分配）在截骨缺损处接受骨移植。术后38 - 70天使用CT评估截骨部位的骨愈合情况。CT图像通过骨桥接的客观测量以及6位放射科医生的主观评估进行评价。采用重复测量方差分析比较移植和未移植胫骨之间的客观结果。
与未移植胫骨（63.0，标准差36.5%）相比，移植胫骨外侧皮质截骨缺损处的骨桥接平均百分比更高（77.6，标准差35.2%）（p = 0.001），但在内侧皮质无差异（p = 0.1）。与未移植胫骨（3.6，标准差2.9 mm）相比，移植胫骨的平均最小骨痂宽度更大（7.2，标准差3.3 mm）（p < 0.001）。移植和未移植胫骨的骨痂平均衰减（以亨氏单位测量）无差异（p = 0.5）。在放射科医生进行的60次主观评估中，50次认为移植胫骨的骨愈合更好。
与未使用移植相比，使用自体松质骨移植进行TTA后，通过CT分析检测到更好的骨桥接。这表现为外侧皮质更高的桥接百分比和更宽骨痂的形成。6位放射科医生的定性评估也支持使用自体松质骨移植可改善骨愈合的结论。CT是评估TTA后骨愈合证据的有用方法。
这些发现证明了自体松质骨移植在犬只TTA后促进愈合中的应用合理性。
