Lee Jiyun, Sim Heedong, Jeong Jaemin, Kim Sun-Young, Yang Seokjo, Jeong SeongMok, Lee HaeBeom
Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 34134, Daejeon, Republic of Korea.
Department of Mechatronics Engineering, College of Engineering, Chungnam National University, 34134, Daejeon, Republic of Korea.
BMC Vet Res. 2020 Dec 3;16(1):471. doi: 10.1186/s12917-020-02644-5.
BACKGROUND: Femoral varus deformities complicating the realignment of the quadriceps muscles are frequently associated with medial patellar luxation (MPL) in dogs. Therefore, distal femoral osteotomy (DFO) is recommended in dogs affected with severe MPL and a distal femoral varus deformity. The presence of an anatomic lateral distal femoral angle (aLDFA) of ≥ 102° has been anecdotally recommended as an indication for performing corrective DFO in large-breed dogs. However, the effect of a femoral varus deformity on MPL has not been scientifically evaluated. We aimed to evaluate the influence of a femoral varus deformity on MPL using a finite element method based computer model. Three-dimensionally reconstructed computed tomographic images of a normal femur from a Beagle dog were deformed using meshing software to create distal varus deformities. A total of thirteen aLDFAs, including 95°, 98° and 100°-110°, were simulated. The patellar positions and reaction force between the patella and trochlear grooves were calculated for all finite element models under constant rectus femoris muscle activation. RESULTS: The patella was displaced medially from the trochlear groove at an aLDFA of ≥103°. With an aLDFA of 103° to 110°, the reaction force was equal to zero and then decreased to negative values during the simulation, while other models with aLDFAs of 95°, 98°, and 100°-102° had positive reaction force values. The patella began to luxate at 24.90 seconds (sec) with an aLDFA of 103°, 19.80 sec with an aLDFA of 104°, 21.40 sec with an aLDFA of 105°, 20.10 sec with an aLDFA of 106°, 18.60 sec with an aLDFA of 107°, 15.30 sec with an aLDFA of 108°, 16.60 sec with an aLDFA of 109°, and 11.90 sec with an aLDFA of 110°. CONCLUSION: Severe distal femoral varus with an aLDFA of ≥103° caused MPL when other anatomical factors were controlled. Thissimplified computer model provides complementary information to anecdotal cutoffs for DFO, hence it should be applied to clinical patients with caution.
背景:股四头肌重新排列时并发的股骨内翻畸形常与犬的内侧髌骨脱位(MPL)相关。因此,对于患有严重MPL和股骨远端内翻畸形的犬,建议进行股骨远端截骨术(DFO)。传闻建议,大型犬的解剖学外侧远端股骨角(aLDFA)≥102°作为进行矫正性DFO的指征。然而,股骨内翻畸形对MPL的影响尚未得到科学评估。我们旨在使用基于有限元方法的计算机模型评估股骨内翻畸形对MPL的影响。使用网格软件对一只比格犬正常股骨的三维重建计算机断层扫描图像进行变形,以创建远端内翻畸形。总共模拟了13个aLDFA,包括95°、98°以及100° - 110°。在股直肌恒定激活下,计算所有有限元模型的髌骨位置以及髌骨与滑车沟之间的反作用力。 结果:当aLDFA≥103°时,髌骨从滑车沟向内侧移位。在模拟过程中,aLDFA为103°至110°时,反作用力等于零,然后降至负值,而aLDFA为95°、98°以及100° - 102°的其他模型具有正的反作用力值。当aLDFA为103°时,髌骨在24.90秒开始脱位;aLDFA为104°时,在19.80秒脱位;aLDFA为105°时,在21.40秒脱位;aLDFA为106°时,在20.10秒脱位;aLDFA为107°时,在18.60秒脱位;aLDFA为108°时,在15.30秒脱位;aLDFA为109°时,在16.60秒脱位;aLDFA为110°时,在11.90秒脱位。 结论:当控制其他解剖因素时,aLDFA≥103°的严重股骨远端内翻会导致MPL。这个简化的计算机模型为DFO的经验性临界值提供了补充信息,因此应谨慎应用于临床患者。
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