十字韌帶斷裂

CranialCruciate

LigamentRuptureCranialCruciateLigamentRupture多數跛行患者病因不是髕骨脫位的可能性高!!WHY??為什么?大部分髕骨脫位是先天性的!伴隨著成長已適應痛癥!步行姿勢不自然!急劇脫臼等級(Grade)上升時出現跛行!嚴重的等級

或

伴隨著十字韌帶斷裂會出現跛行!CranialCruciateLigamentRupture(十字韌帶斷裂)中大型犬后肢跛行多出現髕骨脫位的患者必須確認十字韌帶斷裂!!CranialDrawermovementtest!!

(顱抽屜運動試驗)放射線拍照

–StressView!!(壓迫影像)Infra-patellarfatpadsign!!(髕骨下脂肪的影像)

CranialCruciateLigamentRupture(十字韌帶斷裂)

-Diagnosis(診斷)CranialDrawermovementtest!!(顱抽屜運動試驗)CranialCruciateLigamentRupture

(十字韌帶斷裂)

-Diagnosis(診斷)放射線拍照

–StressView!!(壓迫性)CranialCruciateLigamentRupture

(十字韌帶斷裂)

-Diagnosis(??)Infra-patellarfatpadsign!!(髕骨下脂肪)CranialCruciateLigamentRupture

(十字韌帶斷裂)

-Diagnosis(診斷)CranialCruciateLigamentRupture

(十字韌帶斷裂)

-Diagnosis(診斷)CranialCruciateLigamentRupture

(十字韌帶斷裂)

Diagnosis-Jointmice(診斷–關節內小骨)CranialCruciateLigamentRupture

(十字韌帶斷裂)

-Treatment(治療)

清除斷裂的韌帶!!CranialCruciateLigamentRupture

(十字韌帶的斷裂)

-Treatment1非手術治療

-不適合做手術的患者(老齡

及

其他疾病)-限制運動

-繃帶

-體重管理

-NSAID(非類固醇類抗炎藥)CranialCruciateLigamentRupture

-Treatment2手術

–人工韌帶方法-LateralSuture(antirotationalsuture)*FishingWire,*Nylon,*ETHIBONDCranialCruciateLigamentRupture

-Treatment3手術–自身韌帶法-OVERTHETOPTechnique

CranialCruciateLigamentRupture

-Treatment4手術–自身韌帶法-腓骨變位術CranialCruciateLigamentRupture

Treatment5??–Osteotomy&Ostectomy

-CTWO(CranialTibialWedge

Ostectomy)-顱脛骨楔形（三角）切骨術

-TPLO(Tibial

Plateaulevelling

Osteotomy)-脛骨平臺調平截骨

-PTIO(ProximalTibial

Intraaticular

Ostectomy)-脛骨近端關節內切除術-TTO(TripleTibial

Osteotomy)-三脛骨截骨術-TTA(Tibial

TuberosityAdvancement)

–脛骨粗隆前移術

-cTTA(circularTibialTuberosityAdvancement)-圓形的脛骨結節前移術CranialCruciateLigamentRupture

(十字韌帶斷裂)

-利用脛骨

Osteotomy&Ostectomy(截骨術)的十字韌帶斷裂手術的原理

TPLO(脛骨平臺調平截骨)建議的

作用機制

(Proposedmechanismofaction)CranialCruciateLigamentRupture(十字韌帶斷裂)

-

-利用脛骨

Osteotomy&Ostectomy(截骨術)的十字韌帶斷裂手術的原理

Dx:RtCCLR.Stressview

CranialCruciateLigamentRupture(十字韌帶斷裂)

CTWO(CranialTibialWedge

Ostectomy)

顱脛骨楔形（三角）切骨術前方十字韌帶斷裂的診斷Dx:RtCCLR.CTWO(顱脛骨楔形（三角）切骨術)的計算Dx:RtCCLR.TPAPost–OPX-rayTx:CCLR:

CTWO(CranialTibialWedgeOstectomy)CranialCruciateLigamentRupture

(十字韌帶斷裂)

TPLO(TibialPlateaulevellingOsteotomy)

脛骨平臺調平截骨

CranialCruciateLigamentRupture

(十字韌帶斷裂)

PTIO(ProximalTibial

Intraaticular

Ostectomy)

脛骨近端關節內切除術CranialCruciateLigamentRupture(???????)

TTA(TibialTuberosityAdvancement)脛骨結節前移術

CranialCruciateLigamentRupture(十字韌帶斷裂)

TTA(TibialTuberosityAdvancement)脛骨結節前移術CranialCruciateLigamentRupture(???????)

cTTA(circularTibialTuberosityAdvancement)

圓形脛骨結節前移術

CranialCruciateLigamentRupture

cTTA(circularTibialTuberosityAdvancement)

CranialCruciateLigamentRupture

cTTA(circularTibialTuberosityAdvancement)CranialCruciateLigamentRupture(十字韌帶斷裂)

TTO(TripleTibial

Osteotomy)三脛骨截骨術

???????????

TibialPlateau

DepressionOstectomy

脛骨高平部凹陷

截骨術

???????????

(TibialPlateauDepressionOstectomy)

??????????脛骨結節

曲柄

截骨術

TibialTuberosityCrankOsteotomy(TTCO)??????????

TibialTuberosityCrankOsteotomy(TTCO)脛骨結節曲柄截骨術

TibialTuberosityCrankOsteotomy(TTCO)脛骨結節曲柄截骨術

TibialTuberosityCrankOsteotomy(TTCO)??????????

TibialTuberosityCrankOsteotomy(TTCO)脛骨結節曲柄截骨術

TibialTuberosityCrankOsteotomy(TTCO)其他膝關節疾病膝反屈膝反屈膝反屈的治療膝反屈治療后的步行脛骨結節生長板的殘留

脛骨結節剝離性骨折不可逆性的膝關節損傷的治療???????????????,????????.?????????(??)?????

-???????

-?????????-????????-???????????

-?????????

???????????

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????????,???????????

????????????????????????????????

??,???,?????K-??????

????

&

??????????????膝關節固定術<Case1>手術前

確認感染及

不可逆性的關節損傷

手術前治療感染之后

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