3D打印模型辅助手术治疗犬髌骨Ⅳ级内脱伴前交叉韧带断裂

doi:10.11843/j.issn.0366-6964.2023.09.035

畜牧兽医学报 ›› 2023, Vol. 54 ›› Issue (9): 3977-3984.doi: 10.11843/j.issn.0366-6964.2023.09.035

3D打印模型辅助手术治疗犬髌骨Ⅳ级内脱伴前交叉韧带断裂

张彬¹, 张晗¹, 石磊¹, 袁占奎^1,2*

1. 北京中农大动物医院有限公司, 北京 100193;
2. 中国农业大学动物医学院, 北京 100193

收稿日期:2022-11-08 发布日期:2023-09-22
通讯作者: 袁占奎,主要从事小动物外科、麻醉的临床、科研及教学工作,E-mail:zk_yuan@cau.edu.cn
作者简介:张彬(1989-),男,山东泰安人,硕士,主要从事小动物软组织外科和骨科疾病研究,E-mail:zbjilin@126.com

Clinical Application of 3D-Printed Model for Surgical Planning and Treatment of Grade Ⅳ Medial Patellar Luxation and Cranial Cruciate Ligament Rupture in a Dog

ZHANG Bin¹, ZHANG Han¹, SHI Lei¹, YUAN Zhankui^1,2*

1. China Agricultural University Veterinary Teaching Hospital, Beijing 100193, China;
2. College of Veterinary Medicine, China Agricultural University, Beijing 100193, China

Received:2022-11-08 Published:2023-09-22

摘要/Abstract

摘要： 旨在报导3D打印辅助手术治疗1例犬髌骨Ⅳ级内脱伴发前交叉韧带断裂的效果。患有髌骨Ⅳ级内脱伴发前交叉韧带断裂的柴犬采用两种方式治疗,先采用改良式胫骨平台水平化截骨术(tibial plateau leveling osteotomy,TPLO)和楔形滑车成形术治疗,后进行CT扫描和3D打印股骨模型对股骨畸形进行评估,辅助制定手术计划,进行股骨远端外侧闭合楔形截骨术(distal femoral lateral closing wedge osteotomy,DFO)治疗。通过检查患犬跛行程度、髌骨位置和影像学检查来判断患犬的恢复程度。结果显示:改良式胫骨平台水平化截骨术和楔形滑车成形术治疗术后第8周出现髌骨脱位复发,说明该方法无法完全纠正髌骨Ⅳ级内脱。通过3D打印辅助制定手术方案,采用DFO治疗后跛行明显改善,术后恢复良好。综上,在高级别髌骨内脱伴有前交叉韧带断裂的病例中,应该同时注意是否存在股骨畸形;采用3D打印技术可以更准确地评估骨骼形态,辅助制定股骨矫正方案,提高手术成功率。

关键词: 髌骨内脱, 前交叉韧带疾病, 改良式胫骨平台水平截骨术, 股骨远端外侧闭合楔形截骨术, 3D打印技术

Abstract: The aim of this study was to report the effect of surgery assisted by 3D printing technique in the treatment of a dog with grade Ⅳ medial patellar luxation and cranial cruciate ligament rupture. A Shiba Inu with grade Ⅳ medial patellar luxation and cranial cruciate ligament rupture is treated in two ways. First, the modified tibial plateau leveling osteotomy (TPLO) and trochlear wedge recession are used. Then, the femoral deformity is evaluated through CT scanning and 3D printing of the femoral model to assist in formulating the surgical plan and carrying out distal femoral lateral closing wedge osteotomy (DFO). The degree of lameness, patella position and imaging examination are used to determine the recovery of the dog. The results showed that patellar luxation recurred 8 weeks after the modified TPLO and trochlear wedge recession, indicating that this method can not completely correct the grade Ⅳ medial patellar luxation. With the help of 3D printing technique, the DFO surgical planning is formulated, lameness is significantly improved after treatment, and postoperative recovery is good. In the case of high-level patellar luxation with cranial cruciate ligament rupture, attention should be paid to whether there is femoral deformity; The use of 3D printing technology can assess bone morphology more accurately, assist in formulating femoral osteotomy plan, and improve the success rate of surgery.

Key words: medial patellar luxation, cranial cruciate ligament disease, modified tibial plateau leveling osteotomy, distal femoral lateral closing wedge osteotomy, 3D printing technology

中图分类号:

张彬, 张晗, 石磊, 袁占奎. 3D打印模型辅助手术治疗犬髌骨Ⅳ级内脱伴前交叉韧带断裂[J]. 畜牧兽医学报, 2023, 54(9): 3977-3984.

ZHANG Bin, ZHANG Han, SHI Lei, YUAN Zhankui. Clinical Application of 3D-Printed Model for Surgical Planning and Treatment of Grade Ⅳ Medial Patellar Luxation and Cranial Cruciate Ligament Rupture in a Dog[J]. Acta Veterinaria et Zootechnica Sinica, 2023, 54(9): 3977-3984.

参考文献

[1] LANGENBACH A,MARCELLIN-LITTLE D J.Management of concurrent patellar luxation and cranial cruciate ligament rupture using modified tibial plateau levelling[J].J Small Anim Pract,2010,51(2):97-103.
[2] JOHNSTON S A,TOBIAS K M.Veterinary surgery:small animal expert consult[M].2nd ed.Amsterdam:Elsevier,2017:1141-1159.
[3] PERRY K L,DÉJARDIN L M.Canine medial patellar luxation[J].J Small Anim Pract,2021,62(5):315-335.
[4] FAURON A H,BRUCE M,JAMES D R,et al.Surgical stabilization of concomitant canine medial patellar luxation and cranial cruciate ligament disease:effect of fixation method on postoperative complication rate and clinical outcome[J].Vet Comp Orthop Traumatol,2017,30(3):209-218.
[5] CAMPBELL C A,HORSTMAN C L,MASON D R,et al.Severity of patellar luxation and frequency of concomitant cranial cruciate ligament rupture in dogs:162 cases (2004-2007)[J].Am Vet Med Assoc,2010,236(8):887-891.
[6] MUIR P.Advances in the canine cranial cruciate ligament[M].2nd ed.Hoboken:American College of Veterinary Surgeons Foundation,2018:261-268.
[7] LEONARD K C,KOWALESKI M P,SAUNDERS W B,et al.Combined tibial plateau levelling osteotomy and tibial tuberosity transposition for treatment of cranial cruciate ligament insufficiency with concomitant medial patellar luxation[J].Vet Comp Orthop Traumatol,2016,29(6):536-540.
[8] 刘佳怡,王媛,马春丽,等.3D打印PLA-nHA复合支架膜在犬牙周组织再生中的应用[J].新疆医科大学学报,2021,44(2):155-161.
LIU J Y,WANG Y,MA C L,et al.Application of 3D printing PLA-nHA composite scaffold membrane in canine GTR[J].Journal of Xinjiang Medical University,2021,44(2):155-161.(in Chinese)
[9] 赵雯,邹彤,吕阳欧,等.犬BMSCs复合3D打印支架制备组织工程半月板及体外成软骨诱导时间对其分化的影响[J].畜牧兽医学报,2019,50(7):1486-1492.
ZHAO W,ZOU T,LÜ Y O,et al.Preparation of tissue engineering meniscus by canine BMSCs composite 3D printed Scaffold and effect of chondrogenic induction time on its differentiation in vitro[J].Acta Veterinaria et Zootechnica Sinica,2019,50(7):1486-1492.(in Chinese)
[10] VEZZONI L,BAZZO S,BOIOCCHI S,et al.Use of a modified tibial plateau levelling osteotomy with double cut and medial crescentic closing wedge osteotomy to treat dogs with cranial cruciate ligament rupture and tibial valgus deformity[J].Vet Comp Orthop Traumatol,2020,33(1):59-65.
[11] YEADON R,FITZPATRICK N,KOWALESKI M P.Tibial tuberosity transposition-advancement for treatment of medial patellar luxation and concomitant cranial cruciate ligament disease in the dog:surgical technique,radiographic and clinical outcomes[J].Vet Comp Orthop Traumatol,2011,24(1):18-26.
[12] LIVET V,TARONI M,FERRAND F X,et al.Modified triple tibial osteotomy for combined cranial cruciate ligament rupture,tibial deformities,or patellar luxation[J].J Am Anim Hosp Assoc,2019,55(6):291-300.
[13] TOMO Y,EDAMURA K,YAMAZAKI A,et al.Evaluation of hindlimb deformity and posture in dogs with grade 2 medial patellar luxation during awake computed tomography imaging while standing[J].Vet Comp Orthop Traumatol,2022,35(3):143-151.
[14] BROWER B E,KOWALESKI M P,PERUSKI A M,et al.Distal femoral lateral closing wedge osteotomy as a component of comprehensive treatment of medial patellar luxation and distal femoral varus in dogs[J].Vet Comp Orthop Traumatol,2017,30(1):20-27.
[15] TOMLINSON J,FOX D,COOK J L,et al.Measurement of femoral angles in four dog breeds[J].Vet Surg,2007,36(6):593-598.
[16] DUDLEY R M,KOWALESKI M P,DROST W T,et al.Radiographic and computed tomographic determination of femoral varus and torsion in the dog[J].Vet Radiol Ultrasound,2006,47(6):546-552.
[17] YASUKAWA S,EDAMURA K,TANEGASHIMA K,et al.Evaluation of bone deformities of the femur,tibia,and patella in Toy Poodles with medial patellar luxation using computed tomography[J].Vet Comp Orthop Traumatol,2016,29(1):29-38.
[18] LEE J,SIM H,JEONG J,et al.Biomechanical analysis of canine medial patellar luxation with femoral varus deformity using a computer model[J].BMC Vet Res,2020,16(1).471.
[19] LONGO F,SAVIO G,CONTIERO B,et al.Accuracy of an automated three-dimensional technique for the computation of femoral angles in dogs[J].Vet Rec,2019,185(14):443.
[20] WORTH A J,CROSSE K R,KERSLEY A.Computer-assisted surgery using 3D printed saw guides for acute correction of antebrachial angular limb deformities in dogs[J].Vet Comp Orthop Traumatol,2019,32(3):241-249.
[21] HALL E L,BAINES S,BILMONT A,et al.Accuracy of patient-specific three-dimensional-printed osteotomy and reduction guides for distal femoral osteotomy in dogs with medial patella luxation[J].Vet Surg,2019,48(4):584-591.
[22] WONG K C.3D-printed patient-specific applications in orthopedics[J].Orthop Res Rev,2016,8:57-66.
[23] 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.(in Chinese)

3D打印模型辅助手术治疗犬髌骨Ⅳ级内脱伴前交叉韧带断裂

Clinical Application of 3D-Printed Model for Surgical Planning and Treatment of Grade Ⅳ Medial Patellar Luxation and Cranial Cruciate Ligament Rupture in a Dog

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