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1.
Axial correction was performed surgically in two miniature dachshunds presenting with lateral patellar dislocation and limping caused by pes varus. Pes varus had resulted from asymmetric closure of the physis of the distal tibia. Prior to surgery, osteotomy was simulated by measuring X-ray films to determine the distance required for the wedge opening. Transverse-opening wedge osteotomy was performed on the medial side of the distal tibia, and beta-tricalcium phosphate (beta-TCP) was inserted in a wedge shape into the area created by the cuneiform osteotomy. Finally, the tibia was fixed by a veterinary 1.5/2.0-mm T-plate. Both dogs were able to walk a few days after surgery, and the lateral dislocation of the patella normalized almost completely in about one month. At two months, X-ray films showed that the implant had remained in position without any dislocation, and the beta-TCP had fused with the surrounding bone.  相似文献   

2.
Objective— To validate a technique to assess radial torsion with and without procurvatum and valgus deformity using computed tomography (CT).
Study Design— Anatomic study.
Animals— Radii (n=3) from normal dogs.
Methods— Three cadaveric radii were scanned using CT (3 mm slices). Transverse image sections were assessed at the distal and proximal physeal scar parallel to the joint surface in both sagittal and dorsal planes. Anatomic landmarks of the radius were identified and torsion was measured. A hinged Ilizarov circular external skeletal fixator was constructed to create known procurvatum, valgus, and torsional deformities.
Results— Between observers results were highly correlated for calculation of torsion (r=0.972, r2=0.9448, P <.00001). Mean baseline torsion of the radius in the construct was 4.88°. At 20° procurvatum and valgus, mean calculated torsion was 5.07° (confidence interval [CI]=4.6–5.6°). At 20° procurvatum and valgus with 22.5°-induced torsion, mean measured torsion was 25.4° (expected=27.38°; CI=22.7–28.1°). At 40° procurvatum and valgus and 45°-induced torsion, mean measured torsion was 51.1° (expected=49.88°; CI=−49.2 to 53.0°).
Conclusion— Assessment of radial torsion by CT is reproducible and accurate in the presence of procurvatum and valgus antebrachial angular limb deformities in the dog.
Clinical Relevance— Despite complex presurgical planning, current measurements only allow for measurement of valgus and procurvatum deformities in the sagittal and dorsal planes, this method allows for more precise measurements of radial torsion in the transverse plane.  相似文献   

3.
OBJECTIVE: To identify factors affecting radial alignment after oblique corrective osteotomy stabilized with a type II external fixator and to evaluate the results of this treatment for antebrachial growth deformities. STUDY DESIGN: Retrospective study SAMPLE POPULATION: Twenty-eight dogs with unilateral antebrachial growth deformities treated with acute corrective osteotomy stabilized with a type II external fixator. METHODS: Medical records and preoperative and postoperative radiographs of the affected and contralateral limb were reviewed. Cause of deformity, age, weight, and gender were recorded. Radial length, varus/valgus angulation, and cranial/caudal angulation were measured from radiographs of the treated and contralateral limbs. Preoperative and postoperative angulation and length discrepancy were compared between affected and contralateral limbs. RESULTS: Correction of varus/valgus angle discrepancy was achieved by using acute corrective osteotomy stabilized with type II external skeletal fixation. No significant change was noted for correction of cranial/caudal angle discrepancy or length discrepancy between the affected and control limb. CLINICAL RELEVANCE: Varus/valgus angle deformities can be treated successfully with type III external fixation after oblique corrective osteotomy. Patients with significant length or cranial/caudal angle discrepancies or both that negatively impact function may require the use of hinged circular fixators or other dynamic techniques to achieve adequate correction.  相似文献   

4.
Background Hinged circular external skeletal fixator constructs are used to perform sequential correction of angular limb deformities, often with resultant limb segment lengthening, via distraction osteogenesis. Although there are several reports describing the use of these constructs for correction of antebrachial deformities in dogs, there is little information regarding their use on other limb segments. This report describes the use of hinged circular fixator constructs for the correction of acquired crural deformities in three skeletally immature dogs. Case reports Two dogs had purely frontal plane deformities (one valgus, one varus) and the third dog had frontal (valgus) and sagittal (recurvatum) components to its deformity. At the time of long‐term evaluation, frontal plane angulation relative to the contralateral limb improved from 40° to 22° of valgus, 30° to 5° of valgus, and 20° to 1° of varus in the three individual dogs. Tibial length discrepancies of 12% and 22% that were initially present in two dogs were improved to 6% and 10%, respectively, of the contralateral tibial length at the time of final evaluation; both dogs had compensatory growth of the ipsilateral femur and all dogs had an excellent functional outcome. Conclusion These cases illustrate the value of using hinged circular fixator constructs for correction of crural angular deformities, particularly when length discrepancies of the tibia are present.  相似文献   

5.
Objective— To report unilateral correction and initial stabilization with external skeletal fixation (ESF) of metatarsal rotation in 4 immature Bernese Mountain Dogs.
Study Design— Case series.
Animals— Bernese Mountain Dogs (n=4).
Methods— The limb deformity, including degree and origin of the deformity at the level of the proximal intertarsal joint and involvement of the central tarsal bone, was characterized by clinical and radiographic assessment. Unilateral surgical correction of the most severely affected limb was performed by disrupting the ligaments and debriding the articular cartilage of the proximal intertarsal joint to allow for derotation of the deformity and arthrodesis of the proximal intertarsal joint stabilized with either circular or linear ESF.
Results— Initial metatarsal rotation of the corrected limbs ranged from 60° to 80° of external rotation (mean, 72.5°). Three limb corrections were stabilized with circular ESF and 1 with a biplanar linear ESF. Implants were removed at the time of radiographic bony union (range, 7–10 weeks; mean, 8.6 weeks). Residual deformity was minimal, ranging from 6° to 15° (mean, 11°). Two minor complications (loosening of 1 pin, serous drainage from 1 pin) resolved with treatment.
Conclusion— Correction of rotational deformity of the pes with intertarsal arthrodesis yielded an excellent clinical outcome, with only a mild residual deformity.
Clinical Relevance— Rotational metatarsal deformities can have a significant impact on gait, ambulation, and appearance. Correction of these deformities and stabilization with ESF and intratarsal arthrodesis can yield an excellent functional outcome, with improved gait and ambulation.  相似文献   

6.
Corrective Osteotomy for Pes Varus in the Dachshund   总被引：1，自引：1，他引：0  
Five dachshunds were treated for a distal varus deformity of one tibia. Angulations of 20 degrees to 30 degrees resulted from shortening of the medial tibial length with the maximum curvature at the distal metaphysis. Comparison with the contralateral limbs was required to determine the amount of correction necessary for functional and cosmetic results. Open wedge osteotomies stabilized with a modified type II external fixator resulted in correction of the deformities, early return of limb function, and healing of the osteotomies.  相似文献   

7.
Objective— To assess whether there is a difference in the mechanical medial proximal tibial angle (mMPTA) measured on a tangential caudocranial (tCdCr) radiographic projection versus a straight caudocranial (sCdCr) projection before and after inducing a varus deformity in the proximal tibia. Study Design— In vitro study. Sample Population— Cadaveric canine tibiae (n=4 pair). Methods— For each tibia, a mediolateral radiographic projection was performed and the tibial plateau angle was measured. sCdCr and tCdCr radiographic projections were obtained and the mMPTA measured. A varus deformity was created in the proximal aspect of the tibia and sCdCr and tCdCr projections were repeated and mMPTA measured. Results— mMPTA for tCdCr was statistically different from mMPTA for the sCdCr projection for the varus tibiae (P<.05). There was no significant difference in the mMPTA measured on the sCdCr projections before and after creation of a varus deformity (P>.05). There was a significant difference in mMPTA measured on the tCdCr projection before and after creation of a varus deformity (P<.05). Conclusion— Varus deformity in the mMPTA was identified on tCdCr projections of the varus tibiae whereas it was not identified on sCdCr projections. Clinical Relevance— Tangential radiographic projections of the tibial plateau may be useful for evaluating varus deformities involving the articular surface of the tibia and should be performed during preoperative evaluation of angular limb deformities involving the proximal aspect of the tibia and for tibial plateau leveling osteotomy (TPLO) planning.  相似文献   

8.
A wire-suture method was used for correcting grade IV medial and lateral luxations of the patella. In seven operated stifles, the method resulted in a normal gait and minimal valgus and varus deformity of the distal femur and proximal tibia.  相似文献   

9.
OBJECTIVE: To determine the effect of osteotomy angle, reduction technique, and tibial plateau rotation angle on angular and rotational limb deformities. STUDY DESIGN: Geometric comparison using bone models. METHODS: Rotational osteotomies were made in the proximal metaphysis of artificial tibias at 0 degrees, 10 degrees, 20 degrees, -10 degrees, and -20 degrees from perpendicular with respect to either the proximodistal and craniocaudal tibial axes. Negative-numbered angles represented osteotomies made from distal to proximal or caudal to cranial. Changes in tibial angulation and torsion were measured using a 3-dimensional digitizing instrument at tibial plateau rotation angles from 0 degrees to 30 degrees at 5 degrees increments. Two osteotomy reduction techniques were used: complete osteotomy reduction and alignment of the medial cortex. The mean of 5 measurements of torsional and angular tibial deformity for each of the 9 osteotomy orientations in each reduction technique group was obtained. RESULTS: All had increasing angular and rotational deformity as tibial plateau rotation angle increased. In the medially aligned cortex group, all tibias had valgus deformity, and 8 of 9 tibias were internally rotated. In the reduced osteotomy group, minimal angular deformity was seen in tibias with osteotomy variation along the proximodistal axis; however, tibias with osteotomy variation along the craniocaudal axis had angular deformity ranging from 6.0 degrees of varus deformity to 14.3 degrees of valgus deformity. Rotational deformity was affected similarly by osteotomy variation along either axis. Reduction technique had greater affect on angular and rotational deformity than osteotomy angle variation. CLINICAL RELEVANCE: These results suggest that osteotomy reduction may play a greater role in angular and rotational deformity than osteotomy angle, although extreme osteotomy angles should be avoided. To decrease the severity of deformity, we recommend that the osteotomy be made perpendicular to the craniocaudal and proximodistal axes and be completely reduced with less regard for alignment of the medial cortex.  相似文献   

10.
Objective— To determine if the clinically practiced method of radiographic femoral varus angle (R-FVA) measurement is repeatable, reproducible, and accurate.
Study Design— Radiographic and anatomic study.
Animals/Sample Population— Normal Walker hound cadavers (n=5) and femora (n=10).
Methods— Cadavers were held in dorsally-recumbent and torso-elevated positions as 3 craniocaudal radiographs were made of each femur, by each of 2 different technicians. Femora were then harvested for direct measurement of anatomic femoral varus angle (A-FVA). R-FVA was measured on each radiograph by each of 3 examiners on 3 separate occasions. Intra-observer (repeatability) and inter-observer (reproducibility) variance in R-FVA measurement and the strength of relationship between R-FVA and A-FVA (accuracy) were determined.
Results— Mean (±SD) A-FVA was 5.2±2.1° (range, 2.4–8.2°). Mean (±SD) R-FVA was 5.8±1.0° (range, 2.7–9.6°). Intra-observer variance (range: 11–16%) and inter-observer variance (16%) were acceptable. The strength of relationship between measured R-FVA and A-FVA (maximum adjusted R2<0) was unacceptably low regardless of observer, patient position, or radiographic technician.
Conclusion— R-FVA measurement was repeatable and reproducible, but not statistically accurate in predicting A-FVA in these 5 normal Walker hounds. The detected inaccuracy may be real or the result of a selection bias for normal dogs obscuring the true relationship.
Clinical Relevance— R-FVA may not be an accurate method of femoral varus measurement in dogs with A-FVA<10°. Using Slocum's criteria for distal femoral osteotomy (R-FVA>10°), the procedure would not have been erroneously performed in any of the normal dogs of this study.  相似文献   

11.
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   

12.
Objective —To evaluate hinged circular external fixation for correction of antebrachial deformities in dogs.
Study Design —Uncontrolled clinical trial.
Animal Population —Seven client-owned dogs.
Methods —Six dogs had one radius corrected and one dog had both radii corrected. Preoperative planning included measurement of the craniocaudal and mediolateral angular deformities, rotational deformity, length deficit, origin of deformity, graphical or mathematical determination of the amplitude and direction of the actual limb deformity, and frame assembly.
Results —Preoperatively, function and cosmesis were assessed to be fair to poor in all dogs. Deformity correction started 48 to 60 hours postoperatively and ranged from 0.46 mm to 1.36 mm twice daily. Hospitalization time ranged from 4 to 6 days. Corrections were mostly made by the owners, at home. Lengthening and angular correction ranged from 3 to 38 mm and 18° to 48°. Mean residual deformities were 2.7% of radial length and 2.7°. The time duration with the circular external fixators in place ranged from 29 to 71 days. Two additional surgeries were necessary in one dog because of wire breakage. Mean follow-up was 40 months. Long-term function and cosmesis were good to excellent in all dogs.
Conclusion—Although complications were present in six of seven dogs, the outcome of hinged Ilizarov external fixation was successful in all dogs treated for deformities of the antebrachium.
Clinical Relevance —Despite complex preoperative planning, the placement of hinged circular external fixators is straightforward, and allows precise correction of complex antebrachial deformities with minimal tissue trauma.  相似文献   

13.
Objective— To describe a method for radiographic measurement of proximal and distal mechanical joint angles of the canine tibia. Normal ranges were established for a population of dogs, and specifically, Labrador retrievers, with cranial cruciate ligament rupture.
Study Design— Retrospective study.
Sample Population— Tibiae (n=105) of dogs evaluated for cranial cruciate ligament rupture; 70 tibiae were from Labrador retrievers, 35 tibiae were from other breeds.
Methods— Anatomic landmarks were established and craniocaudal radiographs were used to measure the mechanical medial proximal (mMPTA) and distal (mMDTA) tibial angles in the frontal plane.
Results— Means (±SD) for all tibiae were mMPTA, 93.30±1.78°, and mMDTA, 95.99±2.70°. For Labrador retrievers, means were mMPTA, 93.38±1.81°, and mMDTA 96.34±2.51°. No significant differences were detected between Labrador Retrievers and non-Labrador retrievers with respect to mMPTA (power=0.5) or mMDTA (power=0.342). Labrador Retrievers were significantly younger than non-Labradors ( P =.003).
Conclusion— A method for measurement of the mechanical joint angles of the canine tibia in the frontal plane was established and reference ranges for a population of dogs and Labrador Retrievers with cranial cruciate ligament rupture are reported.
Clinical Relevance— The established method of measurement and references ranges can be used to aid in diagnosis, determining indications, and surgical planning for angular limb deformities of the tibia, especially when affected bilaterally. The methodology and reference values may also be used for postoperative critique.  相似文献   

14.
OBJECTIVE: To determine long-term outcome of distal femoral osteotomy as a component of treatment for distal femoral varus and medial patellar luxation in large-breed dogs. DESIGN:Retrospective case series. ANIMALS: 12 dogs (16 stifle joints). PROCEDURES: Medical records and radiographs were reviewed to identify large-breed dogs with medial patellar luxation (grade > or = 2) and femoral varus angle > or = 12 degrees treated with distal femoral osteotomy, with a minimum follow-up (by a veterinarian) of 18 months. Signalment, weight, medial patellar luxation and lameness grade, pre- and postoperative femoral varus angle, surgical technique, time to radiographic bone union, and complications were recorded. Follow-up with owners via questionnaire was performed > 18 months after surgery. RESULTS: 16 corrective distal femoral osteotomies were performed with ancillary medial patellar luxation procedures in 12 dogs; 4 dogs had staged bilateral procedures. Mean +/- SD preoperative and postoperative femoral varus angles were 16.3 +/- 4.3 degrees and 3.9 +/- 2.5 degrees , respectively. Mean +/- SD time to radiographic union of the distal femoral osteotomy was 52.6 +/- 13 days. One dog had Kirschner wire migration from the tibial tuberosity. Patellar luxation was not detected after surgery in any dog. Mean +/- SD follow-up by a veterinarian was 1,335 +/- 410 days and by use of an owner questionnaire was 1,497 +/- 464 days. All 10 variables of owner-observed patient comfort and function were significantly improved. CONCLUSIONS AND CLINICAL RELEVANCE: Distal femoral osteotomy in combination with traditional treatment provided predictable osteotomy healing, patellar stabilization, and long-term improvement in patient comfort and function when used to treat combined distal femoral varus and medial patellar luxation in large-breed dogs.  相似文献   

15.
This case report describes the treatment of recurrent medial patellar luxation associated with varus deformity of the distal femur by distal femoral ostectomy stabilised using a distal femoral plate. Four dogs (five affected limbs) were included in the study. All cases had received previous surgery for medial patellar luxation but remained significantly lame. All were treated by femoral ostectomy to correct distal femoral varus deformity with application of a distal femoral bone plate. All cases improved following surgery. An excellent outcome was recorded in four of five cases. Lameness persisted in one case despite satisfactory patellar stability as a result of concurrent cranial cruciate ligament deficiency. One case suffered implant failure. Femoral ostectomy is an effective treatment for medial patellar luxation associated with femoral varus deformity. The distal femoral plate provides a convenient method by which to stabilise the ostectomy. Care should be exercised when the 2 mm distal femoral plate is applied.  相似文献   

16.
A lag-screw technique for transphyseal bridging of the medial aspect of the distal tibial physis in foals with tarsal valgus deformities and results of the technique in 11 foals (6 with bilateral tarsal valgus deformities and 5 with unilateral tarsal valgus deformities) are described. Briefly, horses were anesthetized, and a single stab incision was made through the skin to the underlying bone over the most distal aspect of the medial malleolus. A 20-gauge needle was placed in the incision to guide screw placement, and a lag screw was inserted parallel to the medial cortex of the tibia under radiographic guidance. Screws were removed when the tarsal valgus deformity was clinically assessed to have improved by at least 80%. Clinically, all horses had evidence of a tarsal valgus deformity of > 7 degrees prior to surgery. Mean age at the time of lag-screw implanation was 220 days (range, 116 to 364 days). Mean time the implant was in place was 62 days (range, 39 to 89 days). The tarsal valgus deformity resolved in all 11 horses with excellent cosmetic results.  相似文献   

17.
OBJECTIVE: To compare the biomechanical effects of multistage versus one-stage destabilization of a type II external skeletal fixator (ESF) used to stabilize an oblique unstable tibial osteotomy in dogs. STUDY DESIGN: In vitro, in vivo, and ex vivo experimental study. ANIMAL POPULATION: Twelve healthy adult dogs. METHODS: The biomechanical characteristics of the type II ESF used in this study were determined. This fixator was applied to both tibiae of two groups of 6 dogs to stabilize a 2-mm-wide oblique osteotomy. One fixator on each dog remained unchanged throughout the 11-week study (control group). The fixator on the opposite limb was destabilized late and acutely in one group of dogs (single-stage) and early and progressively in the other (multistage). Clinical examination, radiographic examination, and force-plate analysis were used to evaluate the results. All dogs were euthanatized at 11 weeks. All tibiae were scanned to determine the cross-sectional area of the callus in the center of the osteotomy and subjected to biomechanical tests to determine mean pull-out strength of pins and callus strength and stiffness. RESULTS: Stiffness of the type II ESF used in this study was 578 N/mm in axial compression, 0.767 Nm/deg in torsion, 261 N/mm in medio-lateral bending, and 25 N/mm in cranio-caudal bending. Peak vertical forces of the hindlimbs were significantly lower at 2.5 and 5 weeks than before surgery. Peak vertical forces of the hindlimbs did not change before and after destabilization. No significant differences could be detected between the two destabilization sequences or between all control tibiae and pooled destabilized tibiae with regards to radiographic evaluation of the healing osteotomy, cross-sectional periosteal callus area, mean pull-out strength of transfixation pins, callus strength, and callus stiffness. CONCLUSIONS AND CLINICAL RELEVANCE: Bone healing of unstable osteotomies stabilized with a type II ESF is not significantly enhanced by staged destabilization of the fixation as performed in this study.  相似文献   

18.
Objective— To describe a method for radiographic measurement of the mechanical joint angles of the tibia in the sagittal plane and report reference ranges for a population of dogs with cranial cruciate ligament disease, and specifically for Labrador Retrievers.
Study Design— Retrospective evaluation of radiographs.
Animals— Canine tibia (n=150) of dogs evaluated for cranial cruciate ligament disease; 104 tibiae were from Labrador Retrievers, 46 tibiae were from other medium- to large-breed dogs.
Methods— Medial-lateral radiographs were used to establish anatomic landmarks and measure the mechanical cranial distal tibial angle (mCrDTA) and mechanical caudal proximal tibial angle (mCaPTA).
Results— For all tibiae mean mCrDTA was 81.6° and mCaPTA, 63.6°. For Labrador Retriever tibiae mean mCrDTA was 81.7° and mCaPTA, 63.8°. For non-Labradors, means mCrDTA was 81.5° and mCaPTA, 63°. Labrador Retrievers were significantly younger than non-Labradors in our study population. No significant differences were noted between Labrador Retrievers and non-Labradors for mCrDTA or mCaPTA and correlations between mCrDTA and mCaPTA were neither strong nor significant.
Conclusion— A method was established for radiographic measurement of mechanical joint angles of the canine tibia in the sagittal plane. Reference ranges are reported for a population of Labrador Retrievers and a population of non-Labradors with cranial cruciate ligament disease.
Clinical Relevance— Measurement method and reference ranges provided for mechanical tibial angles may be used to aid in diagnosis, surgical planning, and postoperative critique for hindlimb angular deformities.  相似文献   

19.
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   

20.
Tibial osteotomies for cranial cruciate ligament insufficiency in dogs   总被引：2，自引：1，他引：1  
Objective— To review the biomechanical considerations, experimental investigations, and clinical data pertaining to tibial osteotomy procedures for treatment of cranial cruciate ligament (CrCL) insufficiency in dogs.
Study Design— Literature review.
Methods— Literature search through Pub Med, Veterinary Information Network, Commonwealth Agricultural Bureau Abstracts, and conference proceedings abstracts (November 1977 to March 2007).
Results— Reported tibial osteotomy procedures attempt to eliminate sagittal instability (cranial tibial thrust) in CrCL-deficient stifles by altering the conformation of the proximal tibia. Functional stability can be achieved by decreasing the tibial plateau slope (cranial tibial closing wedge osteotomy [CTWO], tibial plateau leveling osteotomy [TPLO], combined TPLO and CTWO, proximal intraarticular osteotomy, chevron wedge osteotomy), altering the alignment of the patellar tendon (tibial tuberosity advancement), or both (triple tibial osteotomy). Clinical reports assessing the efficacy of these procedures frequently use subjective outcome measures, and the periods of follow-up evaluation are highly variable. Satisfactory results have been reported in most (>75%) dogs irrespective of the type of tibial osteotomy procedure.
Conclusions— Currently available data does not allow accurate comparisons between different tibial osteotomy procedures, or with traditional methods of stabilizing the CrCL-deficient stifle. Carefully designed long-term clinical studies and further biomechanical analyses are required to determine the optimal osteotomy technique, and whether these procedures are superior to other stabilization methods.
Clinical Relevance— Limb function in dogs with CrCL insufficiency can be improved using the currently described tibial osteotomy techniques.  相似文献   

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