新型囊外固定手術與脛骨平台水平矯形術治療犬前十字韌帶斷裂的臨床比較

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2024/06/05 新型囊外固定手術與脛骨平台水平矯形術治療犬前十字韌帶斷裂的臨床比較

Clinical comparison of a novel extracapsular stabilization procedure and tibial plateau leveling osteotomy for treatment of cranial cruciate ligament deficiency in dogs
新型囊外固定手術與脛骨平台水平矯形術治療犬前十字韌帶斷裂的臨床比較
James L Cook ¹, Jill K Luther, Jodi Beetem, Josh Karnes, Cristi R Cook
Affiliations expand

PMID: 20345535
DOI: 10.1111/j.1532-950X.2010.00658.x

Abstract
Objective: To develop and test a novel extracapsular technique, TightRope CCL technique (TR), and compare its 6-month clinical outcomes to tibial plateau leveling osteotomy (TPLO) in dogs with cranial cruciate ligament (CCL) deficiency.
Study design: Prospective clinical cohort study.
Animals: Medium, large, and giant breed dogs (n=47) with CCL deficiency.
Methods: Before clinical use, TR was evaluated by mechanical testing and the surgical technique was developed and evaluated in canine cadavers. For the clinical study, dogs were assigned to either TR (n=24) or TPLO (n=23) groups and the assigned technique performed after arthroscopic assessment and treatment of joint pathology. Postoperative management was standardized for both groups. Outcome measures were performed immediately postoperatively and up to 6 months after surgery and included complication types and rate, subjective measurement of cranial drawer and tibial thrust, subjective assessment of radiographic progression of osteoarthritis (OA), and function using a validated client questionnaire (6 months only).
Results: TR with a fiber tape suture had superior mechanical properties for creep, stiffness, yield load, and load at failure. Duration of anesthesia, total surgical time, and stabilization procedure (TR versus TPLO) were all significantly (P<.001) shorter for TR compared with TPLO. Complications requiring further treatment occurred in 12.5% of TR cases and 17.4% of TPLO cases. No significant differences were noted between groups for cranial tibial thrust, but cranial drawer was significantly (P<.05) lower in TR stifles at all postoperative time points. No significant differences were noted between groups for radiographic OA scores. No statistically or clinically significant differences were noted between TR and TPLO for scores for each of the client questionnaire categories.
Conclusions: TR resulted in 6-month outcomes that were not different than TPLO in terms of radiographic progression of OA and client-evaluated level of function. TR was associated with shorter anesthesia and surgery times as well as a lower complication rate.
Clinical relevance: The TR technique is safe and effective and can be considered an appropriate surgical option as part of the overall treatment plan for CCL deficiency in dogs.
Vet Surg

. 2010 Apr;39(3):315-23.
doi: 10.1111/j.1532-950X.2010.00658.x. Epub 2010 Mar 19.

原文出處: https://pubmed.ncbi.nlm.nih.gov/20345535/

新型囊外固定手術與脛骨平台水平矯形術治療犬前十字韌帶斷裂的臨床比較
摘要
目的：
發展測試一種新型囊外固定技術，TightRope CCL 技術(TR)，與脛骨平台整平截骨術(TPLO) 治療犬前十字韌帶(CCL)斷裂術後6 個月的臨床結果進行比較。

動物：患有前十字韌帶(CCL)斷裂的中型、大型和巨型犬（n=47）。

研究設計：前瞻性臨床世代研究法。

方法：
在臨床使用之前，在犬的大體上創立和評估囊外固定技術(TR)手術機械性測試和手術技術來進行評估，在臨床研究中，狗先使用關節鏡評估關節病理和治療後執行指定的手術技術，狗被隨機分配到囊外固定技術(TR)（n=24）或 TPLO（n=23）組，。兩組的術後管理均標準化。術後立即和術後6 個月內進行結果測量，包括併發症類型和發生率、抽屜試驗和脛骨滑動的測量、主觀的評估放射線學的骨關節炎(OA) 進展以及使用有效的飼主問卷調查術後恢復的狀況（僅到術後6 個月）。

結果：
使用囊外固定技術(TR)在潛變 (備註: 在應力作用下固體材料緩慢且永久的變形。它的發生是低於材料屈服強度的應力長時間作用的結果)、剛度、可承受力道 (強韌度) 和無法承受力道方面具有優異的機械性能。與 TPLO 相比，囊外固定技術(TR)的麻醉持續時間、總手術時間和穩固膝關節手術過程（囊外固定技術TR對 TPLO比較）均顯著縮短 (P<.001)。 12.5% 的囊外固定技術(TR)病例和 17.4% 的 TPLO 病例出現的併發症需要進一步治療。各組之間的前脛骨滑動沒有顯著差異，但TR 膝關節的抽屜試驗均在所有時間點顯著降低 (P<.05)。兩組之間的放射線學骨關節炎評分沒有顯著差異。對於飼主問卷各類別的分數，囊外固定技術(TR)和 TPLO 之間沒有統計學上的臨床顯著差異。

結論：
囊外固定技術(TR)與 TPLO術後 6 個月在 OA 的影像學骨關節炎的評估進展和飼主問券調查患肢的使用功能方面沒有不同。囊外固定技術(TR)併發症發生率較低與麻醉時間和手術時間較短有關。
臨床相關性：囊外固定技術(TR)技術安全有效，可作為狗前十字韌帶疾病的手術治療選擇之一。

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