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  • 學位論文

膝關節髕骨垂直位置在內側髕骨異位與正常膝關節小型犬中之比較

Vertical Patellar Position in Small-Breed Dogs with Clinically Normal or Medially Luxated Stifle Joints

指導教授 : 葉力森

摘要


髕骨異位(patellar luxation)是犬隻最常見的骨科問題之一,尤其在小型犬特別好發,其中又以內側髕骨異位佔多數。一般來說,髕骨異位多於無創傷病史的幼年動物中發現,因此目前被認為是一遺傳性相關的疾病。患病的犬隻會出現從負重跛行到抬腳跛行的臨床症狀,嚴重的情況甚至會出現骨骼的變形。造成髕骨異位的病因及機轉目前尚未確切明白,但已有許多假設性的理論被提出,包括:髖關節的內翻和股骨頸前傾角變小,四頭股肌群的萎縮,縫匠肌的異常走向…等等,其中又以髖關節的內翻和股骨頸前傾角變小此推論最廣為接受。根據不同理論多年來已發展出許多不同的手術治療方式,儘管如此,手術後再次異位依舊是最常見的術後併發症。 高位髕骨(patella alta)在近年被發現與大型犬髕骨內側異位有關聯,患有高位髕骨的犬隻,可能因為髕骨本身位於較近端的滑車溝,而在膝關節伸展時,髕骨又更往近端移動,因此失去了滑車脊的拱壁效果,造成髕骨的不穩定,而增加了發展成為髕骨異位的可能性。目前也有對應的手術矯治方式被提出。但到目前為止,尚未有針對小型犬髕骨內側異位與髕骨上移的相關性進行調查。本研究目的希望能了解小型犬高位髕骨與髕骨內側異位的相關性,以便進一步可發展出針對小型犬更系統性的治療方式。 本研究回溯性調查過去一年半就診於台大動物醫院的小型犬,採納標準為:有完整病例紀錄、骨科學檢查,以及品質良好之後肢X光片,共69隻小型犬納入研究,其中內側髕骨異位組有37隻(除了內側髕骨異位外膝關節沒有其他骨關節疾病),膝關節正常組有32隻。實驗方式為比較兩組之膝關節髕骨垂直位置,而膝關節髕骨垂直位置則定義為:膝關節側照X光片中髕骨韌帶長度(Patellar Ligament Length, PLL)與髕骨長度(Patellar Length, PL)之比值,PLL/PL。 實驗結果顯示,膝關節髕骨垂直位置(PLL/PL)在內側髕骨異位組(1.84)和膝關節正常組(1.81)之間並沒有顯著差異(p=0.3644 > 0.05)。這項結果與過去大型犬的研究結果不同,說明了高位髕骨於大型犬與小型犬之髕骨異位中所扮演的角色可能不同,同時也間接證實了大型犬與小型犬造成內側髕骨的病因可能並不完全相同。因此, 建議未來針對內側髕骨異位的致病機轉及其它研究,大型犬與小型犬應該分別進行討論,以便獲得更有效精確的結論,藉此可以分別發展出更具系統性的治療方式。

關鍵字

髕骨 異位 手術 高位

並列摘要


Patellar luxation is one of the most common orthopedic disorders in small-breed dogs. Most of the luxations are congenital, medial, and without trauma history. Affected limbs may appear partial weight bearing to carried lameness, even with skelental deformity. The exact etiology and mechanism of patellar luxation is still not fully understood, and the most popular theory starts in the hip with coax vara and decreased anteversion of the femoral head and neck. Although many surgical treatments were developed according to these proposed etiologies, patella reluxation is a still the most common post-operation complication. The proximal displacement of the patella within the femoral trochlear groove (patella alta) has been suspected to play a role in medial patellar luxation of large-breed dogs. Dogs with patella alta may have a patellofemoral articulation that moves completely proximal to the femoral trochlear groove during stifle extension, and resulting in a loss of the buttressing effects of the trochlear ridges, and increased risk of patellar luxation. To our knowledge, vertical patellar position has not been investigated in small-breed dogs with clinically normal stifles or medial patellar luxation (MPL). Our objective is to define vertical patellar position in a group of small-breed dogs with clinically normal stifles and compare it with a group of dogs with MPL, in the hope to develop a more systemic therapeutic plan for small-breed dogs. Our study retrospectively reviewed the medical records(2009/01/01-2010/06/01) in National Taiwan University Animal Hospital (NTUAH). Inclusion criteria were small-breed dogs(<10kg) with complete medical records, fully orthopedic exam, and good quality of stifle x-ray. A total of 69 dogs were included in our study, 37 dogs fitted the MPL group (documented MPL, no other orthopedic abnormalities in stifles), 32 dogs were fit in the inclusion of clinically normal stifles (NORM). Vertical patellar position was defined as the ratio of the patellar ligament length (PLL) to the patellar length (PL), PLL/PL. The PLL/PL value was compared between MPL group and NORM group. As a result, no significant difference (p=0.3644 > 0.05)of PLL/PL value between MPL group(mean, 1.84) and NORM group(mean, 1.81)was revealed. This result was different from the past study of large-breed dogs, and patella alta may play different roles in MPL among large-breed and small-breed dogs was suspected. Thus, in order to obtain more accurate results and develop a more systemic therapeutic plan, the study of pathogensis of MPL in small-breed and large-breed dogs should be separated.

並列關鍵字

patellar luxation dog surgery alta

參考文獻


Alam, M. R., J. I. Lee, et al. (2007). "Frequency and distribution of patellar luxation in dogs. 134 cases (2000 to 2005)." Vet Comp Orthop Traumatol 20(1): 59-64.
Ali, S. A., R. Helmer, et al. (2009). "Patella alta: lack of correlation between patellotrochlear cartilage congruence and commonly used patellar height ratios." AJR Am J Roentgenol 193(5): 1361-1366.
Arthurs, G. I. and S. J. Langley-Hobbs (2006). "Complications associated with corrective surgery for patellar luxation in 109 dogs." Vet Surg 35(6): 559-566.
Biedert, R. M. and S. Albrecht (2006). "The patellotrochlear index: a new index for assessing patellar height." Knee Surg Sports Traumatol Arthrosc 14(8): 707-712.
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