Abstract
摘要:前十字韌帶損傷為犬隻常見的疾病,主要造成膝關節不穩定、進而引起疼痛和後肢跛行。雖然臨床上已提出許多外科治療方式,然至今仍無確鑿且普遍接受的標準治療方案。膝關節囊外固定術,藉由跨過關節囊的人工線材替代前十字韌帶穩定膝關節的功能,優點為侵入性低、且手術設備與術者技術門檻低,故為目前獸醫外科最常採用的手術方式之一。此術最具挑戰之處在於如何決定線材固定點位置,以使膝關節能夠回復正常活動與穩定性,並能最小化線材在膝關節活動時的張力變化。在關節運動過程中,線材被重複的拉伸與放鬆將導致關節的不穩定,並且可能是造成線材失效的主因。因此,保持囊外縫合線固定點在運動過程中等距,應是避免縫合線因張力變化過大而鬆弛斷裂及避免膝關節出現異常壓力、活動度與穩定度的最直接方式。目前已有許多研究透過評估不同關節角度下線材固定點間的二維長度變化或是張力變化,然而,迄今未有一致且結論性的結果。這可能與實驗設計本身的限制無法重現活體犬隻膝關節的生理條件有關,例如受限於二維量測或是大體研究。囊外固定術的最終目標是希望恢復患犬膝關節在日常功能性活動中的活動度與穩定度,然而過去文獻也鮮少探討囊外固定術對膝關節功能性恢復的影響。為了更佳的估計膝關節上等距點的位置和量化等距點對關節功能恢復的影響,一項可反映活狗生理條件並評估囊外固定後功能恢復的研究是有其必要的。
為解決上述研究的議題與侷限性,本計劃旨在運用客觀的三維量測技術,研究前十字韌帶斷裂犬的囊外固定術線材固定點位置,及其於膝關節生物力學環境重建的狀況。為達此目標,(一)本研究將利用透視攝影和斷層掃描影像,量測健康活犬膝關節的三維運動,找出遠端股骨與近端脛骨面上距離相對固定的兩點作為囊外固定術的線材潛在固定點; (二)進行手術可行性分析,排除不適於做為線材固定點的位置; (三)於大體上依據前兩項實驗所得之固定點組合與傳統手術建議位置進行囊外固定術,探討固定點位置與線材張力組合對膝關節穩定度和活動度的影響,量化該手術對恢復正常膝關節生物力學功能的效益。
本研究期盼最終可找出關節囊外固定術最佳的線材等距固定點位置與張力組合,使患犬的膝關節活動性與穩定性得到復原的同時能最小化線材鬆弛和斷裂的風險,以提升該手術成效。完成此二年期計劃後,預計進一步規畫臨床試驗,將此研究成果應用於臨床病犬,深入探討囊外固定術的臨床效益,包括關節的功能性恢復、術後併發症與手術成功率。
Abstract: Cranial cruciate ligament deficiency (CCLD) is a common injury of the canine stifle, leading to the stifle joint instability, pain, and hindlimb lameness. Although various surgical techniques have been developed, there is still no conclusive and generally accepted standard protocols for treating CCLD. Extracapsular stabilization (ECS) techniques, one of the commonly used approach, were devised to provide artificial stabilization of the unstable stifle joint by placing a prosthesis suture across the joint to mimic the functional role of the CCL. The primary challenge of ECS is to determine the anchor sites on bones for the suture, such that the normal mobility and functional stability of the joint are restored and the variation in suture tension is minimized throughout the stifle range of motion. To maintain the isometry between extracapsular suture attachments is considered a straightforward way to minimize the tension variations of the suture and avoid abnormal pressure and function of the canine stifle. Previous studies have investigated several potentially isometric points by measuring planar distances or suture tensions on cadaveric stifle joints. However, no consistent and conclusive results were found, which may arise from the fact that the studies typically failed to reproduce the physiological conditions of living dogs. Moreover, the influence of the ECS on the stifle functional recovery was also rarely investigated. To address the issues raised in the above introduction, a study both reflecting the physiological conditions of living dogs and assessing the functional recovery after ECS is warranted
This project aims to investigate the suture attachments of ECS for CCLD canine stifle with an objective and 3-D measurement approach and to assess the influence of the suture attachments and suture preloads on the function recovery of the stifle joint. To accomplish the goals: (1) An in vivo study will be conducted to determine the potentially isometric suture attachments on the femur and tibia for the ECS based on the dynamic tibiofemoral kinematics of the healthy dogs measured using fluoroscopy and CT; (2) A surgical feasibility analysis will be conducted to rule out the points that are not feasible for the suture sites; (3) The effects of the suture attachments and suture preloads on the resulting stifle stability and mobility will be investigated to ensure that the selection of suture attachment pairs and preloads are capable of restoring the normal functions of the stifle joint.
It is anticipated the outcome can eventually conclude the optimal combination of isometric suture attachments and suture preloads for the ECS that are capable of restoring the normal stability and mobility of the canine stifle joint and minimizing the risk of suture failure simultaneously. Based on the research outcome in the current project, we are going to initialize a clinical study on CCLD dogs concerning the clinical efficacy of the ECS in terms of the in vivo functional recovery, post-operated complications, and the surgical successful rate.
Keyword(s)
前十字韌帶損傷
囊外固定術
等距點
透視攝影
動作捕捉
犬
cranial crucial ligament deficiency
extracapsular stabilization
isometric points
fluoroscopy
motion capture
canine