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1.
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
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
2.
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
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
3.
Clements DN Gemmill T Corr SA Bennett D Carmichael S 《The Journal of small animal practice》2003,44(8):355-358
Ten dogs were presented with fractures of the proximal tibial epiphysis and tuberosity. All dogs had a cranioproximal-caudodistal angulation of the tibial plateau. Six dogs had marked caudal displacement of the proximal tibial epiphysis, five of which had also sustained fractures of the proximal fibula. The estimated mean angle of inclination of the tibial plateau of affected limbs was 45.8 +/- 9.6 degrees, which was significantly greater (P<0.0005) than the estimated mean angle of the normal contralateral limb 26.2 +/- 6.6 degrees. The mean angle of inclination of the tibial plateau of dogs with fibular fractures (n=5) was not significantly different from dogs without fibular fractures (n=5) (P>0.25). Five dogs were treated conservatively and five were treated by three different methods of surgical repair. Surgically treated dogs had significantly greater preoperative tibial plateau angles (P<0.05). All dogs regained full limb usage, regardless of the method of treatment chosen. 相似文献
4.
Kergosien DH Barnhart MD Kees CE Danielson BG Brourman JD DeHoff WD Schertel ER 《Veterinary surgery : VS》2004,33(5):468-474
OBJECTIVE: To investigate radiographic changes of the tibial tuberosity after tibial plateau leveling osteotomy (TPLO) surgery and identify clinical findings and risk factors associated with such changes. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: Hundred and eighty-six client-owned dogs (219 stifles) that had TPLO surgery. METHODS: Patient data retrieved included radiographic changes of the tibial tuberosity during re-examination, age, body weight, whether unilateral or single-session bilateral surgery had been performed, location of the anti-rotational pin, approximate tibial tuberosity area, and approximate average tibial tuberosity width. RESULTS: Fracture with resulting caudal displacement of the proximal tibial tuberosity (1.4%; 3 of 219) occurred less frequently than non-displaced tibial tuberosity fractures (7.3%; 16 of 219). Age, weight, average tibial tuberosity width, location of the anti-rotational pin, and single session bilateral surgery were identified as risks factors for non-displaced fracture. Weight divided by the square of the average tibial tuberosity width may be a stronger risk factor than either weight or average tibial tuberosity width alone. CONCLUSIONS: Dogs undergoing single session bilateral TPLO surgery are at greater risk for developing non-displaced tibial tuberosity fractures. The non-displaced tibial tuberosity fracture does not appear to adversely affect outcome or lead to tibial tuberosity avulsion. Significant risk factors for fracture of the proximal tibial tuberosity with caudal displacement were not identified. CLINICAL RELEVANCE: Factors including age, weight, tibial tuberosity thickness, and conditions that may enhance strain on the tibial tuberosity, such as single-session bilateral procedures, may increase risk of fracture. 相似文献
5.
Leitner M Pearce SG Windolf M Schwieger K Zeiter S Schawalder P Johnson KA 《Veterinary surgery : VS》2008,37(4):357-365
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
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
6.
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
7.
OBJECTIVES: To compare centered versus distal tibial plateau leveling osteotomy (TPLO) position on cranial tibial subluxation, postoperative tibial plateau angle (TPA), and tibial long axis shift (TLAS). STUDY DESIGN: In vitro biomechanical evaluation. ANIMALS: Six pairs of canine cadaveric hind limbs. METHODS: One limb of each pair was randomly assigned to the distal (TPLO-D) or centered (TPLO-C) osteotomy group. Cranial tibial subluxation (CTS) under load was quantified sequentially under 3 conditions: intact, after cranial cruciate ligament transection, and after TPLO; a corrected CTS value was also calculated. Postoperative TPA and TLAS were measured. Comparisons were made using 1-way repeated measures ANOVA with a Tukey's multiple comparison post hoc test for CTS, and a Wilcoxon's sign rank test for TPA and TLAS. Significance was set at P<.05. RESULTS: TPLO-C had a significantly lower mean CTS than TPLO-D (P<.01). Corrected CTS was also significantly lower in TPLO-C than in TPLO-D (P<.001). Postoperative TPA and TLAS were less in TPLO-C than in TPLO-D (P=.0312). CONCLUSION: Our results confirm that distal centering of the TPLO leads to craniodistal translation of the tibial plateau, TLAS, and a postoperative TPA that is greater than expected. This geometric effect has the biomechanical effect expected of inadequate tibial plateau leveling, namely incomplete neutralization of cranial tibial thrust. CLINICAL RELEVANCE: The centered osteotomy position is geometrically more precise, and biomechanically more effective than the distal position. 相似文献
8.
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
9.
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
10.
Schmerbach KI Boeltzig CK Reif U Wieser JC Keller T Grevel V 《Veterinary surgery : VS》2007,36(2):156-163
OBJECTIVE: To evaluate the influence of a tibial plateau leveling jig on osteotomy orientation, fragment reduction, and postoperative tibial plateau angle (TPA) during tibial plateau leveling osteotomy (TPLO). STUDY DESIGN: In vitro experimental study. ANIMALS: Large-breed canine cadavers (n=20). METHODS: TPLO was performed on 40 hindlimbs using 4 methods. Group 1: Jig; dogs in dorsal recumbency with the osteotomy parallel to the distal jig pin. Groups 2-4: No jig; dogs in lateral recumbency with the osteotomy in a vertical orientation (group 2: tibia parallel to the table top; group 3: controlled superimposition of the femoral condyles; group 4: internal rotation of the tibia). Postoperative TPA, fragment reduction, and osteotomy orientation relative to the tibial plateau were compared. Positive or negative values denoted deviation from parallel relative to the tibial plateau. RESULTS: Postoperative TPA, fragment reduction, and proximodistal osteotomy orientation were not significantly different between groups. Craniocaudal osteotomy orientation was significantly different (P<.005) from the tibial plateau. Median deviations were -4.0 degrees (group 1), 11.8 degrees (group 2), 11.2 degrees (group 3), and 0.2 degrees (group 4). Group 1 was not significantly different from group 4. CONCLUSIONS: A jig is not essential for osteotomy orientation, tibial plateau rotation, or fragment reduction. Comparable results were achieved performing a vertical osteotomy with the tibia slightly internally rotated (10 degrees -15 degrees) and parallel to the table surface. CLINICAL RELEVANCE: TPLO without use of a jig reduces surgical trauma, is less time consuming, and reduces cost. 相似文献
11.
OBJECTIVE: To describe a surgical technique, and outcome, for treatment of cranial cruciate ligament (CrCL) deficient stifle joints with excessive tibial plateau angle (TPA) by combined tibial plateau leveling osteotomy and cranial closing wedge osteotomy (TPLO/CCWO). STUDY DESIGN: Retrospective clinical study. ANIMALS: Fifteen client-owned dogs (18 stifle joints). METHODS: Medical records of dogs that had TPLO/CCWO were reviewed. Pre- and postoperative TPA, CCWO technique, method of fixation and complications were recorded. In-hospital re-evaluation of limb function and length of time to radiographic healing was reviewed. Long-term outcome was assessed by owner telephone interview. RESULTS: Mean pre- and postoperative TPA was 42 degrees and 8 degrees, respectively. The Slocum biradial saw was used to create the CCWO in 4 stifle joints (mean postoperative TPA, 16 degrees) and a sagittal saw was used in 14 stifle joints (mean postoperative TPA, 5 degrees). Postoperative surgical complications were documented in 77.8% of cases; including patellar tendon thickening (61.1%), and implant loosening or breakage (27.8%), seroma formation (11.1%), and local irritation (11.1%). A second surgical procedure was performed in one-third of cases primarily to retrieve implants. Mean time to documented radiographic healing was 18 weeks. Final in-hospital re-evaluation of limb function (mean, 23 weeks postoperatively) was recorded as no lameness in 73.3% and mild lameness in 26.7%. All interviewed owners were satisfied with outcome and 90.9% reported marked improvement or a return to preinjury status. CONCLUSIONS: Long-term clinical outcome of TPLO/CCWO was very good in dogs with excessive TPA, with high owner satisfaction. Longer healing times and a higher complication rate were observed compared with TPLO alone. CLINICAL RELEVANCE: TPLO/CCWO of the tibia in stifle joints with excessive TPA allows for full correction of the TPA to 5 degrees without eliminating buttress support of the tibial tuberosity. 相似文献
12.
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
13.
D B Guastella D B Fox J L Cook 《Veterinary and comparative orthopaedics and traumatology》2008,21(2):125-128
OBJECTIVES: To compare tibial plateau angle (TPA) among Labrador Retrievers, Rottweilers, Boxers, and German Shepherd Dogs that had undergone tibial plateau leveling osteotomies (TPLO) for cranial cruciate ligament disease, and to determine if higher TPAs are associated with increased risk for concurrent meniscal injury. METHODS: This was a retrospective study including 275 client-owned dogs of one of the four aforementioned breeds that received TPLO radiographs between 1999 and 2005 prior to undergoing the TPLO procedure. The TPA measured by the original surgeon was compared among four breeds and analyzed with respect to presence or absence of meniscal injury diagnosed via arthroscopy or arthrotomy at the time of surgery. RESULTS: Labrador Retrievers, Rottweilers, Boxers, and German Shepherd Dogs had mean TPAs of 25.9 degrees , 26.2 degrees , 25.9 degrees , and 28.2 degrees , respectively. The TPA of German Shepherd Dogs was significantly higher than that of the other breeds of dogs examined. TPA higher than the mean for dogs in this study did not significantly increase the risk for concurrent meniscal injury. CLINICAL SIGNIFICANCE: German Shepherd Dogs with cranial cruciate ligament disease had a significantly higher TPA compared to the other breeds examined. Higher TPA did not increase the likelihood of meniscal tears in this study. However, several variables that were not assessed, including the degree of cranial cruciate ligament integrity at the time of surgery and the time between original CrCL deficiency and surgical assessment, could have affected this analysis. 相似文献
14.
15.
OBJECTIVE: To evaluate the effect of tibial plateau leveling on the biomechanics of the canine stifle. STUDY DESIGN: Analysis of a 3-dimensional (3-D) anatomically accurate theoretical model of the canine stifle. METHODS: A 3-D, 3-segment mathematical model of the normal canine stifle was modified to simulate the effect of rotation of the tibial plateau during tibial plateau leveling osteotomy (TPLO). The model examined the normal stifle, the stifle with a tibial plateau angle (TPA) of 0 degrees, and the stifle with a TPA of 5 degrees. Analysis of the models at 10 consecutive equally spaced positions during the stance phase yielded data such as ligament forces and joint reaction forces at each position. RESULTS: Rotation of the tibial plateau to a TPA of 0 degrees almost eliminates forces in the cranial cruciate ligament (CCL) throughout the stance phase. Rotation to a TPA of 5 degrees did not, however, substantially decrease the load in the CCL. Both procedures increased the load in the caudal cruciate ligament (CaCL). CONCLUSIONS: Cranial tibial thrust (CTT) is converted into caudal tibial thrust when the TPA is 0 degrees ; however, rotating the plateau to a TPA of 5 degrees does not eliminate the CTT. CLINICAL RELEVANCE: The TPLO procedure performed as currently recommended (rotating the tibial plateau to a TPA of 5 degrees) may not eliminate the CTT, but only reduce it. Both TPLO procedures evaluated here were found to increase the load in the CaCL. 相似文献
16.
Comparison of surgical treatment options for cranial cruciate ligament disease in large-breed dogs with excessive tibial plateau angle 总被引：1，自引：1，他引：0
Objective— To identify surgical techniques performed by veterinary surgeons for the treatment of cranial cruciate ligament disease in large-breed dogs with excessive tibial plateau angle (eTPA), compare their outcomes, identify risk factors for postoperative complications, and compare outcome and complication rate with tibial plateau leveling osteotomy (TPLO) in dogs without eTPA.
Study Design— Multicenter, case–control study.
Animals— eTPA group (TPA≥35°)=58 dogs (78 stifles); control group (TPA≤30°)=58 dogs (72 stifles).
Methods— Control and eTPA group dogs were identified. Medical records, radiographic reviews, and pet-owner interviews were used to identify surgical treatments performed, their complications, and outcome. Odds ratios with 95% confidence intervals, χ2 tests, and t-tests were calculated to discern differences between eTPA and control-group dogs.
Results— TPLO was the most common treatment for eTPA. Owner-perceived outcome was superior for eTPA group dogs when TPLO resulted in TPA≤14° compared with those with postoperative TPA>14°. Loss of tibial plateau leveling during convalescence was the most commonly observed major complication; addition of ancillary implants to TPLO significantly reduced its incidence. Postoperative complications were more common in dogs with eTPA than in dogs without eTPA; however, no difference in owner-perceived outcome was identified.
Conclusions— Surgical treatment of dogs with eTPA has a higher complication rate, but comparable outcome to that of dogs without eTPA.
Clinical Relevance— Postoperative TPA≤14° and addition of ancillary implants are recommended when using TPLO to treat dogs with eTPA. 相似文献
Study Design— Multicenter, case–control study.
Animals— eTPA group (TPA≥35°)=58 dogs (78 stifles); control group (TPA≤30°)=58 dogs (72 stifles).
Methods— Control and eTPA group dogs were identified. Medical records, radiographic reviews, and pet-owner interviews were used to identify surgical treatments performed, their complications, and outcome. Odds ratios with 95% confidence intervals, χ
Results— TPLO was the most common treatment for eTPA. Owner-perceived outcome was superior for eTPA group dogs when TPLO resulted in TPA≤14° compared with those with postoperative TPA>14°. Loss of tibial plateau leveling during convalescence was the most commonly observed major complication; addition of ancillary implants to TPLO significantly reduced its incidence. Postoperative complications were more common in dogs with eTPA than in dogs without eTPA; however, no difference in owner-perceived outcome was identified.
Conclusions— Surgical treatment of dogs with eTPA has a higher complication rate, but comparable outcome to that of dogs without eTPA.
Clinical Relevance— Postoperative TPA≤14° and addition of ancillary implants are recommended when using TPLO to treat dogs with eTPA. 相似文献
17.
MELISSA J. HOFFER DVM DAVID J. SCHAEFFER BS MS PhD ANN L. JOHNSON DVM MS Diplomate ACVS MICHAEL W. THOMAS DVM MS Diplomate ACVR 《Veterinary surgery : VS》2008,37(7):639-647
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
18.
OBJECTIVE: To assess the relationship between postoperative tibial plateau angle (TPA) and ground reaction forces (GRFs) in Labrador Retrievers at least 4-months after tibial plateau leveling osteotomy (TPLO) surgery. STUDY DESIGN: A retrospective longitudinal study. ANIMALS: Thirty-two Labrador Retrievers with unilateral cranial cruciate ligament disease that had TPLO and concurrent meniscal surgery. METHODS: TPA and GRFs were measured pre- and > or = 4 months postoperatively. Preoperative GRFs, preoperative TPA, duration of injury, postoperative TPA and degree of rotation were each compared with postoperative GRFs using correlation analysis. Dogs were also grouped by postoperative TPA and compared using 1-way analysis of variance (ANOVA). Postoperative function was compared with meniscal release/meniscectomy, patient age, sex, body weight and follow-up time using ANOVA. RESULTS: No significant relationship was found between preoperative GRFs, preoperative TPA, duration of injury, postoperative TPA, degree of rotation, or meniscal release/meniscectomy and postoperative function. Mean preoperative GRFs for all dogs were 28.8 +/- 9.5 for peak vertical force (PVF) and 9.3 +/- 3.1 for peak vertical impulse (VI). Mean postoperative GRFs for all dogs were 40.4 +/- 5.0 for PVF and 14.1 +/- 1.9 for VI. CONCLUSIONS: No statistically significant relationship was found between postoperative TPA and GRFs after TPLO > or = 4 months after surgery, where the postoperative angle was between 0 and 14 degrees. No significant relationship was found between the preoperative TPA and postoperative function. CLINICAL RELEVANCE: Limb function in Labrador Retrievers was not affected by postoperative TPA and re-operation for cases with a postoperative TPA between 0 and 14 degrees is not recommended. 相似文献
19.
MARCOS D. UNIS DVM MS ANN L. JOHNSON DVM MS Diplomate ACVS DAVID J. SCHAEFFER PhD GUILLAUME R. RAGETLY DVM MELISSA J. HOFFER DVM CHANTAL A. RAGETLY DVM MS 《Veterinary surgery : VS》2010,39(2):187-194
Objective— To compare the intra‐ and interobserver variability occurring when observers with differing experience levels measure tibial plateau angles (TPAs) with a novel digital radiographic projection program (tibial plateau leveling osteotomy [TPLO] planning program), the Kodak Picture Archiving and Communications System (PACS), and standard sized printed films (SF). Study Design— Cross‐sectional study. Sample Population— Dogs (n=36) with cranial cruciate ligament (CCL) rupture that had a TPLO. Methods— Six observers, divided into 3 equal groups based on experience level, measured TPA on 36 digitally captured radiographic images of tibiae of dogs clinically affected with CCL rupture. Each observer used 3 methods of measuring TPA and repeated the measurements 3 times with each method. The intra‐ and interobserver variability was compared using the coefficient of variation. Results— Averaged over all replications and images, there was no significant difference (P>.05) in the average variability occurring with each method for all but 1 observer. There was no effect of experience level on measurement variability; however, interobserver variability was significantly less with measurements made with the PACS and TPLO planning program compared with measurements made from SF (P<.05). Conclusions— Repeated measurements of TPA made using digital images and computer‐based measurement programs were significantly less variable between observers than those made from images printed on standard radiographic films. Clinical Relevance— Digital radiography and computer‐based measurement programs are effective for determining the TPA, allowing less variability in measurements compared with SF. The ability to manipulate the image may allow better identification of anatomic landmarks. 相似文献
20.
Thomas J. Coletti Mark Anderson Mary Jean Gorse Richard Madsen 《The Canadian veterinary journal. La revue veterinaire canadienne》2014,55(3):249-254
This retrospective study identified complications associated with tibial plateau leveling osteotomy (TPLO) and predisposing factors for these complications in a large population of dogs from a metropolitan area with cruciate ligament deficiency. There were 943 dogs that underwent unilateral TPLO and 288 with staged bilateral TPLO for a total of 1519 procedures. There were 47 cases with at least 1 major complication and 126 cases with at least 1 minor complication but no major complications. The total complication rate (major or minor) was 11.4% [95% confidence interval (CI) estimate: 9.8%, 13.2%]; the major complication rate was 3.1% (95% CI: 2.3%, 4.1%); and the minor complication rate was 8.3% (95% CI: 7.0%, 9.8%). Factors associated with development of complications included being a German shepherd dog [odds ratio (OR): 3.2], tibial plateau angle > 30° (OR: 1.6), and heavier weights (for every 4.5 kg increase in body weight the OR increased by 1.10). Tibial plateau leveling osteotomy is a common treatment for dogs with cruciate ligament deficiency and has a low complication rate. 相似文献