胫骨平台水平化截骨术治疗犬前交叉韧带疾病的手术效果和并发症分析

doi:10.11843/j.issn.0366-6964.2023.09.034

摘要/Abstract

摘要： 旨在评估胫骨平台水平化截骨术(tibial plateau leveling osteotomy,TPLO)治疗犬前交叉韧带疾病(cranial cruciate ligament disease,CCLD)的手术效果和并发症,分析影响手术效果和并发症的因素。回顾了在中国农业大学动物医院采用TPLO手术治疗犬CCLD的病历记录,并进行回访。入选病例满足:回访时间大于5个月;病例信息记录完整。结果表明:共纳入85只犬的101例TPLO手术,包含了20个品种的犬,主要有杂种犬(n=17,20.0%)、贵宾犬(n=15,17.7%)、比熊犬(n=11,12.9%)、金毛(n=10,11.8%),拉布拉多(n=8,9.4%)。患犬的体重及年龄的中位数分别是14.4 kg(范围,4~53 kg)和7岁(范围,1~14岁)。整体并发症发生率为37.6%(38/101),其中36例(35.6%, 36/101)发生了轻微并发症(包括创口相关并发症和绷带相关并发症),2例(2.0%)发生严重并发症(包括1例螺钉松脱和1例胫骨结节骨折)。创口相关并发症(23.8%,24/101)中,15只舔舐创口的患病动物均出现创口相关并发症,相比未舔舐创口的犬更易发生创口相关并发症(P<0.01)。使用绷带的患病动物有34.6%(18/52)出现了相关并发症。2例严重并发症均采取了手术治疗,术后结果良好。获得回访结果的病例中,95.6%(86/90)功能恢复良好。未见与手术结果相关的风险因素;术后使用绷带会增加并发症发生的风险(P=0.047,OR=3.873,95%CI:1.015~14.776)。综上:TPLO用于CCLD患犬的治疗具有理想的结果,严重并发症发生率低;舔舐会引起伤口相关并发症,术后应严格防止患犬舔舐创口;应减少绷带的使用以降低相关并发症。

关键词: 前交叉韧带疾病, 胫骨平台水平化截骨术, 犬, 手术效果, 并发症

Abstract: This study aimed to evaluate the surgical effect and complications of tibial plateau leveling osteotomy (TPLO) for cranial cruciate ligament disease (CCLD) in dogs, and analyze factors that affect surgical effect and complications. The medical records of canine CCLD treated by TPLO in China Agricultural University Veterinary Teaching Hospital were reviewed and followed up. The inclusion criteria are:follow-up time more than 5 months; case information record is completed. Results were as follows:101 TPLO procedures in 85 dogs of 20 breeds were included, including crossbreed (n=17, 20.0%), poodle (n=15, 17.7%), bichon (n=11, 12.9%), golden retriever (n=10, 11.8%) and Labrador retriever (n=8, 9.4%). The median weight and age were 14.4 kg (range, 4-53 kg) and 7 years (range, 1-14 years old), respectively. The overall complication rate was 37.6% (38/101). Thirty-six cases (35.6%, 36/101) had minor complications (including wound-related complications and bandage-related complications), and 2 cases (2.0%) had major complications (including 1case of screw loosening and 1 case of tibial tuberosity fracture). Wound-related complications (23.8%, 24/101) were more likely to occur in dogs with wound licking (P<0.01), which were found in all the 15 dogs with wound licking. Related complications occurred in 18 (34.6%) of 52 dogs treated with bandage. Two major complications were treated by revision surgery with good results. Among the cases with follow-up results, 95.6% (86/90) cases had good functional recovery. Besides, postoperative bandage increased the risk of complications (P=0.047, OR=3.873, 95%CI:1.015-14.776). However, no risk factors associated with surgical outcomes were found. In summary, TPLO of dogs with CCLD has desirable results and a low proportion of major complications. Licking can cause wound-related complications, therefore licking wounds should be strictly prevented postoperatively. Moreover, the use of bandages should be reduced to decrease associated complications.

Key words: cranial cruciate ligament disease, tibial plateau leveling osteotomy, canine, surgical effect, complications

中图分类号:

S857.128

石磊, 马裔寒, 袁占奎, 孙艺虹, 王虓, 张彬, 乔康佳. 胫骨平台水平化截骨术治疗犬前交叉韧带疾病的手术效果和并发症分析[J]. 畜牧兽医学报, 2023, 54(9): 3964-3976.

SHI Lei, MA Yihan, YUAN Zhankui, SUN Yihong, WANG Xiao, ZHANG Bin, QIAO Kangjia. Analysis of Surgical Effect and Complications of Tibial Plateau Leveling Osteotomy for the Treatment of Cranial Cruciate Ligament Disease in Dogs[J]. Acta Veterinaria et Zootechnica Sinica, 2023, 54(9): 3964-3976.

参考文献

[1] MOSSMAN H, VON PFEIL D J, NICHOLSON M, et al. Accuracy of three pre-and intra-operative measurement techniques for osteotomy positioning in the tibial plateau levelling procedure[J]. Vet Comp Orthop Traumatol, 2015, 28(4):250-255.
[2] WITSBERGER T H, VILLAMIL J A, SCHULTZ L G, et al. Prevalence of and risk factors for hip dysplasia and cranial cruciate ligament deficiency in dogs[J]. J Am Vet Med Assoc, 2008, 232(12):1818-1824.
[3] COOK J L. Cranial cruciate ligament disease in dogs:biology versus biomechanics[J]. Vet Surg, 2010, 39(3):270-277.
[4] DUERR F M, MARTIN K W, RISHNIW M, et al. Treatment of canine cranial cruciate ligament disease. A survey of ACVS Diplomates and primary care veterinarians[J]. Vet Comp Orthop Traumatol, 2014, 27(6):478-483.
[5] SLOCUM B, SLOCUM T D. Tibial plateau leveling osteotomy for repair of cranial cruciate ligament rupture in the canine[J]. Vet Clin North Am Small Anim Pract, 1993, 23(4):777-795.
[6] HOOTS E A, PETERSEN S W. Tibial plateau leveling osteotomy and cranial closing wedge ostectomy in a cat with cranial cruciate ligament rupture[J]. J Am Anim Hosp Assoc, 2005, 41(6):395-399.
[7] RAY W M, GUSTAFSON S B, HUBER M J. Tibial plateau leveling osteotomy in a llama with a ruptured cranial cruciate ligament[J]. J Am Vet Med Assoc, 2004, 225(11):1739-1742, 1702.
[8] WITTE P G, SCOTT H W. Tibial plateau leveling osteotomy in small breed dogs with high tibial plateau angles using a 4-hole 1. 9/2. 5 mm locking T-plate[J]. Vet Surg, 2014, 43(5):549-557.
[9] COSENZA G, REIF U, MARTINI F M. Tibial plateau levelling osteotomy in 69 small breed dogs using conically coupled 1. 9/2. 5 mm locking plates. A clinical and radiographic retrospective assessment[J]. Vet Comp Orthop Traumatol, 2015, 28(5):347-354.
[10] AMIMOTO H, KOREEDA T, OCHI Y, et al. Force plate gait analysis and clinical results after Tibial Plateau levelling osteotomy for cranial cruciate ligament rupture in small breed dogs[J]. Vet Comp Orthop Traumatol, 2020, 33(3):183-188.
[11] BERGER B, KNEBEL J, STEIGMEIER-RAITH S, et al. Long-term outcome after surgical treatment of cranial cruciate ligament rupture in small breed dogs. Comparison of tibial plateau leveling osteotomy and extra-articular stifle stabilization[J]. Tierarztl Prax Ausg K Kleintiere Heimtiere, 2015, 43(6):373-380.
[12] 王虓, 吴楚琳, 袁占奎, 等. 31例犬前十字韧带断裂手术治疗的调查报告[J]. 黑龙江畜牧兽医, 2022(10):68-72, 75.
WANG X, WU C L, YUAN Z K, et al. Investigation report on surgical treatment of 31 cases of canine cranial cruciate ligament rupture[J]. Heilongjiang Animal Science and Veterinary Medicine, 2022(10):68-72, 75.
[13] 吴楚琳, 王佳尧, 张晗, 等. 前十字韧带断裂犬胫骨平台角的X线和CT测量[J]. 中国畜牧兽医, 2021, 48(10):3896-3904.
WU C L, WANG J Y, ZHANG H, et al. Radiographic and CT measurements of tibial plateau angle in dogs with cranial cruciate ligament rupture[J]. China Animal Husbandry & Veterinary Medicine, 2021, 48(10):3896-3904.
[14] IMPELLIZERI J A, TETRICK M A, MUIR P. Effect of weight reduction on clinical signs of lameness in dogs with hip osteoarthritis[J]. J Am Vet Med Assoc, 2000, 216(7):1089-1091.
[15] QUINN M M, KEULER N S, LU Y, et al. Evaluation of agreement between numerical rating scales, visual analogue scoring scales, and force plate gait analysis in dogs[J]. Vet Surg, 2007, 36(4):360-367.
[16] COOK J L, EVANS R, CONZEMIUS M G, et al. Proposed definitions and criteria for reporting time frame, outcome, and complications for clinical orthopedic studies in veterinary medicine[J]. Vet Surg, 2010, 39(8):905-908.
[17] GATINEAU M, DUPUIS J, PLANTÉ J, et al. Retrospective study of 476 tibial plateau levelling osteotomy procedures. Rate of subsequent 'pivot shift', meniscal tear and other complications[J]. Vet Comp Orthop Traumatol, 2011, 24(5):333-341.
[18] COLLINS J E, DEGNER D A, HAUPTMAN J G, et al. Benefits of pre-and intraoperative planning for tibial plateau leveling osteotomy[J]. Vet Surg, 2014, 43(2):142-149.
[19] AULAKH K S, HARPER T A M, LANZ O I, et al. Effect of stifle angle on the magnitude of the tibial plateau angle measurement in dogs with intact and transected cranial cruciate ligament. A cadaveric study[J]. Vet Comp Orthop Traumatol, 2011, 24(4):272-278.
[20] REIF U, DEJARDIN L M, PROBST C W, et al. Influence of limb positioning and measurement method on the magnitude of the tibial plateau angle[J]. Vet Surg, 2004, 33(4):368-375.
[21] UNIS M D, JOHNSON A L, GRIFFON D J, et al. Evaluation of intra-and interobserver variability and repeatability of tibial plateau angle measurements with digital radiography using a novel digital radiographic program[J]. Vet Surg, 2010, 39(2):187-194.
[22] BELL J C, NESS M G. Does use of a jig influence the precision of tibial plateau leveling osteotomy surgery?[J]. Vet Surg, 2007, 36(3):228-233.
[23] SCHMERBACH K I, BOELTZIG C K M, REIF U, et al. In vitro comparison of tibial plateau leveling osteotomy with and without use of a tibial plateau leveling jig[J]. Vet Surg, 2007, 36(2):156-163.
[24] LEE S, KANG J S, KIM N, et al. Evaluation of a customized 3D-printed saw guide for tibial plateau leveling osteotomy:An ex vivo study[J]. Vet Surg, 2022, 51(6):963-973.
[25] BURTON N J, FITZPATRICK N, WALLACE A M. Evaluation of cut accuracy and cis cortical damage for tibial plateau leveling osteotomy performed with and without aid of a novel saw guide:an in vitro study[J]. Vet Surg, 2013, 42(1):28-37.
[26] TAN C J, BERGH M S, SCHEMBRI M A, et al. Accuracy of tibial osteotomy placement using 2 different tibial plateau leveling osteotomy jigs[J]. Vet Surg, 2014, 43(5):525-533.
[27] CONKLING A L, FAGIN B, DAYE R M. Comparison of tibial plateau angle changes after tibial plateau leveling osteotomy fixation with conventional or locking screw technology[J]. Vet Surg, 2010, 39(4):475-481.
[28] KOWALESKI M P, BOUDRIEAU R J, BEALE B S, et al. Radiographic outcome and complications of tibial plateau leveling osteotomy stabilized with an anatomically contoured locking bone plate[J]. Vet Surg, 2013, 42(7):847-852.
[29] SOLANO M A, DANIELSKI A, KOVACH K, et al. Locking plate and screw fixation after tibial plateau leveling osteotomy reduces postoperative infection rate in dogs over 50 kg[J]. Vet Surg, 2015, 44(1):59-64.
[30] PACCHIANA P D, MORRIS E, GILLINGS S L, et al. Surgical and postoperative complications associated with tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture:397 cases (1998-2001)[J]. J Am Vet Med Assoc, 2003, 222(2):184-193.
[31] PRIDDY II N H, TOMLINSON J L, DODAM J R, et al. Complications with and owner assessment of the outcome of tibial plateau leveling osteotomy for treatment of cranial cruciate ligament rupture in dogs:193 cases (1997-2001)[J]. J Am Vet Med Assoc, 2003, 222(12):1726-1732.
[32] STAUFFER K D, TUTTLE T A, ELKINS A D, et al. Complications associated with 696 tibial plateau leveling osteotomies (2001-2003)[J]. J Am Anim Hosp Assoc, 2006, 42(1):44-50.
[33] FITZPATRICK N, SOLANO M A. Predictive variables for complications after TPLO with stifle inspection by arthrotomy in 1000 consecutive dogs[J]. Vet Surg, 2010, 39(4):460-474.
[34] COLETTI T J, ANDERSON M, GORSE M J, et al. Complications associated with tibial plateau leveling osteotomy:a retrospective of 1519 procedures[J]. Can Vet J, 2014, 55(3):249-254.
[35] NAZARALI A, SINGH A, WEESE J S. Perioperative administration of antimicrobials during tibial plateau leveling osteotomy[J]. Vet Surg, 2014, 43(8):966-971.
[36] NAZARALI A, SINGH A, MOENS N M, et al. Association between methicillin-resistant Staphylococcus pseudintermedius carriage and the development of surgical site infections following tibial plateau leveling osteotomy in dogs[J]. J Am Vet Med Assoc, 2015, 247(8):909-916.
[37] HANS E C, BARNHART M D, KENNEDY S C, et al. Comparison of complications following tibial tuberosity advancement and tibial plateau levelling osteotomy in very large and giant dogs 50 kg or more in body weight[J]. Vet Comp Orthop Traumatol, 2017, 30(4):299-305.
[38] BROWN G, MADDOX T, SILES M M B. Client-assessed long-term outcome in dogs with surgical site infection following tibial plateau levelling osteotomy[J]. Vet Rec, 2016, 179(16):409.
[39] TUTTLE T A, MANLEY P A. Risk factors associated with fibular fracture after tibial plateau leveling osteotomy[J]. Vet Surg, 2009, 38(3):355-360.
[40] TAYLOR J, LANGENBACH A, MARCELLIN-LITTLE D J. Risk factors for fibular fracture after TPLO[J]. Vet Surg, 2011, 40(6):687-693.
[41] KERGOSIEN D H, BARNHART M D, KEES C E, et al. Radiographic and clinical changes of the tibial tuberosity after tibial plateau leveling osteotomy[J]. Vet Surg, 2004, 33(5):468-474.
[42] BERGH M S, RAJALA-SCHULTZ P, JOHNSON K A. Risk factors for tibial tuberosity fracture after tibial plateau leveling osteotomy in dogs[J]. Vet Surg, 2008, 37(4):374-382.
[43] BOUDRIEAU R J, MCCARTHY R J, SISSON R D, Jr. Sarcoma of the proximal portion of the tibia in a dog 5.5 years after tibial plateau leveling osteotomy[J]. J Am Vet Med Assoc, 2005, 227(10):1613-1617.
[44] MEESON R L, DAVIDSON C, ARTHURS G I. Soft-tissue injuries associated with cast application for distal limb orthopaedic conditions[J]. Vet Comp Orthop Traumatol, 2011, 24(2):126-131.
[45] BERGH M S, SULLIVAN C, FERRELL C L, et al. Systematic review of surgical treatments for cranial cruciate ligament disease in dogs[J]. J Am Anim Hosp Assoc, 2014, 50(5):315-321.
[46] THIEMAN K M, TOMLINSON J L, FOX D B, et al. Effect of meniscal release on rate of subsequent meniscal tears and owner-assessed outcome in dogs with cruciate disease treated with tibial plateau leveling osteotomy[J]. Vet Surg, 2006, 35(8):705-710.
[47] CHRISTOPHER S A, BEETEM J, COOK J L. Comparison of long-term outcomes associated with three surgical techniques for treatment of cranial cruciate ligament disease in dogs[J]. Vet Surg, 2013, 42(3):329-334.
[48] DE MEDEIROS M, BUSTINDUY M S, RADKE H, et al. Early kinematic outcome after treatment of cranial cruciate ligament rupture by tibial plateau levelling osteotomy in the dog[J]. Vet Comp Orthop Traumatol, 2011, 24(3):178-184.
[49] BÖDDEKER J, DRÜEN S, MEYER-LINDENBERG A, et al. Computer-assisted gait analysis of the dog:comparison of two surgical techniques for the ruptured cranial cruciate ligament[J]. Vet Comp Orthop Traumatol, 2012, 25(1):11-21.
[50] INNES J F, BARR A R S. Can owners assess outcome following treatment of canine cruciate ligament deficiency?[J]. J Small Anim Pract, 1998, 39(8):373-378.