Department of Large Animal Clinical Sciences, Marion duPont Scott Equine Medical Center, Virginia - Maryland Regional College of Veterinary Medicine, Leesburg, Virginia, USA.
School of Veterinary Medicine, Texas Tech University, Amarillo, Texas, USA.
Vet Surg. 2024 Jan;53(1):54-66. doi: 10.1111/vsu.14013. Epub 2023 Aug 21.
The recent availability of standing computed tomography (CT) for equine paranasal sinus disease has enhanced diagnosis and enabled more targeted surgery compared to radiography and sinoscopy. To date, there have been no studies which have critically evaluated the benefit of preoperative CT versus radiography and sinoscopy on complications and outcome in horses undergoing sinus trephination.
Retrospective study.
A total of 229 equids.
The medical records of equids (229) presented for sinusitis treated via trephination that had CT, radiography and/or sinoscopy at time of surgery between 2009 and 2022 were reviewed. Outcome and complications were evaluated for six different pre- and intraoperative imaging modalities.
The six groups did not differ in demographics or disease category, though equids with less weight (p = .0179) and shorter disease duration (p = .0075) were more likely to have radiography and sinoscopy based surgical planning. Short-term postoperative complications occurred in 30.1% and were higher in groups using preoperative CT imaging (p = .01), with hemorrhage being the most common surgical complication. Following initial trephination surgery, 57.0% (127/223) of cases resolved and there was no difference between the imaging groups. Final resolution after follow-up medical or surgical treatment increased to 94.6% (211/223) and was not different between the imaging groups or between primary or secondary sinusitis. Additional nasal fenestrations to improve sinonasal drainage, maxillary septal bulla fenestrations and trephinations to treat nasal conchal bullae were made in the CT groups.
CT provided additional diagnostic information and enabled different surgical approaches but did not improve resolution in this study population.
与放射影像学和鼻内镜检查相比，最近可用于马鼻窦疾病的站立式计算机断层扫描（CT）增强了诊断能力，并使手术更具针对性。迄今为止，还没有研究对接受鼻窦环锯术的马匹进行术前 CT 与放射影像学和鼻内镜检查在并发症和结果方面的益处进行过严格评估。
回顾性研究。
总计 229 匹马。
对 2009 年至 2022 年间因鼻窦炎接受环锯术治疗且在手术时进行了 CT、放射影像学和/或鼻内镜检查的 229 匹马的病历进行了回顾。评估了六种不同的术前和术中成像方式的结果和并发症。
这六组在人口统计学或疾病类别方面没有差异，但体重较轻（p=0.0179）和疾病持续时间较短（p=0.0075）的马更有可能根据放射影像学和鼻内镜检查结果进行手术规划。30.1%的马出现短期术后并发症，且使用术前 CT 成像的组中发生率更高（p=0.01），最常见的手术并发症为出血。初次环锯术后，有 57.0%（127/223）的病例得到解决，且不同成像组之间无差异。经后续药物或手术治疗后，最终完全缓解率增加至 94.6%（211/223），且不同成像组之间、原发性或继发性鼻窦炎之间无差异。在 CT 组中，为改善鼻窦鼻道引流进行了额外的鼻侧开窗术、上颌窦隔泡开窗术和针对鼻甲骨的环锯术。
CT 提供了额外的诊断信息，并可采用不同的手术方法，但在本研究人群中并未改善缓解率。
