Rotura do ligamento cruzado cranial: utilização da técnica cirúrgica tta porosa - estudo retrospetivo de 60 casos clínicos
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2017-11-06
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A rotura do ligamento cruzado cranial é o principal problema ortopédico observado no cão e é a maior causa de claudicação dos membros posteriores. Desde 1926, altura em que a rotura foi descrita no cão, foram surgindo estudos sobre o porquê da sua ocorrência, no entanto a sua exata patogenia permanece desconhecida. A rotura pode ser traumática ou degenerativa, sendo esta última a mais comum. O grupo de cães mais afetados com esta doença são os mais jovens e de raças mais pesadas, mas qualquer animal pode desenvolver rotura do ligamento. O proprietário leva o seu animal à consulta no médico veterinário, uma vez que o seu cão apresenta claudicação do membro posterior com diminuição do apoio de carga. O diagnóstico baseia-se então, na história de claudicação, na informação obtida na anamnese, exame ortopédico e outros exames complementares de diagnóstico como radiografias, artroscopia, entre outros. Relativamente ao tratamento da rotura do ligamento cruzado cranial, este pode ser conservativo ou cirúrgico, sendo o cirúrgico o mais recomendado pela rapidez na estabilização da articulação do joelho e pelo retorno da função mais precoce. As técnicas cirúrgicas são várias e dividem-se em técnicas intracapsulares, que, entretanto, foram substituídas pelas extracapsulares, utilizadas com frequência em cães mais leves e as osteotomias da tíbia. Estas últimas são as mais utilizadas para a resolução cirúrgica da rotura do ligamento cruzado cranial e correspondem à Tibial Plateau Levelling Osteotomy (TPLO), Tibial Tuberosity Advancement (TTA) e Triple Tibial Osteotomy (TTO), no entanto não há uma superioridade de uma delas relativamente às restantes. Apesar da existência de inúmeras técnicas cirúrgicas, continuam a surgir novas variantes das técnicas que já existem, como é o caso da TTA Porosa desenvolvida pelo Instituto Tecnológico de Canárias. Assim, este estudo retrospetivo centrou-se na análise dos resultados obtidos com a TTA Porosa relativamente às complicações intra e pós-operatórias, comparando-os com a TTA Clássica, de forma a avaliar se existem vantagens de uma em relação à outra e a segurança e eficácia da técnica estudada.
The cranial cruciate ligament rupture (CCLr) is the main orthopaedic problem observed in dogs and the most common cause of the lameness of the hind limbs. Since 1926, when this disease was first described in a dog, many studies have been made in order to explain why the disease occurs, however the exact pathogenesis remains unknown. The rupture can be traumatic or degenerative, the latter being the most common. The group of dogs most affected with this disease are the youngest and of the heaviest breeds, but any animal can develop ligament rupture. The owner takes his pet to the veterinarian's, since the dog exhibits lameness of the hind limb with decreased load bearing. The diagnosis is then based on the history of lameness, the information obtained in the anamnesis, orthopedic examination and other complementary diagnostic tests such as radiography, arthroscopy, among others. Regarding the treatment of cranial cruciate ligament rupture, it may be conservative or surgical, but the surgical one is most recommended because of the rapid stabilization of the stifle joint and a faster function return. There are many surgical techniques described and they are divided in intracapsular techniques that were replaced by the extracapsular ones, the last being frequently used in lighter dogs and in osteotomies of the tibia. The osteotomy techniques are the way to go for the surgical resolution of cranial cruciate ligament rupture and correspond to the Tibial Plateau Levelling Osteotomy (TPLO), Tibial Tuberosity Advancement (TTA) and Tibial Osteotomy (TTO), however there is no major advantage of one of them compared to the others. Even though there are a lot of surgical techniques, new variants of existent techniques are developed, for instance the Porous TTA made by the Instituto Tecnológico de Canarias. In summary, this retrospective study centred around the analysis of the obtained results with the Porous TTA relatively to the intraoperative and postoperative issues, comparing them with the Classical TTA, in order to evaluate the efficiency and safety of the studied technique and if there are advantages when using one compared to the other
The cranial cruciate ligament rupture (CCLr) is the main orthopaedic problem observed in dogs and the most common cause of the lameness of the hind limbs. Since 1926, when this disease was first described in a dog, many studies have been made in order to explain why the disease occurs, however the exact pathogenesis remains unknown. The rupture can be traumatic or degenerative, the latter being the most common. The group of dogs most affected with this disease are the youngest and of the heaviest breeds, but any animal can develop ligament rupture. The owner takes his pet to the veterinarian's, since the dog exhibits lameness of the hind limb with decreased load bearing. The diagnosis is then based on the history of lameness, the information obtained in the anamnesis, orthopedic examination and other complementary diagnostic tests such as radiography, arthroscopy, among others. Regarding the treatment of cranial cruciate ligament rupture, it may be conservative or surgical, but the surgical one is most recommended because of the rapid stabilization of the stifle joint and a faster function return. There are many surgical techniques described and they are divided in intracapsular techniques that were replaced by the extracapsular ones, the last being frequently used in lighter dogs and in osteotomies of the tibia. The osteotomy techniques are the way to go for the surgical resolution of cranial cruciate ligament rupture and correspond to the Tibial Plateau Levelling Osteotomy (TPLO), Tibial Tuberosity Advancement (TTA) and Tibial Osteotomy (TTO), however there is no major advantage of one of them compared to the others. Even though there are a lot of surgical techniques, new variants of existent techniques are developed, for instance the Porous TTA made by the Instituto Tecnológico de Canarias. In summary, this retrospective study centred around the analysis of the obtained results with the Porous TTA relatively to the intraoperative and postoperative issues, comparing them with the Classical TTA, in order to evaluate the efficiency and safety of the studied technique and if there are advantages when using one compared to the other
Descrição
Dissertação de Mestrado em Medicina Veterinária
Palavras-chave
Rotura do ligamento cruzado cranial , TTA Clássica , TTA Porosa , Cão