Veterinary Surgery最新文献

Objective: To compare three measurement methods for acetabular sizing and evaluate the influence of osteoarthritis (OA) on the accuracy of measurements.

Study design: Observational study.

Sample: Radiographic images of 73 hip joints from 60 dogs with cementless cups.

Methods: Radiographs were anonymized and measured independently by three observers. One observer measured 12 sets of radiographs three times. A best-fit acetabular circle (AC) and cranial-caudal acetabular line (AL) were measured on ventral-dorsal (VD) radiographic view and open leg lateral (OLL) view. A best-fit femoral head circle (FHC) was measured on VD, OLL, and craniocaudal horizontal beam (CCHB) views. Two observers scored the OA in each hip joint. Intra- and interobserver consistency and repeatability and bias relative to implanted cup size were calculated and analyzed.

Results: Intraobserver consistency and repeatability were excellent for all measurements. Interobserver consistency was excellent (ICC > 0.9) for AC_VD and AC_OLL and was good (0.75 < ICC ≤ 0.9) for all other methods. Bias was small for AC and AL measurements (range, -0.46 to 0.45 mm) and large for FHC measurements (-3.58 to -2.42 mm). OA score significantly influenced bias for all acetabular measurement methods (p < 0.05).

Conclusion: All acetabular measurement methods were highly consistent within an observer. Interobserver consistency was highest for AC_VD and AC_OLL. FHC measurements underestimated cup size. Higher OA scores decreased the accuracy of all acetabular measurement methods.

Clinical significance: Superimposing a circle on the acetabulum seen on VD radiographic view accurately measures the acetabulum before cementless cup placement.

Objective: To assess the use of a newly developed aiming compression device (ACD) for screw insertion in non-fractured navicular bones (NB) in cadavers.

Study design: Cadaveric study.

Sample population: A total of 10 cadaveric front limbs of adult horses.

Methods: Placement of a 3.5 mm cortical screw in non-fractured NB under radiographic guidance was performed in 10 cadaver limbs in a standing position. An ACD was used to stabilize the NB and to guide the drilling process. Preparation and surgical time as well as the number of radiographic images were noted. A postoperative scoring system was used to assess screw placement by cone beam computed tomography (CBCT) and gross examination by two evaluators.

Results: The total procedure time was 25-62 min (median 33.5). During the procedure, 11-21 radiographs (median 18.5) were taken. The postoperative gross examination revealed an excellent screw placement in nine NB and poor in one. This could not be reliably assessed with post-procedure CBCT.

Conclusion: The described technique achieves an excellent screw placement in 9/10 bones without disrupting the articular or flexural surface of the NB and with no protrusion of the screw head or tip, in a median procedure time of under 35 min.

Clinical significance: Adequate screw placement is paramount for NB fracture repair. The described approach under radiographic guidance allows adequate screw placement using the ACD to stabilize the NB by lateral to medial compression. This technique facilitates adequate screw placement within the NB without the use of advanced imaging techniques.

Objective: The aim of the present study was to report the outcomes and complications of minimally invasive tarsal arthrodesis (MITA) in dogs.

Study design: Bi-institutional retrospective study.

Sample population: A total of 15 client-owned dogs.

Methods: Medical records of dogs undergoing MITA were reviewed to determine outcome and complications. Radiographs were recommended every 4 weeks until clinical union and reviewed to evaluate tibiotarsometatarsal alignment, implant position, subsequent osseous union of the debrided articulations. Time to clinical union and complications were recorded. Clinical union was defined as functional weightbearing limb use with at least 50% of osseous union. Final limb function was defined as full, acceptable, or unacceptable.

Results: Partial tarsal arthrodesis was performed in 10 cases and pantarsal arthrodesis in five cases. Postoperative swelling was minimal. Most complications, 26% major and 40% minor, were implant-related, and explant was required in three dogs. No catastrophic complications occurred. Mean (±sd) radiographic follow-up was 11.4 (±13.1) months Mean (±sd) time to radiographic osseous union was 1.8 (±0.5) months. Mean (±sd) time to clinical union was 3.7 (±0.8) months. Physiological alignment was restored in 12/15 dogs. Complete radiographic union occurred in 46% while in the remaining 54% obtained partial radiographic union, but clinical instability was not observed. Limb function was considered full in six and acceptable in eight dogs. Function was unacceptable in one dog, but the cause was not related to MITA.

Conclusion: MITA resulted in restoration of alignment, which was accomplished using MITA techniques. Furthermore, MITA appeared to result in faster healing times and reduced soft tissue complications compared to conventional open approach arthrodesis.

Clinical significance: MITA may be considered as an option to obtain functional arthrodesis in dogs.

Objective: To describe the feasibility, efficiency, and extent of thoracoscopic pericardiectomy (TP) on a ventilated dog with an intercostal approach in lateral recumbency (ILR), in comparison with the traditional transdiaphragmatic paraxiphoid approach in dorsal recumbency (PDR).

Study design: Randomized experimental study.

Animals: Twenty canine cadavers (n = 10 per group).

Methods: Thoracoscopic pericardiectomy was performed on mechanically ventilated cadavers to remove the largest pericardial fragment possible using either the ILR or PDR technique. Approach and procedure time were recorded, and surgical extent (cardiac exposure/exteriorization, pericardial fragment area) was assessed. Procedural difficulty and intraoperative visibility were also assessed to evaluate feasibility.

Results: Total surgical time (sum of approach and pericardiectomy time) did not differ between groups, although PDR pericardiectomy took longer (p = .045) by an average of 5.2 min. Exteriorization of the heart from the pericardial sac was achieved for all trials. Pericardial fragments from PDR trials were larger than those of ILR (p = .004), with a mean difference of 23.21 cm². Cardiac exposure and operative visibility scores were greater for PDR procedures.

Conclusion: The ILR approach with bilateral ventilation was a feasible alternative for performing partial pericardiectomies, which did not require more total surgical time when compared with the PDR approach.

Clinical significance: The ILR approach for TP warrants further evaluation in live dogs as it may hold promise for treating causes of pericardial effusion that do not require subtotal pericardiectomy and improving efficiency when paired with other ILR procedures such as thoracic duct ligation.

Objective: To measure truncated face and open face versions of the biological fixation (BFX) cup in a three-dimensional (3D) model simulating the ventrodorsal radiographic projection with different cup and pelvis positions.

Study design: Computer simulation.

Methods: Simulated ventrodorsal views were generated in silico using 3D models of a BFX cup and a medium-sized canine pelvis. Truncated face and open face versions of the BFX cup were defined and measured with various angles of cup version, cup inclination, and pelvic extension.

Results: Truncated face version was different from and underestimated open face version by 12° to 22° (p < .001). Open face version varied with inclination while truncated face version was unaffected by inclination. Open face version was dependent on the degree of pelvic extension while truncated face version was unaffected.

Conclusion: Open face version differed from truncated face version. Changes in open face version were not consistently matched by a change in truncated face version.

Clinical significance: The open face of the cup may be excessively retroverted without this being reflected by truncated face retroversion as seen on a ventrodorsal radiographic view. However, in this study, BFX cups placed with truncated face version and inclination in the normal range and an ALO of 45° yielded predictable open face version.

Objective: To evaluate the use of a temporary calcaneotibial screw (CTS) to immobilize medial or lateral tarsocrural joint instability (TCI) in dogs.

Study design: Retrospective study.

Animals: Twelve dogs (including five active working farm dogs) with TCI.

Methods: Medical records (January 2015-June 2023) were retrospectively reviewed for cases of TCI managed surgically including temporary joint immobilization using a CTS and external coaptation. Clinical data consisted of medical records and an online survey completed by the owner.

Results: Surgical techniques to address TCI included primary ligamentous repair, synthetic ligament reconstruction, or malleolar fracture repair. Immobilization with a CTS was employed for 6-8 weeks postoperatively. The online survey was completed for 10 dogs. All dogs exhibited good-to-excellent functional outcomes at the follow-up (median, 31 months; range, 4-66). All working farm dogs (5) were able to return to normal or substantial levels of their work. Four distinct complications were reported in three dogs including one CTS breakage and three bandage-related soft-tissue injuries.

Conclusion: This retrospective study represents the first report of employing a temporary CTS for TCI in dogs.

Clinical significance: A temporary CTS was effective in immobilizing the tarsocrural joint for dogs with TCI and the postoperative complication rate in this study was relatively low. A CTS screw and external coaptation is a viable alternative to previously reported methods of tarsocrural joint stabilization.

Objective: To describe percentage length changes in the femur after total hip replacement (THR) performed before skeletal maturity.

Study design: Retrospective study.

Animals: Twenty-four dogs younger than 8.5 months which underwent unilateral THR and had radiographic follow up.

Methods: Preoperative and follow-up radiographs were reviewed. Radiographic measurements included the length of the greater trochanter, femoral diaphysis and distal epiphysis, width of the femur 10 mm distal to the distal aspect of the greater trochanter, width of the femur at 50%, and femoral condylar offset. Percentage changes in length over time were compared among operated and contralateral femurs used as controls. Measurements were collected in triplicate in 10 dogs to evaluate consistency.

Results: All repeated measurements had excellent consistency. The percentage increase in length of the greater trochanter was smaller in operated femurs than controls (mean difference: -11.5%, p = .017), but no differences were observed for the femoral diaphysis and distal epiphysis (-1.0%, p = .595), or the femur overall (-2.3%, p = .232). The percentage increase in femoral cortical width was greater in operated femurs than controls, both 10 mm distal to the greater trochanter (4.6% difference, p = .037) and at 50% length (8.5% difference, p = .030).

Conclusion: In growing dogs, cementless THR decreased trochanteric growth by approximately 10% but did not change diaphyseal growth and femoral growth.

Clinical significance: Cementless THR performed in skeletally immature dogs with severe hip problems did not impact femoral length in a clinically relevant fashion.

Objective: To compare novices' performance on simulated laparoscopic tasks with a box trainer and virtual reality (VR) trainer before and after training on one system, and to compare performance between groups following training.

Study design: Randomized, prospective study.

Sample population: Twelve veterinary students without prior hands-on laparoscopic experience were randomly assigned to the box or VR training group.

Methods: Performance of basic laparoscopic tasks on box and VR trainers and simulated surgical task were scored before and after completion of a designated training program. Scores for each task were compared within and between groups.

Results: The box group's post-training scores were higher than pretraining scores for all box tasks. The VR group's post-training scores were higher than pretraining scores for most VR tasks. Median post-training scores were higher in the box group than the VR group for all box tasks. Median post-training scores were higher for the VR group than the box group only for VR intracorporeal suturing. Neither program led to a substantial improvement in simulated surgical task performance.

Conclusion: In this study the box trainer seemed more effective than the VR trainer for training novices to perform most basic tasks. The lack of substantial improvement of simulated surgical task performance is likely related to study limitations including small sample size and short training timeline.

Impact: Both training systems increased basic laparoscopic skills in novices. Laparoscopic simulation training may be applicable within veterinary school curricula. Additional studies are warranted to assess these systems with different tasks and trainee experience.

Objective: To determine the influence on surgical site infection (SSI) rates when using 0.7% iodophor and 74% isopropyl alcohol versus 2% chlorhexidine and 70% isopropyl alcohol. To evaluate the adherence of an iodophor-impregnated surgical incise drape when used in conjunction with 0.7% iodophor and 74% isopropyl alcohol.

Study design: Combines retrospective control and prospective data.

Sample population: This study included dogs and cats, 653 retrospective cases and 435 prospective cases, with 447 incisions.

Methods: The SSI rate of a 2% chlorhexidine and 70% isopropyl alcohol preparation was retrospectively reviewed. The prospective population received 0.7% iodophor and 74% isopropyl alcohol; risk factors for SSI were evaluated and incise drape lift was documented.

Results: A 1.8% difference in SSI between the chlorhexidine group and 0.7% iodophor and 74% isopropyl alcohol group was found (p = .25). The drape lift was 13.2%. Drape lift (p = .026), increased body weight (p = .008), and the use of glutaraldehyde for instrument sterilization (p = .055) were associated with an increased risk of SSI development.

Conclusion: The 0.7% iodophor and 74% isopropyl alcohol treatments demonstrated similar effectiveness to 2% chlorhexidine and 70% isopropyl alcohol in skin preparation. Using an iodophor-impregnated drape with 0.7% iodophor and 74% isopropyl alcohol reduced both drape lift and the risk of SSI.

Clinical significance: These findings support the combined use of an incise drape with 0.7% iodophor and 74% isopropyl alcohol preparation, provide evidence against the use of glutaraldehyde, and indicate that heavier patients have an increased risk of SSI.