الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
Summary
The present study has been focused on the arthroscopic surgery of the carpal, hock, stifle, fetlock and coffin joints in horses. Arthroscopic surgery was performed for the treatment of articular disorders in 500 joints (372 horses). The information collected from each case were, age, breed, sex, joint involved, lesion type, lesion location, antimicrobial use and postoperative infectious complications.
The goals of the present study were: to perform a detailed descriptive study of the prevalence and distribution of articular disorders that can be treated with arthroscopy and to evaluate arthroscopic surgery for the prevalence of development of postoperative surgical site infection.
The procedures were performed under general anesthesia, with the horses in dorsal or lateral recumbency. The arthroscope was introduced into the joint via a scope portal that was created using specific landmarks for the particular joint being evaluated. Once the bone/cartilage or soft tissue lesions were identified and their location in the joint were determined, a second small incision was made in a position that allows an instrument to be inserted into the joint to manipulate the lesion. During surgery joint distension and continuous irrigation should be maintained to allow joint inspection and surgery. At the conclusion of surgery the joint was thoroughly lavaged to remove any cartilage or bone debris. The skin incisions were closed with one to two simple interrupted sutures using 2-0 polypropylene.
The results of the present study revealed that:
Arthroscopic surgery was performed on a total of 84 intercarpal joints and 29 radiocarpal joints. The most common carpal disease treated with arthroscopic surgery was the carpal osteochondral chip fragments, followed by osteoarthritis, third carpal bone slab fracture, medial palmar intercarpal ligament tear and septic arthritis respectively.
Arthroscopic surgery of the tarsocrural joint was performed on a total of 182 joints. The most common tarsocrural disease treated with arthroscopic surgery was the tarsocrural joint osteochondritis dissecans, followed by synovitis, septic arthritis, intraarticular fractures and osteoarthritis respectively.
Arthroscopic surgery of the femoropatellar joint was performed on a total of 31 joints. The most common femoropatellar disease treated with arthroscopic surgery was the femoropatellar joint osteochondritis dissecans, followed by synovitis, septic arthritis, and osteoarthritis.
Arthroscopic surgery was performed on a total of 16 medial femorotibial joints and 1 lateral femorotibial joint. The most common medial femorotibial joint disease treated with arthroscopic surgery was the subchondral cystic lesion of the medial femoral condyle, followed by medial meniscal tear and osteoarthritis respectively. The operated lateral femorotibial joint was a case of septic arthritis.
Arthroscopic surgery of the fetlock joint was performed on a total of 94 metatarsophalangeal joints and 55 metacarpophalangeal joints. The most common fetlock joint disease treated with arthroscopic surgery was osteochondral fragmentation of the proximal end of the first phalanx, followed by fracture of the proximal sesamoid bones, osteochondritis dissecans of the distal metacarpus or metatarsus, osteoarthritis, septic arthritis and subchondral cystic lesion in the distal end of the metacarpal bone respectively.
Arthroscopic surgery of the coffin joint was performed on a total of 8 forelimb coffin joints. The most common coffin joint disease treated with arthroscopic surgery was extensor process fragmentation, followed by septic arthritis and osteoarthritis respectively.
Arthroscopic treatment of septic arthritis was performed in 15 joints. Arthroscopy allowed effective evaluation of the cavity, identification and removal of the foreign material and devitalized tissue, followed by copious lavage of the joint.
Arthroscopic treatment of osteoarthritis was performed in 25 joints. Arthroscopy allowed accurate evaluation to the degree and extend of cartilage damage in cases of osteoarthritis.
The overall infectious complications developed in the joints operated arthroscopically for joints diseases other than septic arthritis were recorded in 7/485 joints (1.4%). Incisional surgical site infection developed in 5/485 joints (~1%) and septic arthritis developed in 2/485 joints (0.4%).
All cases of the incisional surgical site infection were resolved by systemic antibiotic and non steroidal anti-inflammatory drugs and local therapy which included suture removal, cleaning of the incisional site and application of bandage for 2-3 days.
The two joints that developed septic arthritis were both hock joints. Staphylococcus aurues was isolated from both joints as the cause of infection. Infection resolved in one case after arthroscopic debridment and lavage, but the seconed case was euthanized by the owner request.