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61.
Objective— To review the proposed biomechanical basis of the tibial plateau leveling osteotomy (TPLO) and tibial tuberosity advancement (TTA) and recommendations for these techniques.
Study Design— Literature review.
Methods— Literature search through Ovid Medline Plus, Pub Med, CAB Abstracts, and conference proceedings abstracts (August 1983 to March 2008).
Results— TPLO and TTA stabilize the cranial cruciate ligament (CrCL) deficient stifle joint neutralizing tibiofemoral shear forces by altering the geometry of the proximal aspect of the tibia. Stability is attained by placing the joint in a functionally greater flexion angle so that the patellar tendon angle (PTA) remains ≤90°. Both procedures target slightly differing endpoints, the significance of which is unknown. Many of the biomechanical variables investigated appear to favor the TTA; however, TPLO appears to have more clinical versatility. The clinical ramifications of these differences remain to be determined but the reported results for both procedures are comparable. Only the early results of these techniques have been reported, which is reflected in the relatively high number of complications associated with the early learning curve for both procedures.
Conclusions— There are many similarities between TPLO and TTA although it remains to be fully elucidated if either procedure is superior and under what conditions.
Clinical Relevance— TPLO and TTA are effective at returning dogs with a CrCL-deficient stifle joint to good limb function. Surgeon discretion and case selection drive selection of TPLO or TTA based mostly on anecdotal evidence and personal experience. 相似文献
Study Design— Literature review.
Methods— Literature search through Ovid Medline Plus, Pub Med, CAB Abstracts, and conference proceedings abstracts (August 1983 to March 2008).
Results— TPLO and TTA stabilize the cranial cruciate ligament (CrCL) deficient stifle joint neutralizing tibiofemoral shear forces by altering the geometry of the proximal aspect of the tibia. Stability is attained by placing the joint in a functionally greater flexion angle so that the patellar tendon angle (PTA) remains ≤90°. Both procedures target slightly differing endpoints, the significance of which is unknown. Many of the biomechanical variables investigated appear to favor the TTA; however, TPLO appears to have more clinical versatility. The clinical ramifications of these differences remain to be determined but the reported results for both procedures are comparable. Only the early results of these techniques have been reported, which is reflected in the relatively high number of complications associated with the early learning curve for both procedures.
Conclusions— There are many similarities between TPLO and TTA although it remains to be fully elucidated if either procedure is superior and under what conditions.
Clinical Relevance— TPLO and TTA are effective at returning dogs with a CrCL-deficient stifle joint to good limb function. Surgeon discretion and case selection drive selection of TPLO or TTA based mostly on anecdotal evidence and personal experience. 相似文献
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PETER BÖTTCHER Dr med vet Diplomate ECVS DOROTHEE KRASTEL DVM JOHANNES HIERHOLZER Dr med KERSTIN WESTPHALEN Dr med STEPHANIE FLORIAN Dr med vet GUIDO HILDEBRANDT Dr med GREVEL VERA Dr med vet Diplomate ECVS GERHARD OECHTERING Dr med vet Diplomate ECVAA 《Veterinary surgery : VS》2009,38(7):888-901
Objective— To (1) evaluate the analgesic effect of percutaneous cementoplasty (PC) in dogs with primary bone tumor (PBT) of the distal aspect of the radius and (2) evaluate the impact on the course of disease by adding PC to a palliative, multimodal treatment protocol in these dogs.
Study Design— Prospective pilot study.
Animals— Dogs (n=4) with PBT of the distal aspect of the radius.
Methods— Tumor lesions were filled percutaneously with polymethylmethacrylate under fluoroscopic guidance. Pamidronate was administered once in a week before PC. Radiotherapy and chemotherapy were initiated 2 and 6 weeks after PC, respectively. Force plate analysis was performed immediately before 2, and 6 weeks after PC. Survival time was defined from PC to euthanasia.
Results— Two dogs had a significant increase in peak vertical force 2 weeks after PC ( P =.043) and remained free of lameness for 18 and 20 weeks, respectively. One dog had an acute relapse after an initially lame-free period of 10 days. The remaining dog failed to improve ( P =.686). Three dogs developed at least 2 complications including transient worsening of the lameness after PC, cement leakage, wound infection and suspected thromboembolism in combination with cough and anemia. Median survival was 4.8 months (range, 1–5.7 months).
Conclusions— PC in combination with pamidronate significantly improved lameness in 2 dogs; however, PC is not risk-free. Deep wound infection, intraarticular cement leakage, and venous thrombosis were the main complications.
Clinical Relevance— PC might be a useful addition to established palliative, multimodal treatment protocols in dogs with PBT; however, because of the complications encountered PC warrants further study before routine use can be considered. 相似文献
Study Design— Prospective pilot study.
Animals— Dogs (n=4) with PBT of the distal aspect of the radius.
Methods— Tumor lesions were filled percutaneously with polymethylmethacrylate under fluoroscopic guidance. Pamidronate was administered once in a week before PC. Radiotherapy and chemotherapy were initiated 2 and 6 weeks after PC, respectively. Force plate analysis was performed immediately before 2, and 6 weeks after PC. Survival time was defined from PC to euthanasia.
Results— Two dogs had a significant increase in peak vertical force 2 weeks after PC ( P =.043) and remained free of lameness for 18 and 20 weeks, respectively. One dog had an acute relapse after an initially lame-free period of 10 days. The remaining dog failed to improve ( P =.686). Three dogs developed at least 2 complications including transient worsening of the lameness after PC, cement leakage, wound infection and suspected thromboembolism in combination with cough and anemia. Median survival was 4.8 months (range, 1–5.7 months).
Conclusions— PC in combination with pamidronate significantly improved lameness in 2 dogs; however, PC is not risk-free. Deep wound infection, intraarticular cement leakage, and venous thrombosis were the main complications.
Clinical Relevance— PC might be a useful addition to established palliative, multimodal treatment protocols in dogs with PBT; however, because of the complications encountered PC warrants further study before routine use can be considered. 相似文献
63.
IAN M. WRIGHT MA VetMB DEO Diplomate ECVS MRCVS MATTHEW R. W. SMITH BVetMed CertES Diplomate ECVS MRCVS 《Veterinary surgery : VS》2009,38(6):689-695
Objectives— To report the technique, observations on fracture configurations and results of treatment by fixation lag screw following the fracture plane determined by an approach to the third metacarpal/metatarsal bone (MC3/MT3) that begins laterally over the metacarpo(metatarso)phalangeal joint and extends dorsally over the diaphysis of the bone.
Study Design— Case series.
Animals— Thoroughbred horses (n=18) with propagating fractures of the medial condyle of MC3/MT3.
Methods— Retrospective analysis of case records of horses with fractures of the medial condyle of MC3/MT3 that propagated sagittaly or in a spiral configuration into the diaphysis, repaired surgically under general anesthesia by screw fixation in lag fashion through a lateral approach with periosteal reflection.
Results— Fractures were readily identified at surgery, enabling screw fixation in lag fashion following the fracture plane. Fracture configurations varied and could be classified as sagittal and spiral fractures with fractures within each group generally following a similar course. All horses recovered relatively uneventfully from general anesthesia and surgery, and all fractures healed well. Thirteen horses returned to training; 5 subsequently raced.
Conclusions— Repair of propagating sagittal and spiral fractures of the medial condyle of MC3/MT3 with diaphyseal involvement, through a lateral approach with periosteal reflection permits stable fixation with minimal complications. In this series there were no catastrophic failures.
Clinical relevance— Fractures of the medial condyle of MC3/MT3 that propagate either sagittaly or in a spiral configuration into the diaphysis can be successfully repaired with screw fixation in lag fashion using a lateral approach with periosteal reflection. 相似文献
Study Design— Case series.
Animals— Thoroughbred horses (n=18) with propagating fractures of the medial condyle of MC3/MT3.
Methods— Retrospective analysis of case records of horses with fractures of the medial condyle of MC3/MT3 that propagated sagittaly or in a spiral configuration into the diaphysis, repaired surgically under general anesthesia by screw fixation in lag fashion through a lateral approach with periosteal reflection.
Results— Fractures were readily identified at surgery, enabling screw fixation in lag fashion following the fracture plane. Fracture configurations varied and could be classified as sagittal and spiral fractures with fractures within each group generally following a similar course. All horses recovered relatively uneventfully from general anesthesia and surgery, and all fractures healed well. Thirteen horses returned to training; 5 subsequently raced.
Conclusions— Repair of propagating sagittal and spiral fractures of the medial condyle of MC3/MT3 with diaphyseal involvement, through a lateral approach with periosteal reflection permits stable fixation with minimal complications. In this series there were no catastrophic failures.
Clinical relevance— Fractures of the medial condyle of MC3/MT3 that propagate either sagittaly or in a spiral configuration into the diaphysis can be successfully repaired with screw fixation in lag fashion using a lateral approach with periosteal reflection. 相似文献
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RICHARD REARDON BVetMed MARTIN KUMMER DrMedVet Diplomate ECVS CHRISTOPH LISCHER DrMedVet Diplomate ECVS 《Veterinary surgery : VS》2009,38(4):537-542
Objective— To report a novel technique for cervical vertebral fusion in a foal with cervical vertebral malformation (CVM).
Study Design— Case report.
Methods— A 3-month-old Warmblood filly with ataxia, weakness, and stenotic myelopathy at the level of the articulation of the 6th (C6) and 7th (C7) cervical vertebrae had a 7-hole broad locking compression plate (LCP) applied to the ventral aspect of C6 and C7 using seven 5.0-mm locking screws. Revision surgery was required to replace the self-drilling screws, which had migrated, with longer non self-drilling screws. Fusion and growth of the vertebrae were monitored radiographically at 4, 10, and 16 months using radiography and the filly was followed for 32 months.
Results— The filly recovered well from the surgical procedures and by 30 months had improved by 2.5 neurologic grades. Ventral inter-central joint fusion was evident by 10 months. Continued vertebral growth occurred in all but the cranial physis of the C7 vertebral body.
Conclusions— A ventrally placed LCP provided adequate support for fusion and stability of cervical vertebrae.
Clinical Relevance— Use of an LCP applied ventrally offers an alternative to basket use in small or immature horses for fusion of cervical vertebrae. 相似文献
Study Design— Case report.
Methods— A 3-month-old Warmblood filly with ataxia, weakness, and stenotic myelopathy at the level of the articulation of the 6th (C6) and 7th (C7) cervical vertebrae had a 7-hole broad locking compression plate (LCP) applied to the ventral aspect of C6 and C7 using seven 5.0-mm locking screws. Revision surgery was required to replace the self-drilling screws, which had migrated, with longer non self-drilling screws. Fusion and growth of the vertebrae were monitored radiographically at 4, 10, and 16 months using radiography and the filly was followed for 32 months.
Results— The filly recovered well from the surgical procedures and by 30 months had improved by 2.5 neurologic grades. Ventral inter-central joint fusion was evident by 10 months. Continued vertebral growth occurred in all but the cranial physis of the C7 vertebral body.
Conclusions— A ventrally placed LCP provided adequate support for fusion and stability of cervical vertebrae.
Clinical Relevance— Use of an LCP applied ventrally offers an alternative to basket use in small or immature horses for fusion of cervical vertebrae. 相似文献
66.
JUSTIN D. PERKINS BVetMed MS Cert ES Diplomate ECVS ZOË WINDLEY BVetMed PADRAIC M. DIXON MVB PhD MATTHEW SMITH BVetMed Cert ES Diplomate ECVS SAFIA Z. BARAKZAI BVM&S MSc DESTS Diplomate ECVS 《Veterinary surgery : VS》2009,38(5):613-619
Objective— To evaluate the use of sinoscopy for detection and treatment of ventral conchal sinus (VCS) and/or rostral maxillary sinus (RMS) disease in horses.
Study Design— Case series
Animals— Horses (n=60) with suspected paranasal sinus disease.
Methods— Horses were evaluated by sinoscopy through a conchofrontal sinus (CFS) portal with ventral conchal bulla (VCB) fenestration. Other endoscopic sinus approaches and adjunctive diagnostic tests; oral examination, computed tomography, radiography, scintigraphy and endoscopic examination of the upper portion of the respiratory tract were used in some horses.
Results— The CFS approach permitted adequate observation of the RMS and VCS in 53 horses (88%). Hemorrhage caused by VCB fenestration prevented examination of the RMS and/or VCS in 12 horses (21%). Observation of lesions was possible in all horses diagnosed with neoplasia, sinus cysts, and progressive ethmoidal hematomas. Endoscopy of the paranasal sinuses was useful diagnostically in 82% of horses with primary sinusitis. Other diagnostic modalities were usually required to confirm a diagnosis of dental sinusitis.
Conclusions— Trephination into the CFS with VCB fenestration is a minimally invasive technique that provides consistent access to the RMS and VCS. It facilitates diagnosis of many sinus disorders and endoscopically guided treatment of many horses with sinus cysts and primary sinusitis, in combination with sinus lavage.
Clinical Relevance— Many diseases affecting the RMS and VCS can be diagnosed and resolved endoscopically using a CFS approach with VCB fenestration, thus avoiding the need for osteoplastic sinus surgery and its associated risks and complications. 相似文献
Study Design— Case series
Animals— Horses (n=60) with suspected paranasal sinus disease.
Methods— Horses were evaluated by sinoscopy through a conchofrontal sinus (CFS) portal with ventral conchal bulla (VCB) fenestration. Other endoscopic sinus approaches and adjunctive diagnostic tests; oral examination, computed tomography, radiography, scintigraphy and endoscopic examination of the upper portion of the respiratory tract were used in some horses.
Results— The CFS approach permitted adequate observation of the RMS and VCS in 53 horses (88%). Hemorrhage caused by VCB fenestration prevented examination of the RMS and/or VCS in 12 horses (21%). Observation of lesions was possible in all horses diagnosed with neoplasia, sinus cysts, and progressive ethmoidal hematomas. Endoscopy of the paranasal sinuses was useful diagnostically in 82% of horses with primary sinusitis. Other diagnostic modalities were usually required to confirm a diagnosis of dental sinusitis.
Conclusions— Trephination into the CFS with VCB fenestration is a minimally invasive technique that provides consistent access to the RMS and VCS. It facilitates diagnosis of many sinus disorders and endoscopically guided treatment of many horses with sinus cysts and primary sinusitis, in combination with sinus lavage.
Clinical Relevance— Many diseases affecting the RMS and VCS can be diagnosed and resolved endoscopically using a CFS approach with VCB fenestration, thus avoiding the need for osteoplastic sinus surgery and its associated risks and complications. 相似文献
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DENIS J. MARCELLIN-LITTLE DEVD Diplomate ACVS ANTONIO FERRETTI DVM Diplomate ECVS SIMON C. ROE BVSC MS PhD Diplomate ACVS DAVID J. DEYOUNG DVM Diplomate ACVS Diplomate ACVS 《Veterinary surgery : VS》1998,27(3):231-245
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
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
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