Despiste precoce de displasia da anca: uma outra perspectiva sobre o diagnóstico radiológico da displasia da anca
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2015-07-01
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A Displasia da Anca (DA) é uma doença ortopédica, de natureza hereditária, que afecta maioritariamente cães de porte grande e gigante, que se caracteriza por uma falta de congruência entre a cabeça femoral e a cavidade acetabular e que leva invariavelmente à instauração de osteoartrite na articulação coxofemoral e a um consequente desconforto que se traduz na perda de qualidade de vida do animal afectado.
O despiste oficial de DA é realizado em Portugal segundo os critérios da Federação Cinológica Internacional (FCI) ao ano de idade, no entanto, o despiste realizado em idades precoces traria um sem número de vantagens, já que além de permitir selecionar animais livres de displasia para reprodução, permitiria também atuar bem mais cedo no tratamento dos animais displásicos, nomeadamente através de cirurgias consideradas preventivas e que apenas podem ser realizadas em idades muito jovens.
Aldo Vezzoni desenvolveu um despiste precoce que se destaca do PennHip porque visa o eventual tratamento precoce e não o controlo da doença. Para o efeito, além da lassidão articular passiva, avalia também a lassidão articular funcional ao englobar no seu exame uma outra variável, o ângulo do rebordo acetabular dorsal, esperando-se deste modo que as previsões sejam mais precisas que as encontradas segundo o outro método.
De forma a compreendermos melhor o que pensam os médicos veteriários especializados em animais de companhia sobre o despiste de displasia da anca e mais precisamente sobre o despiste precoce, realizámos um pequeno inquérito que foi disponibilizado num círculo de profissionais, com o intuito de nos ajudar a definir quais seriam os objectivos a alcançar com a realização deste trabalho. Deste inquérito realizado a 49 profissionais, concluiu-se que apenas um terço dos inquiridos realiza exame radiográfico de despiste de DA em raças de porte médio, grande e gigante uma vez atingido o ano de idade e 83% destes afirmou não realizar o despiste precoce, apesar de 100% dos inquiridos considerar que se trata de uma técnica útil. De referir que a dificuldade sentida na realização do despiste e na interpretação dos resultados foram a principal razão apontada para a não realização desta técnica.
Neste trabalho foram analizados 19 casos clínicos de animais avaliados com o diagnóstico precoce de displasia da anca com idades compreendidas entre as 19 e as 28 semanas e com a estimativa do grau de displasia que cada animal atingiria em idade. Esta classificação foi também comparada com a classificação definitiva obtida após o ano de idade.
As previsões concordaram com a classificação definitiva em 91,67% dos casos o que permite concluir que este despiste precoce apresenta resultados bastante fidedignos, uma vez que prevê com grande exactidão qual o grau de displasia que irá o animal estudado alcançar ao atingir a idade adulta. A outra grande utilidade desta técnica está no facto de permitir também colocar em prática técnicas cirúrgicas como a osteotomia pélvica tripla, osteotomia pélvica dupla e sinfisiodese púbica juvenil, que levam a uma estabilização ou a um atraso na progressão da osteoartrite no animal displásico, as quais, sem um diagnóstico tão precoce, não poderiam ser opções.
The Hip Dysplasia (HD) is an orthopedic disease, hereditary by nature, affecting primarily large dogs and giant, which is characterized by a lack of congruence between the femoral head and the acetabular cavity, which invariably leads to the establishment of osteoarthritis in the hip joint and the consequent discomfort which results in loss of quality of life of the affected animal. The official HD screening is performed in Portugal according to the criteria of the FCI – Fedération Cynologique Internacionale at 12 months of age, however, the screening carried out at early ages would bring a number of benefits, as well as allowing to select dysplasia free animals for reproduction, and would also allow to act much earlier in the treatment of dysplasic animals, including through preventive surgeries that can only be considered and carried out at very young ages. Aldo Vezzoni developed an early screening that stands out of PennHip because seeks the possible early treatment, and not the disease control. For this purpose, besides the passive joint laxity also assesses functional joint laxity by including in its examination another variable, the angle of the acetabular rim, and thus it is expected that the estimates are more accurate than those found under other method. In order to better understand what think the veterinarians specialized in small animals about the screening for hip dysplasia, and more precisely, at the early screening, we conducted a small survey that was made available in a circle of professionals, with the aim of helping us define what were the objectives to achieve with this work. This survey was answered by 49 professionals, and was concluded that only a third of respondents performs radiographic screening of HD in medium, large and giant breeds once hit one year old, and 83% of them said they did not realize the early screening , while 100% of respondents said that this is a useful technique. Noted that the difficulty experienced in performing the screening and interpretation of the results, were the main reason given for not performing this technique. In this work we analyzed 19 clinical cases of animals evaluated with early diagnosis of hip dysplasia aged between 19 and 28 weeks and estimatid the grade of dysplasiathat would each animal reach at adulthood. This classification was also compared with the classification obtained after the final of the 12 months of age. The predictions agreeded with the final classification in 91.67% of cases leading to the conclusion that this early screening and presents results are quite reliable since they predict very accurately the degree of dysplasia that will reach the animal studied when achieve adulthood. The other major utility of this technique is that allows to put into practice surgical techniques such as triple pelvic osteothomy (TPO), double pelvic osteotomy (DPO) and juvenile pubic symphysiodesis (JPS), which leads to a stabilization or a delay in the progression of osteoarthritis dysplasia in animals, which without such an early diagnosis, could not be options.
The Hip Dysplasia (HD) is an orthopedic disease, hereditary by nature, affecting primarily large dogs and giant, which is characterized by a lack of congruence between the femoral head and the acetabular cavity, which invariably leads to the establishment of osteoarthritis in the hip joint and the consequent discomfort which results in loss of quality of life of the affected animal. The official HD screening is performed in Portugal according to the criteria of the FCI – Fedération Cynologique Internacionale at 12 months of age, however, the screening carried out at early ages would bring a number of benefits, as well as allowing to select dysplasia free animals for reproduction, and would also allow to act much earlier in the treatment of dysplasic animals, including through preventive surgeries that can only be considered and carried out at very young ages. Aldo Vezzoni developed an early screening that stands out of PennHip because seeks the possible early treatment, and not the disease control. For this purpose, besides the passive joint laxity also assesses functional joint laxity by including in its examination another variable, the angle of the acetabular rim, and thus it is expected that the estimates are more accurate than those found under other method. In order to better understand what think the veterinarians specialized in small animals about the screening for hip dysplasia, and more precisely, at the early screening, we conducted a small survey that was made available in a circle of professionals, with the aim of helping us define what were the objectives to achieve with this work. This survey was answered by 49 professionals, and was concluded that only a third of respondents performs radiographic screening of HD in medium, large and giant breeds once hit one year old, and 83% of them said they did not realize the early screening , while 100% of respondents said that this is a useful technique. Noted that the difficulty experienced in performing the screening and interpretation of the results, were the main reason given for not performing this technique. In this work we analyzed 19 clinical cases of animals evaluated with early diagnosis of hip dysplasia aged between 19 and 28 weeks and estimatid the grade of dysplasiathat would each animal reach at adulthood. This classification was also compared with the classification obtained after the final of the 12 months of age. The predictions agreeded with the final classification in 91.67% of cases leading to the conclusion that this early screening and presents results are quite reliable since they predict very accurately the degree of dysplasia that will reach the animal studied when achieve adulthood. The other major utility of this technique is that allows to put into practice surgical techniques such as triple pelvic osteothomy (TPO), double pelvic osteotomy (DPO) and juvenile pubic symphysiodesis (JPS), which leads to a stabilization or a delay in the progression of osteoarthritis dysplasia in animals, which without such an early diagnosis, could not be options.
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária, Ciências Veterinárias
Palavras-chave
Cão , Displasia da anca , Diagnóstico precoce , Cirurgia preventiva