Hogan P M, McIlwraith C W, Honnas C M, Watkins J P, Bramlage L R
Texas Veterinary Medical Center, College Station, Texas 77843-4475, USA.
Equine Vet J. 1997 Nov;29(6):477-82. doi: 10.1111/j.2042-3306.1997.tb03162.x.
Subchondral cystic lesions (SCLs) in the condyle of the third metacarpal bone (MCIII) were surgically treated in 15 horses. The median age at presentation was 18 months (range 10 months-12 years) with 10 of 15 horses less than age 2 years. The SCLs were confined to the front limbs in all cases with 2 horses having bilateral lesions. Lesions were isolated to the medial condyle(s) of MCIII in 13 of 15 horses; a cystic lesion occurred in the lateral condyle in one horse and in the sagittal ridge in one horse. One horse with bilateral lesions had an additional cystic lesion located in the right medial femoral condyle. Fourteen of 15 horses had a history of moderate lameness attributable to the metacarpophalangeal joint; the lesion was an incidental finding in one horse. Duration of lameness ranged from 4 weeks to 8 months and was either acute in onset, or occurred intermittently and was associated with exercise. Fetlock flexion significantly exacerbated the lameness in all cases. Synovial effusion was absent in 8 (53%) cases. Cystic lesions were curetted arthroscopically in 12 horses, and through a dorsal pouch arthrotomy in 3 horses. Concurrent osteostixis of the cystic cavity was performed in 7 horses. Two horses were treated arthroscopically for osteochondral fragmentation of the proximodorsal aspect of the proximal phalanx one year following surgical curettage of the SCL. Twelve of 15 horses (80%) were sound for intended use following surgical treatment. Two horses did not regain soundness and follow-up information was unavailable for one horse. Total period of follow-up was 1-6 years. Follow-up radiographic examinations were available for 9 horses. Mild periarticular osteophyte formation and enthesiophyte formation at the dorsal joint capsular attachments was present in 5 of the 9 horses. Bony ingrowth of the cystic lesion was detectable in 8 horses and enlargement of the cystic cavity was observed in one horse. Based on the information gained from this study, it would appear that surgical treatment of SCLs in the distal metacarpus can result in a favourable outcome for athletic use.
对15匹马的第三掌骨（MCIII）髁部的软骨下囊性病变（SCLs）进行了手术治疗。就诊时的中位年龄为18个月（范围为10个月至12岁），15匹马中有10匹年龄小于2岁。所有病例中SCLs均局限于前肢，2匹马有双侧病变。15匹马中有13匹马的病变仅累及MCIII的内侧髁；1匹马的外侧髁出现囊性病变，1匹马的矢状嵴出现囊性病变。1匹双侧病变的马在右内侧股骨髁还有1个额外的囊性病变。15匹马中有14匹有因掌指关节导致的中度跛行病史；1匹马的病变是偶然发现的。跛行持续时间为4周至8个月，起病急或间歇性发作，与运动有关。在所有病例中，球节屈曲均显著加重跛行。8例（53%）无滑膜积液。12匹马通过关节镜刮除囊性病变，3匹马通过背侧囊切开术刮除。7匹马同时对囊性腔进行了骨填塞。2匹马在SCL手术刮除术后1年因近端指骨近端背侧的骨软骨碎片接受了关节镜治疗。15匹马中有12匹（80%）术后恢复健康可用于预期用途。2匹马未恢复健康，1匹马没有随访信息。总随访期为1至6年。9匹马有随访X线检查结果。9匹马中有5匹在背侧关节囊附着处有轻度关节周围骨赘形成和附着点骨赘形成。8匹马可检测到囊性病变的骨内生长，1匹马观察到囊性腔扩大。根据本研究获得的信息，远端掌骨SCLs的手术治疗似乎可为运动用途带来良好结果。
