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  • 學位論文

前十字韌帶患犬以囊外固定合併不同等距點修復之生物力學評估

Biomechanical Evaluation of Extracapsular Stabilization with Different Quasi-isometric Attachment Sites in Canine Cranial Cruciate Ligament Deficient Stifles

指導教授 : 武敬和
共同指導教授 : 林正忠(Cheng-Chung Lin)
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摘要


前十字韌帶疾病是造成臨床上犬隻跛行的其中一個常見原因,而犬前十字韌帶疾病的手術治療方式可以概略分為囊內重建術、囊外固定術,以及脛骨骨切開校正術。儘管脛骨骨切開校正術式在近年為外科獸醫師較偏好的手術治療選項,囊外固定術因其技術門檻要求較低、且手術費用相對低廉,因此仍是受歡迎的手術治療選項之一。以生物力學方式評估犬前十字韌帶疾病手術治療後成效的相關研究有很多,然而其中只有少數研究針對犬膝關節術後的三維運動學進行量化分析。因此本研究的目的在於:(1) 建立一個客製化測試架具,並合併紅外線攝影動態捕捉分析系統,以量化膝關節在六項自由度中的運動學參數;(2) 希望評估並比較不同前十字韌帶狀態下(包括完整前十字韌帶、前十字韌帶受損和以囊外固定術修復後的犬膝關節)膝關節的運動性(mobility)和穩定度(stability),其中囊外固定術使用骨錨 (bone anchors) 搭配單股尼龍線材、選擇兩組不同的等距點(quasi-isometric attachment sites)進行手術修復。 本實驗共自七隻成年犬隻大體蒐集十二條無明顯膝關節骨骼肌肉異常的犬大體後肢,每條大體後肢會在三種不同的前十字韌帶狀態下進行重複測試:完整前十字韌帶、前十字韌帶受損,以及用囊外固定術以骨錨修復後的犬膝關節;其中囊外固定術修復組可再依據所選的不同等距點分為兩個亞組 (IP1組:F2-T1,和IP2組: F2-T3)。所有大體後肢在不同前十字韌帶狀態下會分別接受膝關節運動性與穩定度測試。運動性測試旨在評估膝關節在完整伸展彎曲範圍下六項自由度的運動學參數;而穩定度測試則包括脛骨前移抽屜試驗(cranial drawer test)與脛骨內轉測試(tibial internal rotation test),此兩項測試目的為量化膝關節在接受固定脛骨前向負重或扭力時的脛骨前移量(cranial tibial translation)及內轉量。 本實驗結果指出,在運動性測試方面,兩對不同等距點的手術修復亞組之間的六項自由度運動學沒有顯著差異。在穩定度測試方面,脛骨前移抽屜試驗當中兩手術組的脛骨前移量與前十字韌帶完整組相比,沒有發現顯著差異;且兩手術組之間也沒有顯著差異。而脛骨內轉測試則顯示,在以囊外固定術修復後,兩手術組都出現脛骨過度外轉,此結果與前人研究近似。此外,在膝關節角度為135和150度時兩手術亞組的脛骨內轉量發現顯著差異。 總結來說,使用骨錨和單股尼龍線材進行囊外固定術時,固定於兩組膝關節等距點能獲得相似的運動性。而兩個手術亞組(兩對膝關節等距點)都能有效消除前十字韌帶受損造成的脛骨前移,但術後可能會導致過度限制脛骨內轉,在獸醫臨床應用上此過度脛骨外轉結果應列入考量。

並列摘要


Cranial cruciate ligament (CCL) disease is one of the most common causes of lameness in dogs. Surgical treatment of CCL disease can be broadly classified as intra-articular ligament reconstruction, extracapsular stabilization (ECS), and tibial osteotomy procedures. Although the tibial osteotomy procedures have gained more preference among surgical options, the ECS techniques remain popular because of their lower technical demand and lower cost. The biomechanical outcome after surgical correction for CCL disease has been widely investigated. However, only a few studies quantitatively evaluated the 3-D kinematics of the stifle joint post-operatively. Therefore, the study aimed (I) to build a custom-made testing platform integrating with an optical motion capture system to quantify the six-degrees-of-freedom kinematics of the stifle joint; and (II) to assess and compare the mobility and stability of the CCL-intact, CCL-deficient, and CCL-repaired stifle joint. The ECS at two different pairs of quasi-isometric attachment sites using bone anchors and monofilament nylon leader (MNL) sutures was chosen as the surgical treatment. Twelve cadaveric pelvic limbs free from musculoskeletal abnormality at the stifle joints were harvested from seven adult dogs. Each specimen was tested under three different CCL conditions: intact-CCL, CCL-deficiency, and repaired with ECS using bone anchors. The ECS group was further divided into two subgroups, each with different chosen pairs of isometric points (IP: F2-T1 and F2-T3). All the pelvic limbs in each tested condition underwent both mobility tests and stability tests. The mobility tests aimed to evaluate 6-degrees-of-freedom kinematics of the stifle joint during full ranges of flexion and extension. The stability tests involved cranial drawer (CD) test and tibial internal rotation (IR) test, which aimed to quantify the cranial tibial translation (CTT) and tibial internal rotation angles under constant applied loading and torque. The results indicated that there was no significant difference in the six-degrees-of-freedom kinematics between surgical treated groups with different IP in the mobility tests. In the CD test, there was no significant difference in CTT between intact-CCL group and each surgical-treated groups or between the two surgical-treated groups. The result of the tibial IR test showed generally excessive tibial external rotation after ECS, which were also reported in previous studies. Significant difference in tibial internal rotation angle between the IP1 (F2-T1) and IP2 (F2-T3) groups were found at the stifle angles of 135˚ and 150˚. In general, the ECS using bone anchors and monofilament nylon leader (MNL) sutures attached at both pairs of IPs led to similar mobility at the stifle. Both the ECS subgroups tend to diminish the tibial cranial thrust caused by CCL deficiency, but lead to over-constraint tibial internal rotation comparing to both intact and CCL-deficient groups, in agreement with previous studies. While the two chosen pairs of isometric points were shown to effectively decrease the cranial tibial displacement, the excessive tibial external rotation in comparison to those of intact stifle joint should be concerned.

參考文獻


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