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犬膝关节囊周围脱敏技术的开发:一项解剖学尸体研究

Development of a Pericapsular Knee Desensitization Technique in Dogs: An Anatomical Cadaveric Study.

作者信息

Garbin Marta, Moura Raiane A, Souza Yasmim C, Cavalcanti Mariana, Stern Adam W, Romano Marta, Vettorato Enzo, Otero Pablo E, Portela Diego A

机构信息

Department of Clinical Science, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC J2S 8H5, Canada.

Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32608, USA.

出版信息

Vet Sci. 2025 Jun 19;12(6):599. doi: 10.3390/vetsci12060599.

DOI:10.3390/vetsci12060599
PMID:40559836
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12197552/
Abstract

Regional anesthesia techniques targeting articular nerve branches offer promising avenues for managing articular pain. This study developed and compared the success rates of an ultrasound-guided versus a blind pericapsular knee desensitization (PKD) technique in canine cadavers. In Phase I, gross dissection and ultrasound evaluations were performed in eight limbs to characterize the anatomy of the medial (MAN), lateral (LAN), and posterior (PAN) articular branches of the saphenous, common fibular, and tibial nerves, respectively, and to identify suitable anatomical and ultrasonographic landmarks. In Phase II, ultrasound-guided and blind PKD injections of a dye solution were randomly performed in 10 cadavers (20 limbs), followed by dissection and histological assessment of staining accuracy. The ultrasound-guided technique achieved a significantly higher overall success rate (96.7%) than the blind technique (73.3%; = 0.02). The MAN was successfully stained in 100% of ultrasound-guided and 50% of blind injections ( = 0.03), while the LAN and PAN were stained with high but comparable success. Parent nerve involvement was minimal for MAN and PAN but frequent for the common fibular nerve following LAN injections. Histological confirmation supported the anatomical findings, although PAN identification remained inconsistent. These results support the feasibility and increased precision of ultrasound-guided PKD, providing a foundation for further clinical evaluation.

摘要

针对关节神经分支的区域麻醉技术为管理关节疼痛提供了有前景的途径。本研究在犬类尸体中开发并比较了超声引导与盲法关节周围膝关节脱敏(PKD)技术的成功率。在第一阶段,对八个肢体进行大体解剖和超声评估,以分别描述隐神经、腓总神经和胫神经的内侧(MAN)、外侧(LAN)和后(PAN)关节分支的解剖结构,并确定合适的解剖学和超声标志。在第二阶段,对10具尸体(20个肢体)随机进行超声引导和盲法PKD染料溶液注射,随后进行解剖和染色准确性的组织学评估。超声引导技术的总体成功率(96.7%)显著高于盲法技术(73.3%;P = 0.02)。MAN在100%的超声引导注射和50%的盲法注射中成功染色(P = 0.03),而LAN和PAN染色成功率高但相当。MAN和PAN的母神经受累最小,但LAN注射后腓总神经受累频繁。组织学证实支持解剖学发现,尽管PAN的识别仍不一致。这些结果支持超声引导PKD的可行性和更高的精确度,为进一步的临床评估奠定了基础。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/174c/12197552/c09115df8218/vetsci-12-00599-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/174c/12197552/762a3ca49333/vetsci-12-00599-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/174c/12197552/8bb77305cf84/vetsci-12-00599-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/174c/12197552/8e6d41e0c32e/vetsci-12-00599-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/174c/12197552/23f79da4140b/vetsci-12-00599-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/174c/12197552/c09115df8218/vetsci-12-00599-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/174c/12197552/762a3ca49333/vetsci-12-00599-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/174c/12197552/8bb77305cf84/vetsci-12-00599-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/174c/12197552/8e6d41e0c32e/vetsci-12-00599-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/174c/12197552/23f79da4140b/vetsci-12-00599-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/174c/12197552/c09115df8218/vetsci-12-00599-g005.jpg

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本文引用的文献

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Vet Sci. 2025 Apr 17;12(4):374. doi: 10.3390/vetsci12040374.
2
Prevalence of osteoarthritis in the shoulder, elbow, hip and stifle joints of dogs older than 8 years.8 岁以上犬只的肩、肘、髋和膝关节骨关节炎的流行情况。
Vet J. 2024 Jun;305:106132. doi: 10.1016/j.tvjl.2024.106132. Epub 2024 May 16.
3
Prevalence of radiographic appendicular osteoarthritis and associated clinical signs in young dogs.
年轻犬四肢影像学骨关节炎的流行情况及其相关临床体征。
Sci Rep. 2024 Feb 3;14(1):2827. doi: 10.1038/s41598-024-52324-9.
4
Saphenous and Sciatic Nerve Blockade with and without Obturator Nerve Block for Tibial Plateau Levelling Osteotomy Surgery in Dogs: A Randomized Controlled Trial.犬胫骨平台平整截骨术采用与不采用闭孔神经阻滞的隐神经和坐骨神经阻滞:一项随机对照试验
Animals (Basel). 2023 Dec 8;13(24):3792. doi: 10.3390/ani13243792.
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Ultrasound-guided lateral pericapsular hip desensitization of the articular branches of the cranial gluteal nerve: A canine cadaveric study and feasibility study in dogs.超声引导下髋关节囊外侧颅臀神经关节支去传入神经支配术:犬尸体研究和犬的可行性研究。
Vet Anaesth Analg. 2023 Nov;50(6):507-516. doi: 10.1016/j.vaa.2023.08.008. Epub 2023 Aug 14.
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Motor-sparing peripheral nerve blocks for hip and knee surgery.用于髋关节和膝关节手术的保留运动神经的外周神经阻滞。
Curr Opin Anaesthesiol. 2023 Oct 1;36(5):541-546. doi: 10.1097/ACO.0000000000001287. Epub 2023 Jun 23.
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Genicular nerve block for emergency department patient: a successful management of subacute osteoarthritic knee pain.膝神经阻滞治疗急诊亚急性膝骨关节炎疼痛:一种有效的管理方法。
Pain Manag. 2023 Jul;13(7):373-378. doi: 10.2217/pmt-2022-0104. Epub 2023 Jul 17.
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Vet Anaesth Analg. 2022 Nov;49(6):664-673. doi: 10.1016/j.vaa.2022.08.001. Epub 2022 Aug 11.
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2022 AAHA Pain Management Guidelines for Dogs and Cats.2022 年美国兽医协会犬猫疼痛管理指南。
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Ultrasound-guided perineural injections for the medical management of thoracic limb root signature in a dog.超声引导下经皮神经注射用于犬胸肢神经根征的药物治疗
Vet Anaesth Analg. 2021 May;48(3):480-482. doi: 10.1016/j.vaa.2021.03.003. Epub 2021 Mar 19.