Wright Linda, Puchalski Sarah M, Kristoffersen Mads, Lindegaard Casper
Evidensia Equine Hospital Helsingborg, Helsingborg, Sweden.
Circle Oak Equine, Petaluma, CA.
Vet Surg. 2018 Aug;47(6):756-767. doi: 10.1111/vsu.12932. Epub 2018 Jul 13.
To develop arthroscopic approaches to the atlanto-occipital (A-O) and describe associated arthroscopic anatomy.
Experimental ex vivo study and clinical case report.
Ten equine cadaver joints and 1 clinical case.
CT arthrograms of 8 A-O joints were performed to determine the placement of an arthroscopic portal. Arthroscopy was performed via dorsal and/or ventral approaches (dorsal or ventral to the longissimus capitis tendon) in 10 cadaveric A-O joints and the A-O joint of a 2-week-old foal with septic arthritis. Accessible cartilage was debrided in 3 cadaver joints. Accessibility and risks were assessed by review of arthroscopic images, postoperative necropsy, and computed tomography (CT).
Dorsal and ventral outpouchings of the A-O joint were identified with CT. Arthroscopy of the dorsal pouch provided access to 50% of the dorsocranial occipital condyle and 15% of the dorsocranial atlas articular surfaces. Joint distension caused displacement of the dura. Dura perforation occurred with a blind dorsal approach in 2 of 5 joints. Dura perforation did not occur after ultrasonography-guided approaches. Arthroscopic debridement of septic arthritis and osteomyelitis was successful in 1 clinical case.
Approaches to the A-O joint were determined from CT examinations. The cranial aspect of the dorsal pouch of the A-O joint was accessed via arthroscopic triangulation in all horses of this study. Ultrasound-guided joint access prevented perforation of vital structures, including the spinal canal.
Advanced imaging improves the diagnosis of A-O joint pathology. Descriptions of arthroscopic anatomy and accessibility provide important information for surgical intervention.
开发寰枕关节（A - O）的关节镜入路并描述相关的关节镜解剖结构。
体外实验研究和临床病例报告。
10个马尸体关节和1例临床病例。
对8个A - O关节进行CT关节造影以确定关节镜入口的位置。在10个尸体A - O关节以及1匹患有化脓性关节炎的2周龄马驹的A - O关节中，通过背侧和/或腹侧入路（在头最长肌腱的背侧或腹侧）进行关节镜检查。在3个尸体关节中对可触及的软骨进行清创。通过回顾关节镜图像、术后尸检和计算机断层扫描（CT）评估入路的可行性和风险。
CT识别出A - O关节的背侧和腹侧隐窝。背侧隐窝的关节镜检查可观察到枕髁背侧颅部50%的区域以及寰椎背侧颅部关节面15%的区域。关节扩张导致硬脑膜移位。5个关节中有2个采用盲法背侧入路时发生了硬脑膜穿孔。超声引导入路后未发生硬脑膜穿孔。1例临床病例中，关节镜下对化脓性关节炎和骨髓炎的清创成功。
通过CT检查确定了A - O关节的入路。在本研究的所有马匹中，通过关节镜三角测量法进入了A - O关节背侧隐窝的颅侧部分。超声引导下的关节入路可防止包括椎管在内的重要结构穿孔。
先进的影像学检查可改善A - O关节病变的诊断。关节镜解剖结构和可及性的描述为手术干预提供了重要信息。
