A artroscopia no diagnóstico e tratamento da doença do processo coronoide medial no cão
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2014-05-13
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A artroscopia é um meio de diagnóstico e de tratamento da patologia articular atualmente muito usado na prática veterinária. O aperfeiçoamento das técnicas artroscópicas aplicadas para resolução da patologia ortopédica em pequenos animais, assim como, o crescente interesse e exigência por parte dos proprietários foram importantes no seu progresso. Tem vindo por isso a substituir a artrotomia pelas suas vantagens superarem largamente as suas desvantagens relativamente a esta. É amplamente aplicada na articulação do cotovelo, particularmente no diagnóstico e tratamento da displasia do cotovelo, da qual faz parte a doença do processo coronoide medial. Esta patologia tem uma origem poligenética e multifatorial e manifesta-se frequentemente por claudicação dos membros anteriores. Os seus sinais clínicos são comuns a outras patologias da articulação do cotovelo e são usadas várias técnicas imagiológicas e cirúrgicas para o seu diagnóstico definitivo e tratamento. Entre as várias opções a artroscopia tem vindo a destacar-se por possibilitar no diagnóstico da doença do processo coronóide medial a observação direta da cartilagem e simultaneamente o seu tratamento, com uma rápida recuperação pós-operatória. No entanto não impede o desenvolvimento da doença degenerativa articular. Assim, o tratamento definitivo desta patologia é atualmente um dos desafios em cães jovens de raça de médio a grande porte.
Ao longo deste trabalho é descrita a técnica artroscópica e toda a envolvência necessária à sua aplicação, incluindo o material usado, os acessos e o próprio procedimento cirúrgico. É ainda feito um paralelismo com a artrotomia, técnica anteriormente mais aplicada no tratamento desta patologia.
Foram acompanhados cinco casos de animais ao longo de três meses no hospital veterinário da universidade de Gante, os quais foram posteriormente apresentados. Destes casos, quatro apresentavam ao exame artroscópico doença do processo coronóide medial e um apresentava enteseopatia do tendão flexor. Em todos os casos foi descrito o seu exame clínico e exames complementares para o diagnóstico da patologia e o seu tratamento com recurso à artroscopia.
Após observação, análise e comparação dos casos concluiu-se ser o exame artroscópico uma técnica de grande precisão e muito útil no diagnóstico e tratamento das alterações da articulação do cotovelo. É ainda uma técnica que por permitir uma mínima invasão tecidual e uma morbilidade pós-operatória reduzida terá no futuro uma crescente aplicabilidade nas articulações de animais de companhia.
Arthroscopy is a diagnostic and treatment resource for articular disease widely used in veterinary practice currently. The improvement of arthroscopic technics to threat orthopedic diseases in small animals as well as the owners concern and demand has been crucial to arthroscopy development. It has been replacing arthrotomy due to the fact that his advantages largely overcame the disadvantages when compared with classical arthrotomy. Arthroscopy is widely employed in elbow joint, particularly in the diagnosis and treatment of elbow dysplasia that includes medial coronoid process disease. This disease has a polygenetic and multifactorial origin and it generally manifests with forelimb lameness. Clinical signs are the same as other elbow joint diseases and a series of imaging and surgical technics are employed for his definitive diagnostic and treatment. Among all options arthroscopy has become to be noteworthy allowing, during the diagnostic of medial coronoid process disease, the direct visualization of the cartilage and his simultaneous treatment with a rapid postoperative recovery. However it does not discontinue articular degenerative disease. Therefore, the definitive treatment of this disease is currently one of the challenges in medium-large breed dogs. During the course of this work the arthroscopic technic is described and as well as everything that should be required to his application, like the instruments, the approach and the surgical procedure. It is also discrebed a parallelism with arthrotomy, the most executed technic in the treatment of this disease before the use of arthroscopy. Over three months, five cases of animals were followed at the veterinary hospital of Gent University, which were then exhibited. Among these cases, four showed the presence of medial process coronoid disease at arthroscopic examination and one showed primary flexor entheseopathy. About each case is described the clinical examination and imaging tests for the diagnosis of the disease and his treatment with arthroscopy. After observation, review and comparison of the cases it’s possible to deduce that arthroscopy is a technic of accurate precision and very useful for the diagnosis and treatment of the changes in the elbow joint. Arthroscopy is also a technic that permits a minimum tissue invasion and a reduced postoperative morbidity leading to an increasing application in the joints of small animals.
Arthroscopy is a diagnostic and treatment resource for articular disease widely used in veterinary practice currently. The improvement of arthroscopic technics to threat orthopedic diseases in small animals as well as the owners concern and demand has been crucial to arthroscopy development. It has been replacing arthrotomy due to the fact that his advantages largely overcame the disadvantages when compared with classical arthrotomy. Arthroscopy is widely employed in elbow joint, particularly in the diagnosis and treatment of elbow dysplasia that includes medial coronoid process disease. This disease has a polygenetic and multifactorial origin and it generally manifests with forelimb lameness. Clinical signs are the same as other elbow joint diseases and a series of imaging and surgical technics are employed for his definitive diagnostic and treatment. Among all options arthroscopy has become to be noteworthy allowing, during the diagnostic of medial coronoid process disease, the direct visualization of the cartilage and his simultaneous treatment with a rapid postoperative recovery. However it does not discontinue articular degenerative disease. Therefore, the definitive treatment of this disease is currently one of the challenges in medium-large breed dogs. During the course of this work the arthroscopic technic is described and as well as everything that should be required to his application, like the instruments, the approach and the surgical procedure. It is also discrebed a parallelism with arthrotomy, the most executed technic in the treatment of this disease before the use of arthroscopy. Over three months, five cases of animals were followed at the veterinary hospital of Gent University, which were then exhibited. Among these cases, four showed the presence of medial process coronoid disease at arthroscopic examination and one showed primary flexor entheseopathy. About each case is described the clinical examination and imaging tests for the diagnosis of the disease and his treatment with arthroscopy. After observation, review and comparison of the cases it’s possible to deduce that arthroscopy is a technic of accurate precision and very useful for the diagnosis and treatment of the changes in the elbow joint. Arthroscopy is also a technic that permits a minimum tissue invasion and a reduced postoperative morbidity leading to an increasing application in the joints of small animals.
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária, Ciências Veterinárias
Palavras-chave
Artroscopia , Doença do coronoide medial , Displasia do cotovelo , Doença degenerativa articular