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1.
OBJECTIVE: To determine the microchemical and surface composition of tibial plateau leveling osteotomy (TPLO) plates before and after explantation. SAMPLE POPULATION: 7 TPLO plates surgically removed from host dogs 6 to 54 months after implantation; 2 raw unpolished-and-unpassivated 316L TPLO plates; and 2 heat-treated, polished-and-passivated, and cleaned 316L TPLO plates. PROCEDURES: Samples were removed by use of standard techniques to ensure the plate surface was not damaged. Sample pieces were dissolved and analyzed by inductively coupled plasma-mass spectrometry (ICP-MS) to determine bulk elemental composition. Other sample pieces were investigated by use of scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS), and x-ray photoelectron spectroscopy (XPS) for determination of sample morphology, near-surface elemental composition, and surface elemental composition, respectively. To investigate the possibility of corrosion in situ, some samples were chemically corroded and analyzed. RESULTS: ICP-MS confirmed that elemental composition of samples was consistent with 316L stainless steel. The SEM and EDS analyses revealed trace amounts of polishing materials and a nonuniform carbonaceous biofilm on < 1% of the surface area of samples removed from the host dogs. The XPS analysis indicated an increase in the chromium-to-iron ratio on passivated surfaces, with no difference between passivated samples before implantation and after explantation. CONCLUSIONS AND CLINICAL RELEVANCE: Composition of the TPLO plates was consistent with 316L stainless steel. No chemical or topographic changes were detected in TPLO plates that had been implanted in dogs for up to 54 months. A small amount of biofilm was evident on the surface of 2 plates.  相似文献   

2.
Objective— To compare locking screws with conventional screws inserted in the tibial plateau fragment for reduction and stability of the construct after tibial plateau leveling osteotomy (TPLO), using a locking TPLO plate.
Study Design— Experimental biomechanical study.
Animals— Cadaveric canine pelvic limbs (n=8 pairs).
Methods— TPLO was stabilized with either conventional cortical screws or locking screws in a compressed osteotomy model. Titanium pins inserted into the tibial plateau and proximal metaphysis were used to track bone fragment location by computed tomography (CT) imaging. CT imaging was performed after osteotomy reduction, after plate stabilization, and after 30,000 cycles of axial compression testing. After 30,000 cycles, cyclic loading was continued with monotonically increasing peak-load until failure.
Results— The magnitude of rotation about the sawing axis was significantly greater for the conventional screw group because of plate application ( P =.009). Translational movement of the tibial plateau fragment toward the plate was significantly greater for the conventional screw group ( P =.006). There were no significant differences between groups in stiffness or number of cycles to failure.
Conclusion— Maintenance of tibial plateau position was significantly superior for the locking screw group during plate application; however, screw type had no effect on fixation stability under cyclic loading.
Clinical Relevance— These results suggest that conventional screws and careful contouring of the TPLO plate can provide comparable mechanical stability to fixation with locking screws in the tibial plateau under load-sharing conditions, but potentially at the expense of osteotomy reduction.  相似文献   

3.
Objective: To determine (1) risk factors for fibular fracture after tibial plateau leveling osteotomy (TPLO) and (2) if a single postoperative radiographic measurement or measurement ratio of the proximal tibial fragment can be used as a predictor for fibular fracture. Study Design: Multivariate retrospective clinical study. Animals: Dogs (n=326) with cranial cruciate ligament rupture that had TPLO (n=355). Methods: Medical records (January 2004–November 2007) and radiographs of dogs that had TPLO were reviewed. TPLO plate type, distance between tibial plateau and proximal screw, proximodistal tibial plateau fragment length, tibial plateau width, the presence of a fibular drill hole filled with a screw or not, and fibular fractures were recorded. Results: The odds of having a fibular fracture were 10 times greater in dogs with a fibular drill hole than in dogs without a drill hole. The odds of having a fibular fracture were 1.46 times greater for every 4.5 kg increase in body weight. Tibial plateau angle (TPA) at the time of reevaluation was larger than the postoperative TPA and TPA increase was larger in dogs with fibular drill holes than without (P<.01) and in dogs with fibular fractures than without (P<.01). Conclusion: An unfilled fibular drill hole and increased body weight are risk factors for fibular fracture.  相似文献   

4.
OBJECTIVE: To determine the material properties of Slocum TPLO plates and assess the soft tissue reaction adjacent to these plates in dogs that had undergone tibial plateau leveling osteotomy (TPLO). SAMPLE POPULATION: 3 new TPLO plates, 8 retrieved TPLO plates, and 1 new Synthes dynamic compression plate. PROCEDURES: Metallurgic analyses were performed. Tissue samples were obtained from areas adjacent to retrieved plates and submitted for histologic examination. RESULTS: All of the TPLO plates had a 2-phase microstructure consisting of austenite and ferrite in various amounts. Residua, inclusions, and cavities were seen during microscopic examination of the plate surface. The major differences between new and retrieved TPLO plates were the presence of small gaps separating many inclusions from the surrounding matrix and the presence of various-sized pits on the surface of the retrieved plates. The dynamic compression plate had a nearly pure austenitic structure and was largely free from residua, inclusions, and cavities. Histologic examination of tissue samples obtained from areas adjacent to retrieved TPLO plates revealed intra- and extracellular particulate debris. Two types of particles (one consisting of chromium, nickel, molybdenum, and iron and the other consisting of aluminum and silicon) were seen. CONCLUSIONS AND CLINICAL RELEVANCE: Results determined that new and retrieved TPLO plates were manufactured from 316L stainless steel and produced by a casting process, but not all plates met specifications for chemical composition of cast surgical implants (American Society for Testing Materials standard F745); tissues surrounding retrieved plates had evidence of adverse reactions, probably as a result of plate corrosion.  相似文献   

5.
Objective— To determine the incidence of, and risk factors for, fibular fracture after tibial plateau leveling osteotomy (TPLO) in dogs.
Study Design— Case series.
Sample Population— TPLO (n=168) on 142 dogs.
Methods— Medical records (January 2006–September 2007) and radiographs of all dogs that had TPLO were reviewed. Data retrieved were breed, sex, age, weight, type of plate, use of a jig, time to recheck, preoperative tibial plateau angle (TPA), immediate postoperative TPA, and presence or absence of fibular fracture.
Results— Fibular fractures occurred in 5.4% TPLOs. Body weight, change in TPA, and preoperative TPA were significantly higher in dogs with fibular fracture. TPLO without use of a jig was significantly associated with fibular fracture. Age, postoperative TPA, and plate type were not significantly associated with fibular fracture.
Conclusions— Fibular fracture is uncommon after TPLO. Risk factors are increased body weight, greater preoperative TPA, greater change in TPA, and TPLO performed without a jig. All fractures occurred during convalescence.
Clinical Relevance— Owners should be warned of potential complications and risk factors associated for fibular fracture after TPLO.  相似文献   

6.
OBJECTIVE: To report a technique for surgical alteration of the slope of the tibial plateau by a proximal tibial intraarticular ostectomy (PTIO) after injury to the canine cranial cruciate ligament (CCL) and to determine the outcome. STUDY DESIGN: Prospective clinical study. ANIMALS: Dogs (n=52) with CCL injury in 60 stifle joints. METHODS: CCL injury was treated by lateral stifle arthrotomy, removal of CCL remnants, and appropriate meniscal surgery. PTIO was performed to remove a wedge of bone from the proximal aspect of the tibia. The ostectomy site was reduced and stabilized using a bone plate and screws applied to the medial surface of the tibia as well as a craniocaudal positional screw. Dogs were evaluated at 6 weeks, 6, and 12 months by complication assessment, lameness scores, stifle range of motion (ROM), thigh circumference, radiographic assessment, degenerative joint disease (DJD) scores, and surgeon and owner evaluation of function. RESULTS: Lameness scores improved by 6 and 12 months in all but 1 dog. Thigh circumference and DJD were increased at 6 and 12 months. Complications occurred in 20% of dogs with all but 1 occurring perioperatively or within 6 weeks; most common were injury to the long digital extensor tendon (4 dogs) and plate failure (3); 2 other dogs required surgery to treat complications. Most owners (98%) reported that lameness had improved by 12 months; 90% were extremely or very satisfied with the procedure and 90% would have the same procedure performed on another dog. CONCLUSION: PTIO to level the tibial plateau provided a satisfactory clinical outcome in dogs >20 kg with CCL injury and the complication rate was similar to tibial plateau levelling osteotomy (TPLO). Stifle osteoarthritis continued to progress radiographically. CLINICAL RELEVANCE: PTIO represents an alternative to TPLO that does not require specialized surgical equipment.  相似文献   

7.
Objective— To compare the axial compression stiffness of osteotomized canine tibiae stabilized with Slocum, Securos, or Synthes plates after a tibial plateau leveling osteotomy (TPLO) procedure. Study Design— In vitro, paired comparison of cadaveric tibial constructs subjected to mechanical testing under an axial load. Sample Population— Canine tibiae (n=16 pairs) from skeletally mature male and female dogs of various breeds (18–55 kg). Methods— Tibial pairs (n=16) were randomly assigned to 1 of 2 study cohorts (n=8 pairs/cohort): cohort 1, tibial osteotomy stabilization with a Slocum or a Securos plate, or cohort 2, tibial osteotomy stabilization with a Slocum or a Synthes plate. One tibia from each pair was stabilized with 1 of each plate design assigned to the cohort after TPLO. A 3.2 mm osteotomy gap was maintained during plate application in all constructs. Load and axial displacement were recorded while constructs were loaded to 2000 N in axial compression. Failure loads were not reported because no distinct yield point or failure point was evident within the load range for many specimens. Failure modes were recorded for each construct, and photographs of typical failures were obtained. Stiffness (N/mm) was calculated from load–displacement curves. Paired comparisons of mean stiffness were performed within study groups using a paired t‐test. Significance was set at P<.05. Results— The mean construct stiffnesses for the Slocum (383±183 N/mm) and Securos (258±64.1 N/mm) constructs were not significantly different (P=.164; power=0.566). The mean construct stiffness for the Synthes constructs (486±91.0 N/mm) was significantly greater than that of the Slocum constructs (400±117 N/mm); P=.0468. Modes of failure for the Slocum (16/16) and Securos (8/8) constructs included plastic deformation of the implant with valgus deformity combined with fibular luxation (2/16 Slocum; 1/8 Securos) or fibular fracture (2/16 Slocum; 4/8 Securos). Most Synthes constructs underwent elastic deformation (7/8). One Synthes construct fractured in the saggital plane through the tibial plateau depression at the point of load application. Conclusions— The Slocum and Securos plate/tibia construct have similar stiffness, whereas the Synthes/tibia constructs are significantly stiffer than the Slocum/tibia constructs. Modes of fixation failure observed in this model were consistent with TPLO fixation failures observed clinically. Clinical relevance— Construct stiffness in axial load varies with implant type. Implants that confer higher stiffness to the construct may result in greater fixation stability in tibial metaphyseal osteotomies.  相似文献   

8.
OBJECTIVE: To compare the precision of tibial plateau leveling osteotomy (TPLO) surgery when performed with or without a jig. STUDY DESIGN: Cadaveric study. SAMPLE POPULATION: Cadaveric, adult greyhound hindlimbs (n=9 pair). METHODS: TPLO (n=18) was performed on each limb pair; 1 with and 1 without use of a jig. Measurements taken from pre- and postsurgical radiographs were osteotomy position, tibial plateau angle (TPA), varus-valgus malalignment, and tibial torsion. The null hypothesis was that TPLO precision was not affected by use of a jig. Student's t-test was used to investigate differences in TPA, osteotomy location, and frequency and extent of iatrogenic limb malalignment; P<.05 was considered significant. RESULTS: There were no significant differences in postsurgical TPA, tibial crest thickness, varus-valgus malalignment, or tibial torsion between TPLOs performed with or without a jig. Osteotomy location was significantly more distal when a jig was used (P=.03). CONCLUSIONS: Jig use did not improve the precision of TPLO surgery. CLINICAL RELEVANCE: Performing TPLO without a jig should reduce surgery time, eliminate complications related to placement of the distal jig pin and allow unhindered positioning of the osteotomy.  相似文献   

9.
OBJECTIVE: Comparison of 2 methods of surgical management of cranial cruciate ligament (CCL) injury in large-breed dogs using a radiographic osteoarthrosis (OA) scoring system. STUDY DESIGN: Retrospective study. ANIMALS: Client-owned dogs (n=66). METHODS: Radiographs were evaluated from dogs weighing >/=22.7 kg, with surgical management of CCL rupture using extracapsular repair (ECR) or tibial plateau leveling osteotomy (TPLO). Radiographs were taken immediately before surgery and >/=12 months later. An OA score was assigned to each set of radiographs taken at the preoperative and final examinations by evaluating 32 specific features of stifle OA. The difference between preoperative and final OA scores were subtracted and 2 final score categories of a change 5 were created. A logistic regression model was used to evaluate the effect of right versus left pelvic limb, age, preoperative weight, postoperative weight, days from surgery until final radiographic recheck, cranial cruciate status at surgery, medial meniscus status at surgery, and ECR versus TPLO. RESULTS: The ECR group had 27 stifles (22 dogs) and the TPLO group had 52 stifles (44 dogs). ECR dogs had a preoperative weight of 33.4+/-9.3 kg (range 22.7-54.1 kg) and a preoperative OA score of 13.0+/-8.4 (range 1-34) compared with TPLO dogs that had a preoperative weight of 38.9+/-9.1 kg (range 25-63.9 kg) and preoperative OA score of 15.9+/-8.4 (range 4-44). Postoperative weights for ECR and TPLO dogs were 33.6+/-9 kg (range 21.8-54.6 kg) and 39.4+/-10.1 kg (range 24-72 kg), respectively. Final OA scores were: ECR dogs, 26.3+/-10.8 (range, 10-54); TPLO dogs, 23.3+/-9.5 (range, 12-50). Dogs with a final change in OA score of >/=6 were 5.78 times more likely to have had ECR compared with those that had TPLO as stabilization procedure (odds ratio=5.78; Log-likelihood test P-value=.025). Other dependent variables were not significant. CONCLUSIONS: Based on logistic regression analysis, dogs with larger OA score differences were 5.78 times more likely to have had ECR than TPLO. CLINICAL RELEVANCE: Prospective, randomized surgical trials with pre-defined objective measures would be required to further evaluate the clinical importance of these preliminary findings which suggest that TPLO may help stabilize the cranial tibial thrust as originally proposed.  相似文献   

10.
OBJECTIVE: To report the incidence of loss of stifle extension or flexion and its relationship with clinical lameness after tibial plateau leveling osteotomy (TPLO) for treatment of cranial cruciate ligament (CCL) rupture. STUDY DESIGN: Longitudinal study. ANIMALS: Dogs (n=280) with CCL rupture (n=412). METHODS: TPLO was performed without meniscal release or arthrotomy. Angles of extension and flexion of the stifle were measured by goniometry to determine range of motion. Based upon motion loss, stifles were divided in 3 groups: no loss of extension or flexion (n=322), <10 degrees loss of extension or flexion (n=78), > or =10 degrees loss of extension or flexion (n=12). RESULTS: Loss of extension or flexion > or =10 degrees was associated with significantly (P=.001) higher clinical lameness scores in comparison with no loss, or loss of extension or flexion <10 degrees. Osteoarthrosis in the cranial femorotibial joint was significantly correlated (P<.005, r(2)=0.55) with loss of extension. Loss of extension > or =10 degrees was less tolerable and less amenable to physical rehabilitation than flexion loss. CONCLUSIONS: Loss of extension or flexion > or =10 degrees was responsible for higher clinical lameness scores. Osteoarthrosis in the cranial femorotibial joint led to extension loss. CLINICAL RELEVANCE: Loss of extension or flexion should be assessed in dogs with persistent clinical lameness after TPLO so that early intervention can occur. Our study provides guidelines to define clinically relevant loss of extension or flexion of stifle joint after TPLO.  相似文献   

11.
Objectives : To evaluate a novel surgery aimed at managing concurrent medial patellar luxation (MPL) and cranial cruciate ligament (CCL) ruptures in dogs weighing more than 30 kg. Methods : Tibial plateau levelling osteotomy (TPLO) and femoral trochleopasty were performed. The principal tibial fragment was laterally translated by 3 to 6 mm and was externally and abaxially rotated to create a wedge measuring 1·5 to 2·5 mm at the medial and cranial aspect and 1 to 3 mm at the medial and distal aspect of the tibial plateau fragment. The fragments were stabilised with a narrow TPLO plate. Results : Thirteen surgeries were performed in 12 dogs with a mean weight of 39·8 kg. The mean postoperative tibial plateau slope was 8·1°. Additional surgery was required in two cases, one due to failure of fixation and another due to screw breakage. The mean lameness score was 3·5 (out of 5) before surgery, 0·7 after 8 to 12 weeks, and 0·3 at final follow-up. Median follow-up was 1115 days (range, 270 to 2040 days). No patella luxated after surgery. Clinical Significance : MPL and CCL ruptures may be successfully managed by performing a TPLO and simultaneously altering the relationship of the principal and tibial plateau fragments during surgery.  相似文献   

12.
Objective evaluation of patellar ligament changes following tibial plateau leveling osteotomy (TPLO) for cranial cruciate ligament injury has not been published to date. In this study, the patellar ligament was evaluated using radiographs and high-resolution ultrasound in 31 stifles (29 dogs) preoperatively and at 1 month (n=31), 2 months (n=18), and 6 months (n=13) postTPLO. A ratio of the thickness of the proximal to distal patellar ligament was determined for all radiographs evaluated. Ultrasound evaluation included proximal, middle, and distal mid-sagittal thickness and transverse thickness, and transverse area measurements. Subjective grading (0 being normal through a scale of 3) of the ultrasound changes was also performed at each evaluation. Significant thickening of the distal patellar ligament was noted postoperatively as evidenced by thickness and area measurements and a decreased radiographic ratio (P < 0.01). Preoperative patellar ligament thickness and area were similar at the proximal, middle and distal sites. Ultrasound-derived thickness and area measurements of the distal patellar ligament were increased at 1 and 2 months (P < 0.01). The radiographic ratio was significantly decreased at 1, 2 and 6 months (P < 0.01). Subjectively, all patellar ligaments scored a 0 preoperatively and 16/31 received a score of 2 or 3 during follow-up evaluation. Additionally, these dogs had ultrasonographic and radiographic changes consistent with distal patellar ligament thickening. Body weight (kg) and postoperative TPLO angle had a significant influence on 1-month postoperative distal patellar ligament area using a stepwise logistic model (P < 0.05). Patellar ligament desmitis is a common postoperative sequela to the TPLO procedure, however its clinical significance (i.e., correlation with a residual lameness) was not evaluated in this study.  相似文献   

13.
OBJECTIVE: To determine effects of early intensive postoperative physiotherapy on limb function in dogs after tibial plateau leveling osteotomy (TPLO) for deficiency of the cranial cruciate ligament (CCL). ANIMALS: 8 adult dogs with CCL deficiency. PROCEDURE: After TPLO, dogs underwent a physiotherapy program 3 times/wk (physiotherapy group; n = 4) or a walking program (home-exercise group; 4). All dogs were evaluated before surgery, 1 and 10 days after surgery, and 3 and 6 weeks after surgery. Thigh circumference (TC), stifle joint flexion and extension range of motion (ROM), lameness, and weight-bearing scores were recorded. RESULTS: Before surgery, CCL-deficient limbs had significantly reduced TC and reduced flexion and extension ROMs, compared with values for the contralateral control limb. Six weeks after TPLO, the physiotherapy group had significantly larger TC than the home-exercise group, with the difference no longer evident between the affected and nonaffected limbs. Extension and flexion ROMs were significantly greater in the physiotherapy group, compared with values for the home-exercise group, 3 and 6 weeks after surgery. Six weeks after surgery, the difference in flexion and extension ROMs was no longer evident between the affected and nonaffected limbs in the physiotherapy group. Both groups had improvements for lameness and weight-bearing scores over time, but no difference was found between the 2 groups. CONCLUSIONS AND CLINICAL RELEVANCE: After TPLO in CCL-deficient dogs, early physiotherapy intervention should be considered as part of the postoperative management to prevent muscle atrophy, build muscle mass and strength, and increase stifle joint flexion and extension ROMs.  相似文献   

14.
Objective— To evaluate factors that predispose to tibial tuberosity (TT) fracture after tibial plateau leveling osteotomy (TPLO) in dogs.
Study Design— Retrospective study.
Animals— Dogs (n=182) with cranial cruciate ligament (CCL) rupture undergoing 213 TPLO surgeries.
Methods— Medical records and radiographs of 2 groups of dogs that had TPLO surgery (2000–2001, 2004–2005) were evaluated to determine the effect of operative technique and surgeon experience on TT fracture.
Results— TT fracture was diagnosed in 8 dogs (9 TPLO, 4.2% of surgical procedures). Four fractures occurred after unilateral TPLO in 167 dogs (2.4%), 4 fractures occurred after simultaneous bilateral TPLO in 5 dogs (40%), and 1 fracture occurred after staged bilateral TPLO in 36 dogs (2.8%). Simultaneous bilateral TPLO resulted in a 12.4 times higher odds of TT fracture versus unilateral TPLO ( P =.046). The mean absolute thickness of the TT after TPLO was less in dogs sustaining TT fractures (7.2 ± 2.2 mm) than those that did not (10.8 ± 2.7 mm, P <.0001). The odds of fracture decreased by 37% when the absolute TT width postosteotomy increased by 1 mm ( P <.0001). An increase in tibial plateau angle at follow-up versus immediately postoperative was associated with TT fracture ( P =.025). Surgeon experience was not associated with TT fracture.
Conclusion— A combination of surgical decision-making and surgical technique play a role in the occurrence of TT fracture after TPLO. Simultaneous bilateral TPLO was associated with a high percentage of TT fracture.
Clinical Relevance— Careful planning of osteotomy positioning is advised while performing TPLO surgery.  相似文献   

15.
A 10-year-old spayed female Golden Retriever was admitted with chronic lameness of the right hind limb. A tibial plateau leveling osteotomy (TPLO) had been performed on this leg approximately three years previously. A progressively growing soft tissue mass, affecting the right stifle, previously treated with TPLO was biopsied and found to be a histiocytic sarcoma. Previously proposed links between the development of neoplasia in the stifle region and the presence of chronic synovitis, osteotomy, orthopaedic implants, and specifically the Slocum TPLO plate, are briefly discussed.  相似文献   

16.
Objective— To evaluate potential iatrogenic medial meniscal (MM) damage during tibial plateau leveling osteotomy (TPLO) and to establish a safe zone (SZ) for hypodermic needle (HN) identification of the medial aspect of the stifle joint.
Study Design— Prospective cohort.
Animals— Cadaveric canine stifles (n=40).
Methods— HN (20 or 25 G) were inserted through the medial collateral ligament (MCL) of the femorotibial joint and through the SZ insertion points. The medial meniscus was inspected for iatrogenic damage. Statistical comparison of MM damage caused by different needle sizes and insertion sites was performed using Fisher's exact test with significance at P <.05.
Results— Twenty-gauge group: 65% of stifles had minor MM damage with MCL insertion compared with 35% of stifles with SZ insertion ( P =.0049). Severe MM damage occurred in 25% of stifles with MCL insertion compared with 0% of stifles with SZ insertion ( P =.0014). Twenty-five-gauge group: 85% of stifles had minor MM damage with MCL insertion compared with 30% after SZ insertion ( P =.0011); however, no severe MM injury was noted.
Conclusions— HN insertion though the MCL can produce iatrogenic damage to the MM. Use of a 25 G HN and SZ site for insertion reduced the frequency and severity of MM damage.
Clinical Relevance— HN insertion into the medial aspect of the femorotibial joint during TPLO can cause gross iatrogenic MM damage, which may contribute to the incidence and misdiagnosis of latent MM injuries after TPLO.  相似文献   

17.
A 7 yr old spayed female mastiff presented for examination of a left pelvic limb lameness of 3 mo duration. Six years previously, the dog had undergone tibial plateau leveling osteotomy (TPLO) surgery of the left pelvic limb for the treatment of cranial cruciate disease. On presentation, the dog had a painful and swollen proximal tibia. Following investigation, a diagnosis of osteosarcoma of the proximal left tibia at the site of the previous TPLO surgery was made. This is the first reported case of osteosarcoma following TPLO using an implant other than the Slocum plate.  相似文献   

18.
OBJECTIVE: To determine the change in tibial plateau angle (TPA) during healing after tibial plateau leveling osteotomy (TPLO) performed for cranial cruciate ligament insufficiency in dogs and to examine factors that may be associated with the change. STUDY DESIGN: Retrospective study. STUDY POPULATION: One hundred and forty-nine canine stifles after TPLO procedure. METHODS: Records of dogs that had TPLO were reviewed. Patient age, weight, sex, breed, pre- and postoperative TPA, recheck TPA, time to recheck, type of implant used, and radiographic evidence of healing were analyzed. RESULTS: Mean time to recheck evaluation was 46 days (range, 28-65 days). Mean difference between immediate postoperative and recheck TPA measurements was 1.5 degrees (range, -3 to 9 degrees). Recheck TPA was a significantly greater (numerically higher) than immediate postoperative TPA (P<.0001). There was no significant effect of patient weight, type of plate used, or healing status of the osteotomy at the time of recheck. No correlation between pre- or postoperative TPA angles and change in TPA angle was detected. CONCLUSIONS: TPA changes during osteotomy healing after TPLO, but factors influencing this change were not identified. CLINICAL RELEVANCE: TPA may increase during healing after TPLO despite apparently adequate osteotomy fixation. The clinical relevance of this increase is unknown but is likely minimal.  相似文献   

19.
Objectives— To evaluate the outcome in dogs treated with demineralized bone matrix (DBM) as an adjunct to orthopedic procedures. Study Design— Retrospective and case‐match study. Animals— Dogs (n=75). Methods— Medical records (1999–2006) and radiographs of dogs that had orthopedic procedures (comminuted fractures, tibial plateau leveling osteotomy [TPLO] where correction for tibial rotation created an osteotomy gap, arthrodeses, open corrective osteotomies) where DBM was used were reviewed for signalment, quantity of DBM implanted, duration of exercise restriction, radiographic healing, and complications. Dogs that had TPLO and correction of tibial torsion (n=15), or arthrodesis (n=16) were compared with case‐matched controls. Data were analyzed using Kruskal–Wallis test, ANOVA, Tukey's HSD test, and logistic regression analysis. Results— Mean (±SD) healing time for orthopedic surgeries with DBM augmentation were 15±6.97 (weeks) and complication rate was 19% (14 dogs). Dogs with a TPLO gap filled with DBM were allowed to return to normal exercise 2 weeks earlier than dogs with a well‐apposed TPLO site. Radiographic healing, duration of exercise restriction, and timing of destabilization were similar in dogs undergoing carpal and tarsal arthrodesis whether they received DBM, autogenous graft, or both. Conclusions— DBM can be used to treat uncomplicated bone defects associated with comminuted fracture repairs, open osteotomies, and arthrodeses in dogs. Under these circumstances, clinicians might expect similar clinical outcomes without the possibility of side effects associated with the harvest of autogenous cancellous bone. Clinical Relevance— DBM is safe for use in dogs.  相似文献   

20.
Objective: To describe a surgical technique, and outcome, for treatment of proximal tibial deformity (varus, valgus, excessive tibial plateau angle [eTPA], tibial torsion and patellar luxation) by combined tibial plateau leveling osteotomy (TPLO) and transverse corrective osteotomy. Study Design: Cases series. Animals: Dogs (n=12; 19 stifle joints). Methods: Medical records of dogs that had combination TPLO and transverse corrective osteotomy, were reviewed. Pre‐ and postoperative tibial angulation, tibial torsion, tibial plateau angle (TPA), corrective osteotomy technique, method of fixation, and complications were recorded. In hospital re‐evaluation of limb function and alignment and length of time to radiographic healing were reviewed. Long‐term outcome was assessed by visual analog scale (VAS) questionnaire and owner telephone interview. Results: Proximal tibial varus or valgus was present in 68.4%; 73.7% had eTPA; and 47.4% had both. Medial patellar luxation (MPL) was present in 57.9%, of which 47.4% had tibial tuberosity displacement. Severe tibial torsion was present in 68.4%. Mean pre‐ and postoperative TPA was 37.5° and 5.7°, respectively. The mean postoperative mechanical medial proximal tibial angle (mMPTA) and mechanical medial distal tibial angle (mMDTA) were 92.2° (range, 88–96°) and 96.1° (range, 94–101°), respectively. Postoperative surgical complications were documented in 21.0%, which included implant loosening or breakage (5.3%), seroma (5.3%), septic arthritis (5.3%), and infection of the proximal tibia (5.3%). All complications were considered major because they required additional surgery. Mean time to document radiographic healing was 10.4 weeks. In‐hospital re‐evaluation of lameness was obtained at the same time; 82.4% were not lame or had a mild lameness, 17.6% had severe lameness (2/3 with infection). The VAS evaluation revealed excellent results and owner satisfaction in all ten dogs in which long‐term follow‐up was obtained. Conclusions: Long‐term clinical outcome of combination TPLO and transverse corrective osteotomy was excellent, and had a high owner satisfaction. Healing times were comparable to standard TPLO with a similar complication rate.  相似文献   

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