The Royal Veterinary College, North Mymms, Hatfield, UK.
Equine Vet J. 2022 Nov;54(6):1103-1113. doi: 10.1111/evj.13531. Epub 2021 Dec 13.
The evaluation of hindlimb lameness remains a major challenge in everyday clinical practice. In the absence of clear guidelines, veterinarians use different visual assessment methods for this task whose robustness is unknown.
Determination of the robustness of five visual hindlimb lameness assessment methods based on the comparison of left and right tuber coxae movement.
Validated mathematical hindlimb lameness model based on experimental data from the literature.
Vertical movement of left (LTC) and right (RTC) tuber coxae was simulated for the range of common hindlimb lameness movement patterns that horses present within practice. Lameness severity ranged from sound to moderately lame (0% to 60% motion asymmetry). The scenarios of a pelvis held tilted and asymmetrical pelvic roll were included to reflect possible adaptations in pelvic rotation. Across all conditions, the outcomes for five different visual assessment methods based on comparative tubera coxarum movement were quantified, including hip hike, -drop and range of motion. The robustness of each assessment method was established through comparison to sacrum-based overall motion asymmetry as the ground truth.
Tubera coxarum-based lameness assessment was highly sensitive to all the unique lameness patterns and changes in pelvic rotation which a lame horse may adopt. None of the five visual lameness assessment methods was 100% robust across all conditions tested. For everyday clinical practice, comparing the upward movement amplitude of the RTC before right hind foot contact and of the LTC before left hind foot contact (Hip_hike_diff) would be the most robust single tubera coxarum-based visual assessment method.
In the absence of published data regarding the frequency of different movement patterns and hip rotation adaptations in clinical practice, this study cannot indicate the proportion of assessments that would be incorrect for a given visual assessment method.
Using a single tubera coxarum-based visual hindlimb lameness assessment method may lead to incorrect clinical judgement. Therefore, using multiple assessment methods would be beneficial to substantiate impressions.
后肢跛行的评估在日常临床实践中仍然是一项重大挑战。由于缺乏明确的指导方针,兽医在评估时会使用不同的视觉评估方法,但这些方法的稳健性尚不清楚。
确定基于比较左右坐骨结节运动的五种视觉后肢跛行评估方法的稳健性。
基于文献中实验数据的验证数学后肢跛行模型。
模拟了常见的后肢跛行运动模式范围内的左(LTC)和右(RTC)坐骨结节的垂直运动,马匹在实践中会呈现这些运动模式。跛行严重程度从健康到中度跛行(0%至 60%运动不对称)不等。包括骨盆倾斜和不对称骨盆滚动的情况,以反映骨盆旋转的可能适应性。在所有条件下,对基于比较坐骨结节运动的五种不同视觉评估方法的结果进行了量化,包括髋关节抬高、下降和运动范围。通过与基于骶骨的整体运动不对称性(作为真实值)的比较,确定了每种评估方法的稳健性。
基于坐骨结节的跛行评估对跛行马可能采用的所有独特跛行模式和骨盆旋转变化都非常敏感。在所有测试条件下,五种视觉跛行评估方法中没有一种方法是 100%稳健的。对于日常临床实践,比较右后蹄着地前 RTC 的向上运动幅度和左后蹄着地前 LTC 的向上运动幅度(Hip_hike_diff)可能是最稳健的单个坐骨结节基于视觉的评估方法。
由于缺乏关于不同运动模式和髋关节旋转适应性在临床实践中的频率的已发表数据,因此本研究无法表明给定视觉评估方法会有多少评估结果是不正确的。
使用单个基于坐骨结节的视觉后肢跛行评估方法可能会导致不正确的临床判断。因此,使用多种评估方法将有助于证实印象。