Stucki G, Fürst A E, Jackson M A
Department für Pferde, Klinik für Pferdechirurgie, Vetsuisse-Fakultät, Universität Zürich.
Schweiz Arch Tierheilkd. 2024 Jun;166(6):309-320. doi: 10.17236/sat00425.
The aim of this retrospective study is to describe and compare conservative and surgical treatment of navicular fractures in horses. An attempt is made to identify critical points that can favorably influence the prognosis of this orthopedic disease. All horses treated for a navicular fracture at the Equine Clinic, Vetsuisse Faculty, University of Zurich between 2005 and 2017 were included in this study. The severity of lameness at initial examination, radiographic assessment, hoof conformation, treatment (conservative or surgical), complications and outcome were determined from the medical records. Conservative and surgical treatment consisted of stable rest, a controlled exercise program and therapeutic orthopedic shoeing. During surgical treatment, fracture reduction was also carried out with a cortical screw. Computer assisted surgery were used in five horses and computer tomography in three horses. Follow-up examinations included clinical and radiographic examinations. The outcome was divided into three categories: 1 = very good; 2 = good; 3 = poor. Twelve horses met the inclusion criteria; Four horses were treated conservatively and eight were treated surgically. After conservative treatment, two horses (50 %) had a very good outcome and two (50 %) had a good outcome. After surgical treatment, four horses (50 %) had a very good outcome and four (50 %) had a poor outcome. Overall, 67 % of horses had a very good or good outcome, although radiographic signs of bone healing was not present in any of these cases. Various complications were identified, such as the fracture of a screw, the fragmentation of the small navicular bone fragment, the development of osteoarthrosis in the coffin joint and progressive podotrochosis. This study shows that the prognosis of navicular fractures is generally cautious and that degenerative changes to the navicular apparatus worsen the prognosis. In the present study, surgical treatment did not improve the prognosis of navicular fractures despite the intrasurgical use of three-dimensional imaging. However, technical advances could reduce the complication rate in the future.
本回顾性研究的目的是描述和比较马舟骨骨折的保守治疗和手术治疗。试图确定可对这种骨科疾病的预后产生有利影响的关键点。2005年至2017年间在苏黎世大学兽医学院马科诊所接受舟骨骨折治疗的所有马匹均纳入本研究。从病历中确定初诊时跛行的严重程度、影像学评估、蹄形、治疗（保守或手术）、并发症和结果。保守治疗和手术治疗包括稳定休息、有控制的运动计划和治疗性矫形蹄铁。手术治疗期间，还使用皮质螺钉进行骨折复位。5匹马使用了计算机辅助手术，3匹马使用了计算机断层扫描。随访检查包括临床和影像学检查。结果分为三类：1 = 非常好；2 = 好；3 = 差。12匹马符合纳入标准；4匹马接受保守治疗，8匹马接受手术治疗。保守治疗后，2匹马（50%）预后非常好，2匹马（50%）预后良好。手术治疗后，4匹马（50%）预后非常好，4匹马（50%）预后差。总体而言，67%的马匹预后非常好或良好，尽管这些病例中均未出现骨愈合的影像学迹象。发现了各种并发症，如螺钉骨折、小舟骨碎片碎裂、蹄关节骨关节炎的发展和进行性舟骨病。本研究表明，舟骨骨折的预后通常较为谨慎，舟骨装置的退行性改变会使预后恶化。在本研究中，尽管手术中使用了三维成像，但手术治疗并未改善舟骨骨折的预后。然而，技术进步未来可能会降低并发症发生率。
