Dabareiner R M, White N A, Sullins K E
Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic and State University, Leesburg, VA, USA.
Vet Surg. 1996 May-Jun;25(3):199-206. doi: 10.1111/j.1532-950x.1996.tb01399.x.
Medical records, radiographs, and sonograms of 63 horses with metacarpophalangeal joint synovial pad proliferation were examined retrospectively. All horses had lameness, joint effusion, or both signs associated with one or both metacarpophalangeal joints. Bony remodeling and concavity of the distodorsal aspect of the third metacarpal bone (Mc3) just proximal to the metacarpal condyles was identified by radiography in 71 joints (93%); 24 joints (32%) had radiographic evidence of a chip fracture located at the proximal dorsal aspect of the proximal phalanx. Fifty-four joints (71%) were examined by ultrasound. The mean +/- SD sagittal thickness of the synovial pad was 11.3 +/- 2.8 mm. Seventy-nine percent of the horses had single joint involvement with equal distribution, between the right and left forelimbs. Sixty-eight joints in 55 horses were treated by arthroscopic surgery. Sixty joints (88%) had debridement of chondral or osteochondral fragmentation from the dorsal surface of Mc3 beneath the synovial pad and 30 joints (44%) had a bone chip fracture removed from the medial or lateral proximal dorsal eminence of the proximal phalanx. Complete or partial excision of both medial and lateral synovial pads was completed in 42 joints. Only the medial synovial pad was excised or trimmed in 21 joints, and 5 joints had only the lateral pad removed. Eight joints in eight horses were treated by stall rest, administration of intra-articular medication and systemic nonsteroidal anti-inflammatory drugs. Follow-up information was obtained for 50 horses treated surgically and for eight horses treated medically. Forty-three (86%) that had surgery returned to racing; 34 (68%) raced at an equivalent or better level than before surgery. Three (38%) of the medically treated horses returned to racing; only one horse raced better than the preinjury level. Horses that returned to racing at a similar or equal level of performance were significantly younger in age than horses returning at a lower level or not racing (P < or = .05). Overall, horses with synovial pad proliferation treated by arthroscopic surgery had a good prognosis for return to racing at a level equal or better than before injury.
对63匹患有掌指关节滑膜垫增生的马匹的病历、X光片和超声图像进行了回顾性检查。所有马匹均有跛行、关节积液，或伴有一个或两个掌指关节的上述症状。通过X光检查发现，在71个关节（93%）中，第三掌骨（Mc3）掌骨髁近端背侧出现骨质重塑和凹陷；24个关节（32%）的X光片显示近端指骨近端背侧有碎片骨折。对54个关节（71%）进行了超声检查。滑膜垫矢状面的平均厚度±标准差为11.3±2.8毫米。79%的马匹为单关节受累，左右前肢分布均等。对55匹马的68个关节进行了关节镜手术治疗。60个关节（88%）对滑膜垫下方Mc3背侧的软骨或骨软骨碎片进行了清创，30个关节（44%）从近端指骨内侧或外侧近端背侧隆起处取出了骨碎片骨折。42个关节完成了内侧和外侧滑膜垫的完全或部分切除。21个关节仅切除或修整了内侧滑膜垫，5个关节仅切除了外侧滑膜垫。对8匹马的8个关节采用了圈舍休息、关节内用药和全身性非甾体抗炎药治疗。获得了50匹手术治疗马匹和8匹药物治疗马匹的随访信息。43匹（86%）接受手术的马匹恢复了比赛；34匹（68%）的比赛水平与手术前相当或更好。3匹（38%）接受药物治疗的马匹恢复了比赛；只有1匹马的比赛成绩比受伤前更好。恢复到相似或同等比赛水平的马匹在年龄上显著小于恢复到较低水平或未恢复比赛的马匹（P≤0.05）。总体而言，接受关节镜手术治疗的滑膜垫增生马匹恢复到与受伤前同等或更好比赛水平的预后良好。
