Kwananocha Irin, Magré Joëll, Willemsen Koen, Weinans Harrie, Sakkers Ralph J B, How Thijs, Verseijden Femke, Tryfonidou Marianna A, van der Wal Bart C H, Meij Björn P
Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands.
Research and Academic Service, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand.
Front Vet Sci. 2023 Apr 20;10:1160177. doi: 10.3389/fvets.2023.1160177. eCollection 2023.
Hip dysplasia (HD) is a common orthopedic problem in young dogs. To decrease the laxity of the hip joint related to HD, the surgical treatments are recommended to increase femoral head coverage. ACEtabular rim eXtension (ACE-X) using a personalized 3-dimensional printed titanium shelf implant is a new surgical treatment to increase femoral head coverage and decrease laxity of the dysplastic hip joint, however, the efficacy is less know. Client-owned dogs older than 6 months with clinical signs of coxofemoral joint subluxation and radiographic evidence of HD with no or mild osteoarthritis (OA) were included. The Norberg angle (NA), linear percentage of femoral head overlap (LFO), and percentage of femoral head coverage (PC) were investigated radiographically and with computed tomography (CT) before and after surgery. OA was graded (scores 0-3) according to the maximum osteophyte size measured on CT. In addition, joint laxity (Ortolani) test results, gait analysis, and the Helsinki chronic pain index (HCPI) questionnaire were obtained at preoperative, immediately postoperative and at 1.5- and 3-month evaluations. Acetabular rim extension was performed in 61 hips of 34 dogs; NA, LFO, and PC were significantly higher immediately postoperatively and at the 1.5- and 3-month follow-up examinations compared with preoperative values ( < 0.05). Osteophyte size gradually increased over time ( < 0.05). The OA score significantly increased between preoperatively and directly postoperatively, and between preoperatively and at 3-month follow-up ( < 0.05). The laxity test normalized in 59 out of 61 hips after surgery, and the HCPI questionnaire showed that the pain score decreased significantly at 1.5 and 3 months, postoperatively. The force plate showed no significant improvement during the 3 months follow-up. Although pain reduction by the implant was unclear in short-term results, a personalized shelf implant significantly increased femoral head coverage and eliminated subluxation of the dysplastic hip joint. Further studies are required to study the long-term efficacy of gait, chronic pain, and progression of osteoarthritis.
髋关节发育不良（HD）是幼犬常见的骨科问题。为降低与HD相关的髋关节松弛度，建议采用手术治疗以增加股骨头覆盖率。使用个性化三维打印钛制髋臼缘延伸（ACE-X）植入物是一种增加股骨头覆盖率和降低发育不良髋关节松弛度的新手术治疗方法，然而，其疗效尚鲜为人知。纳入6个月以上有股髋关节半脱位临床体征且有HD影像学证据且无或仅有轻度骨关节炎（OA）的家养犬。术前和术后通过X线和计算机断层扫描（CT）研究诺伯格角（NA）、股骨头重叠线性百分比（LFO）和股骨头覆盖率（PC）。根据CT测量的最大骨赘大小对OA进行分级（0-3分）。此外，在术前、术后即刻以及1.5个月和3个月评估时获取关节松弛度（奥托拉尼）试验结果、步态分析和赫尔辛基慢性疼痛指数（HCPI）问卷。对34只犬的61个髋关节进行了髋臼缘延伸手术；与术前值相比，术后即刻以及1.5个月和3个月随访时，NA、LFO和PC显著更高（<0.05）。骨赘大小随时间逐渐增加（<0.05）。术前与术后即刻以及术前与3个月随访之间，OA评分显著增加（<0.05）。61个髋关节中有59个术后松弛度试验恢复正常，HCPI问卷显示术后1.5个月和3个月疼痛评分显著降低。在3个月随访期间，测力板未显示出显著改善。尽管短期内植入物减轻疼痛的效果尚不清楚，但个性化髋臼缘植入物显著增加了股骨头覆盖率并消除了发育不良髋关节的半脱位。需要进一步研究步态、慢性疼痛和骨关节炎进展的长期疗效。
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