Kim Jihye, Jeong Jaemin, Lee Haebeom
Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Chungnam National University, Daejeon, 34134, South Korea.
BMC Vet Res. 2019 Jan 23;15(1):35. doi: 10.1186/s12917-019-1779-y.
Hip arthroscopy has become a viable option over the last few years for small animal orthopedic diseases, including hip dysplasia, osteoarthritis, and joint evaluation. However, the narrow joint spaces make it difficult to manipulate the instrument, and depth of tissues make it difficult to distract the joint space. In addition, it is very difficult to maintain consistent distraction over time with a manual distraction due to hand fatigue. To overcome these difficulties, distractors are used in human medicine to improve safety and accuracy of arthroscopy. Therefore, in this study, distractor devices were applied to hip joints in small toy breed dogs to evaluate their technical efficacy. Potential iatrogenic neurovascular and articular damage were also evaluated by comparing two techniques for performing hip joint arthroscopy: the self-retaining distractor and external manipulation.
The mean ± SD of the joint distraction distance was 8.88 ± 3.54 mm in the self-retaining distraction group and 2.37 ± 0.82 mm in the manual traction group. As the joint space increased, surgeons could more easily place an arthroscopy portal and more comfortably manipulate the instrument with a distractor device. Furthermore, the acetabular cartilage damage (p = 0.004) was significantly greater in the external manipulation group, but articular damage to the femoral head (p = 0.940) was similar in both groups.
The results of this study revealed that use of a distractor device can be a viable option for performing hip arthroscopy in small animals. The device significantly improved the surgeon's performance without surgical assistance, and it reduced iatrogenic cartilage damage compared with manual traction. Further study is needed to quantify neurapraxia associated with distractor placement.
在过去几年中，髋关节镜检查已成为治疗小动物骨科疾病（包括髋关节发育不良、骨关节炎和关节评估）的一种可行选择。然而，狭窄的关节间隙使得器械操作困难，组织深度使得关节间隙难以牵开。此外，由于手部疲劳，手动牵开很难长时间保持一致的牵开效果。为克服这些困难，牵开器在人类医学中用于提高关节镜检查的安全性和准确性。因此，在本研究中，将牵开器装置应用于小型玩具犬的髋关节，以评估其技术效果。还通过比较两种进行髋关节镜检查的技术：自固定牵开器和外部手法操作，评估了潜在的医源性神经血管和关节损伤。
自固定牵开组的关节牵开距离平均值±标准差为8.88±3.54毫米，手动牵引组为2.37±0.82毫米。随着关节间隙增加，外科医生使用牵开器装置更容易放置关节镜入口，并且更舒适地操作器械。此外，外部手法操作组的髋臼软骨损伤（p = 0.004）明显更大，但两组股骨头的关节损伤（p = 0.940）相似。
本研究结果表明，使用牵开器装置可能是在小动物中进行髋关节镜检查的一种可行选择。该装置在无需手术辅助的情况下显著提高了外科医生的操作性能，并且与手动牵引相比减少了医源性软骨损伤。需要进一步研究来量化与牵开器放置相关的神经失用症。
