Rosen Sydney, Duerr Felix Michael, Elam Lindsay Hochman
Department of Clinical Sciences, Colorado State University College of Veterinary Medicine and Biomedical Sciences, Fort Collins, CO, United States.
Front Vet Sci. 2022 Jul 29;9:892662. doi: 10.3389/fvets.2022.892662. eCollection 2022.
The use of orthoses and prostheses is expanding in veterinary medicine. However, research evaluating the efficacy and complications of these devices in veterinary patients is limited. The primary objective of this study was to prospectively determine the complications and outcomes associated with custom orthosis and prosthesis use in the canine patient.
This was a prospective, clinical trial that followed patients for 12 months following device fitting. Owner-perceived complications, clinical metrology instruments, and objective gait analysis were used as outcome measures at various time points. The patients were grouped into the following four major categories: Patients with a carpal orthosis, patients with a stifle orthosis, patients with a tarsal orthosis, and patients with a prosthetic device.
Forty-three patients were included in the study. Thirty-nine out of 43 patients (91%) experienced at least one complication, with 7/7 (100%) prosthesis patients experiencing at least one complication. At least one skin complication was reported for the following patient groups during the first 3 months of use: 8/14 (58%) stifle orthoses, 9/10 (90%) carpal orthoses, 6/10 (60%) tarsal orthoses, and 4/7 (58%) prostheses. Patient non-acceptance of the device was identified in 2/15 (14%) stifle orthoses, 1/10 (10%) tarsal orthoses, and 4/7 (55%) prostheses. One out of 15 (7%) stifle orthoses, 4/10 (40%) carpal orthoses, 4/10 (40%) tarsal orthoses, and 1/7 (15%) prostheses experienced mechanical device problems necessitating repair. The majority of patients with carpal and stifle orthoses showed improvement on objective gait analysis in percent body weight distribution of the affected limb between baseline and the most recent follow-up without the device donned: 83% ( = 6) of patients with carpal orthoses, 100% ( = 11) of patients with stifle orthoses. None of the patients with tarsal orthoses showed a similar improvement (0%; = 4).
Three major complications associated with canine orthosis and prosthesis use were identified in this study as follows: Skin complications (abrasions, loss of hair, and sores), mechanical device problems, and patient non-acceptance of the device. Owners should be notified of these potential complications prior to pursuing orthoses or prostheses as a potential treatment option. Although clinical improvement was noted in the majority of patients with stifle and carpal pathology, given the lack of a control group, it is unknown how much of this improvement can be attributed to the orthoses.
矫形器和假肢在兽医学中的应用正在不断扩大。然而，评估这些装置在兽医患者中的疗效和并发症的研究有限。本研究的主要目的是前瞻性地确定犬类患者使用定制矫形器和假肢的并发症及结果。
这是一项前瞻性临床试验，在装置安装后对患者进行12个月的随访。在不同时间点，将主人感知到的并发症、临床计量仪器和客观步态分析用作结果指标。患者被分为以下四大类：腕关节矫形器患者、膝关节矫形器患者、跗关节矫形器患者和假肢装置患者。
43例患者纳入本研究。43例患者中有39例（91%）至少经历了一种并发症，7例（100%）假肢患者至少经历了一种并发症。在使用的前3个月内，以下患者组报告了至少一种皮肤并发症：8/14（58%）膝关节矫形器患者、9/10（90%）腕关节矫形器患者、6/10（60%）跗关节矫形器患者和4/7（58%）假肢患者。在2/15（14%）膝关节矫形器患者、1/10（10%）跗关节矫形器患者和4/7（55%）假肢患者中发现患者对装置不接受。15例（7%）膝关节矫形器患者、4/10（40%）腕关节矫形器患者、4/10（40%）跗关节矫形器患者和1/7（15%）假肢患者出现了需要维修的机械装置问题。大多数腕关节和膝关节矫形器患者在客观步态分析中显示，在基线与最近一次未佩戴装置的随访之间，患侧肢体的体重分布百分比有所改善：83%（n = 6）的腕关节矫形器患者、100%（n = 11）的膝关节矫形器患者。跗关节矫形器患者均未显示出类似的改善（0%；n = 4）。
本研究确定了与犬类矫形器和假肢使用相关的三大并发症如下：皮肤并发症（擦伤、脱毛和溃疡）、机械装置问题和患者对装置不接受。在将矫形器或假肢作为潜在治疗选择之前，应告知主人这些潜在并发症。尽管大多数膝关节和腕关节病变患者有临床改善，但由于缺乏对照组，尚不清楚这种改善有多少可归因于矫形器。
