AniCura Kleintierklinik Babenhausen GmbH, Alpenstraße 27, Babenhausen, Bavaria, 87727, Germany.
Vet Rec. 2022 Apr;190(7):e1069. doi: 10.1002/vetr.1069. Epub 2021 Nov 6.
Until recent years, arthroscopic subtotal coronoidectomy has been the universally accepted treatment for medial coronoid disease but has variable clinical outcomes. The aim of this study was to evaluate the completeness of arthroscopic medial coronoid debridement and to detect the most vulnerable location of failure.
Eighty-three dogs with a diagnosis of medial coronoid disease were included in the study. Arthroscopic debridement was performed in 92 elbow joints, and the completeness of removal was assessed by postoperative computed tomography scans.
Pathological changes were confined to the coronoid apex in 92/92 (100%) of cases and combined with radial incisure lesions in 39/92 (42%). Apical lesions were completely removed in 66/92 (72%) of cases and radial incisure lesions in 2/39 (5%). Bony remnants were detected at the apex (46%) and base (24%) of the medial coronoid process, free within the elbow joint (9%), and/or within the instrument port (84%). Fissures were positively associated with the occurrence of bony remnants (p = 0.038) and a 37% higher probability of incomplete removal of radial incisure lesions (p = 0.001).
In this study, incomplete removal was more likely to occur in the presence of radial incisure lesions. Thorough assessment of this region during arthroscopy is strongly recommended.
直到近年来，关节镜下部分冠突切除术一直是公认的治疗内侧冠突疾病的方法，但临床结果存在差异。本研究旨在评估关节镜下内侧冠突清创术的彻底性，并发现最容易失败的位置。
本研究纳入了 83 只被诊断为内侧冠突疾病的犬。对 92 个肘关节进行了关节镜下清创术，并通过术后计算机断层扫描评估清除的完整性。
92/92（100%）病例的病理改变局限于冠突顶端，39/92（42%）病例同时伴有桡切迹病变。66/92（72%）病例的冠突顶端病变被完全清除，39 例中的 2 例（5%）桡切迹病变被清除。在 46%的病例中，在冠突内侧突的顶端和 24%的病例中在基底部发现骨残端，在 9%的病例中，骨残端游离于肘关节内，在 84%的病例中，骨残端位于器械端口内。裂隙与骨残端的发生呈正相关（p=0.038），且桡切迹病变不完全清除的概率增加 37%（p=0.001）。
在本研究中，桡切迹病变的存在更可能导致清除不彻底。强烈建议在关节镜检查中彻底评估该区域。
