狗十字斷裂修復手術的相關問題(併發症討論)

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2024/06/05 狗十字斷裂修復手術的相關問題(併發症討論)

最近有飼主私訊小編想詢問關於狗十字斷裂修復手術的相關問題。
目前在動物醫院最常見的手術術方式有兩種

脛骨平台水平矯形術Tibial plateau leveling osteotomy (TPLO)
囊外固定術Extracapsular Repair

兩種術式在網路上已有許多獸醫師都做優缺點的說明，本院獸醫師就不此作討論。
我們選這兩種手術產生的併發症討論。任一項手術都是有輕微、中度及嚴重的併發症。輕微的併發症無需治療即可解決，中度併發症則可能需要再一次手術或藥物治療，嚴重併發症可能導致死亡或喪失活動能力和生活品質。
我們先以脛骨平台水平矯形術tibial plateau leveling osteotomy (TPLO)的併發症來討論
1. 手術傷口感染
與其他類型的手術一樣，可能會出現切口感染。 TPLO 後估計有 7.8% 的病例會出現手術傷口併發症。如果不及時、適當地治療，即使是表淺軟組織感染也會進展為植入物感染和骨感染。
2. 膝蓋骨肌腱發炎
膝蓋骨肌腱炎是連接膝蓋骨和脛骨的肌腱發炎。受影響的狗會感到疼痛和跛行，但這種情況相對良性，可以透過休息和藥物改善。
3. 骨板螺絲鬆動或斷裂
狗的骨板必須保持在原位至少 12 週，以便骨頭癒合並修復受傷造成的損傷。鬆動的鋼板會壓迫神經，導致狗狗局部疼痛。斷裂的螺絲會影響癒合並可能導致關節損傷。
4. 骨板滑動、彎曲或斷裂
當狗在癒合過程的早期進行過多的活動時，骨板或螺絲經常會損壞。有時，骨板會脫離骨頭，甚至斷裂。在某些情況下，TPLO 骨板會被狗的身體排斥，因為它被身體視為異物。
5. 骨頭骨折或感染
文獻報道，TPLO 手術後，1% 至 9% 的狗發生脛骨突起骨折。不正確的定位和使用過大的骨鋸都是危險因子。患有此類骨折的狗的體重、術前術後脛骨平台角度 (TPA)矯正變化過多的，會顯著增加風險。
6. 骨髓炎
是骨感染的醫學術語，很難治療。這種類型的感染需要強效抗生素，通常需要 4 至 6 個月的治療才能緩解。傷口培養可以幫助確定哪種抗生素最有效。
7. 半月板撕裂
患有半月板撕裂的狗經常會出現所謂的“半月板咔噠聲”，這本質上是一種咔嗒聲，是受傷的跡象之一。如果外科醫生在 TPLO 手術期間發現任何損傷跡象，則會切除半月板。如果不取出，以後有可能會撕裂，需要進行第二次手術。

而以下是囊外固定術Extracapsular Repair併發症說明

囊外固定的併發症並不常見，特別是如果為適當的患者選擇了適當的技術。只要嚴格遵循術後指示，小於 10% 的動物會出現併發症。
這些併發症可能包括

感染、
植入物失敗(人工韌帶斷裂、人工韌帶鬆動) 植入物失敗可能包括人工韌帶斷裂，只要及早發現，大多數併發症都可以解決。
半月板損傷或持續性脛骨滑動。

每位獸醫師會依照動物及主人需求來選擇最適合動物的術式

翻譯內容
兩篇譯內容出處如下(如果想要看原文的朋友可以點入觀看):
TPLO Complications in Dogs
https://www.lhah.com/site/blog/2023/01/04/tplo-surgery-compications

Depending on the underlying dynamics, TPLO complications in dogs can be classified as minor, major, or catastrophic. A minor complication can be resolved without the need for treatment. A major complication necessitates additional surgical or medical treatment and can result in death or loss of mobility and quality of life.

Some complications that can arise include:

Surgical Wound Infection
As with other types of surgery, an incision infection is possible. Surgical wound complications after TPLO are estimated to occur in 7.8 percent of cases. When not treated promptly and appropriately, even superficial soft tissue infections have been shown to progress to implant infections and bone infections.

Patellar Tendinosis
Patellar tendinosis is inflammation of the tendon that connects the kneecap (patella) to the tibia. Affected dogs experience pain and lameness, but this condition is relatively benign and improves with rest and medication.

Screw Loosening or Breaking
A dog's bone plate must remain in place for at least 12 weeks to allow the bone to heal and repair the damage caused by injury. A loose plate can press on a nerve, causing localized pain in the dog. A broken screw interferes with healing and may cause joint damage.

Plate Slipping, Bending, or Breaking
When the dog is allowed too much activity early in the healing process, the plate or screws are frequently damaged. Sometimes the plate will pull away from the bone or even break. In some cases, the TPLO plate is rejected by the dog's body because it is perceived as a foreign object.

A Fracture or Infection of the Bone
Tibial tuberosity fractures have been reported in 1 to 9% of dogs following TPLO surgery. Incorrect positioning and the use of oversized saw blades are both risk factors. Body weight, tibial plateau angle (TPA) change and preoperative TPA were all significantly higher in dogs with this type of fracture.

Osteomyelitis, the medical term for a bone infection, is difficult to treat. This type of infection necessitates strong antibiotics and typically requires 4 to 6 months of treatment to resolve. A wound culture can aid in determining which antibiotics will be most effective.

A Meniscal Tear
Dogs with a meniscal tear frequently exhibit what is known as a "meniscal click," which is essentially a clicking noise that is one of the telltale signs of an injury. If the surgeon notices any signs of damage during the TPLO surgery, the meniscus is removed. If it is not removed, there is a chance that it will tear later, necessitating a second surgery.

Extracapsular Repair Complications in Dogs
此翻譯內容出處如下(如果想要看原文的朋友可以點入觀看):
https://www.dvsc.com/cranial-cruciate-ligament-extracapsular-repair

Extracapsular Repair Complications in Dogs
Complications with extra-capsular stabilizations are uncommon, especially if the appropriate technique is chosen for the appropriate patient. Less than 10% of patients have complications as long as the post-operative instructions are followed closely. These complications can include infection, implant failure, meniscal injury, and/or persistent tibial thrust. Implant failure could include suture breakage, suture/anchor pull-out, and implant loosening. Most, if not all, complications can be addressed as long as they are discovered early.

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