Kedi ve köpeklerde ossa coxae kırıkları ile lbuna bağlı gelişen komplikasyonlarınsağaltımı ve geç dönem sonuçlarının klinik değerlendirilmesi

Bu çalışmada ossa coxae kırıklarının kedi ve köpeklerdeki yaygınlığı, bunların oluşum nedenleri, kırıkların tipi, komplikasyonları ve sağaltım seçeneklerinin belirlenmesi amaçlandı. Bu kapsamda, değişik ırk, yaş ve cinsiyette, 61 köpek ve 41 kedide (102 olgu) saptanan 239 ossa coxae (77 pubis, 69 ilium, 52 ischii ve 41 acetabulum) kırığı değerlendirildi. Lezyonlann tanısında anamnez bilgileri yanında klinik ve radyolojik muayenelerden yararlanıldı. Çalışma kapsamına alınan kırık olgularının 54 (22 acetabulum, 30 ilium, 2 ischii kırığı)'ünde operatif; 65 (12 acetabulum, 24 ilium, 19 pubis, 10 ischii kırığı)'inde konservatif; 63 (2 acetabulum, 35 pubis, 26 ischii kırığı)'ünde de hem operatif hem de konservatif sağaltım uygulandı. Diğer olguların bazılarında travmanın etkisiyle kısa sürede ölüm şekillendi, bir kısmında da sahiplerinin tedaviyi kabul etmemesi veya zamanıda tedaviye getirilmemesi nedeniyle sağaltım uygulanmadı. Bazı olgularda ise şiddetli travma ve yaygın eş zamanlı lezyonlar nedeniyle ötenazi uygulandı.Değerlendirme sonucunda, aynı dönemde toplam 936 kırığın 239'unu oluşturan ossa coxae kırıklarının, köpek ve kedilerde karşılaşılan tüm kırıkların % 25.5 (acetabulum % 17.1, pubis %32.2, ilium % 28.8 ve ischii % 21.7)'ini oluşturduğu belirlendi. Olguların 35'inde iyileşme döneminde defekasyon güçlüğü, siyatik ve femoral sinir parazisi, pelvis kanalında daralma gibi farklı komplikasyonlarla karşılaşıldı. Bunların 8'inde sağaltım amacıyla operatif girişim uygulandı. Çalışma boyunca, 9 kedi ve 13 köpeğin geç dönem klinik durumları farklı nedenlere bağlı olarak değerlendirilemedi. Diğer olgularda hasta sahiplerinden alınan bilgiler ve yapılan klinik muayenelerle 27 kedi ve 29 köpekte normal yürüyüşle birlikte iyileşme saptanırken 24 (19 köpek, 5 kedi) olguda çeşitli komplikasyonlara bağlı değişik derecede topallık belirlendi.

Anahtar Kelimeler:

kemik kırıkları, kedi, köpek, klinik muayene, olgu çalışmaları

Treatment of ossa coxae fractures and related complications in cats and dogs and clinical evaluation of late period results

In the present study, the occurrence of ossa coxae fractures, the aetiology, types of the fractures, complications, and treatment ways in cats and dogs were investigated. A total of 239 ossa coxae (77 pubis, 69 ilium, 52 ischii and 41 acetabulum) fractures from various species, races, ages and sexes were investigated from 61 dogs and 41 cats (102 case). For the diagnosis of the lesions not only anamnesis but also clinic and radiologic examinations were used. In the 54 case (22 acetabuium, 30 ilium, 2 ischii fractures) only operative; in the 65 case ( 12 acetabulum, 24 ilium, 19 pubis and 10 ischii fractures) only conservative; in the 63 case (2 acetabulum, 35 pubis, 26 ischii) both operative and conservative treatment were used. In the some cases, because of the trauma, death occurred in a short time. In some other cases the treatment could not be done because of the owners reluctancy or the animals were not brought in time. Euthanasia was applied to the other remain cases because of severe trauma and lesions. After the evaluation of 936 fractures occurred in cats and dogs ossa coxae fractures were seen in the 239 cases which is made 25,5% of the all fractures (acetabulum 17.1%; pubis 32.2%, ilium 28.8% and ischii 21.7%). In the 35 cases, different complications including defecation problems, paralysis of N. ischiadicus and N. femoralis, narrowing of the pelvic canal were observed. Operation' was applied in 8 of these cases. Late period clinical conditions were not possible to evaluate because of the various reasons. In the other 27 cat and 29 dogs full recovery was obtained after the clinical examination and anamnesis obtained from the owners. In the remaining 24 case (19 dog and 5 cat) different levels of lameness due to various Complications were observed.

Keywords:

bone fractures, cats, dogs, clinical examination, case studies,

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1.Dursun N: Veteriner Anatomi. 4. baskı. Medisan Yayınevi, Ankara, 1996.
2.Eaton-Weels RD, Matis U, Robins GM, Whittick WG: The pelvis and the pelvic limb. In, Whittick, WG (Ed). Canine Orthopedics. 2. ed. Lea & Febiger, Philadelphia, 387-433, 1990.
3.Gültekin M: Evcil Memeli ve Kanatlıların Karşılaştırmalı Osteologia'sı. Ankara Üniv Vet Fak Yayınlan, 301, Ankara, 133-143, 1977.
4.Unsaldı E: Köpeklerde deneysel os ilium kırıklarının metal plak, steinman çivisi ve kemik plaka ile sağaltımı. Ankara Üniversitesi Sağlık Bilimleri Enstitüsü Cerrahi Anabilim Dalı, Doktora Tezi, Ankara, 1992.
5.Evans HE: Anatomy of the Dog. 3rd ed. WB Saunders Co. Pennsylvani, 1993.
6.Miller ME: Anatomy of the Dog. WB Saunders Company, Philadelphia, 1964.
7.Aslanbey D, Unsaldı E: Köpeklerde deneysel siyatik paralizinin kas transpozisyonu ile sağaltımı. Ankara Üniv Vet Fak Dergisi, 39:114-131,1992.
8.Olmstead ML: Small Animal Orthopedics. Mosby, Missouri, 219-228, 1995.
9.DeCamp CE: Principles of pelvic fracture management. Seminars in Veterinary Medicine and Surgery: Small Animal, 7: 63-70, J 992.
10.Kaya Ü, Temizsoylu D, Candaş A: The clinical studies on the treatment of pelvic fractures of cats and small breed dogs with mini titanium plates and screws. Ankara Üniv Vet Fak Derg, 46: 199-205, 1999.
11.Verstraete FJM, Lambrechts NE: Diagnosis of soft tissue injuries associated with pelvic fractures. Compend Contin Educ Pract Vet, 14: 921-931, 1992.
12.Denny HR, Butterworth SJ: A guide to Canine and Feline Orthopaedic Surgery. 4th ed. Blackwell Science, London, 441-454,2000.
13.Boswell KA, JR Boone EG, Boudrıeau RJ: Reduction and temporary stabilization of acetabular fractures using ASİF man-dibular reduction forceps: technique and results using plate fix-ation in 25 Dogs. Vet Surg, 30: 1-10,2001.
14.Dunbar AD: Evaluating pelvic fractures: Indications for surgical correction. Veterinary Medicine and Small Animal Clinician, 79: 1047-1048, 1984.
15.Dyce J, Houlton JEF: Use of reconstruction plates for repair of acetabular fractures in 16 dogs. j Small Anim Pract, 34: 547-553, 1993.
16.Jacobson A, Schrader SC: Peripheral nerve injury associated with fracture or fracture-dislocation of the pelvis in dogs and cats: 34 cases (1978-1982). JAVMA, 190: 569-572, 1987.
17.Kuntz CA, Waldron D, Martin RA, Shires PK, Moon M, Shell L: Sacral fractures in dogs: A review of 32 cases. JAAHA, 31: 142-150,1995.
18.Messmer M, Rytz U, Spreng D: Urethral entrapment following pelvic fracture fixation in a dog. j Small Anim Pract, 42: 341-344, 2001.
19.Piermattei DL, Flo GL: Brinker, Piermattei, and Flo's Handbook of Small Animal Orthopedics and Fracture Repair. 3rd ed. WB Saunders Co. Philadelphia, 395-422, 1997.
20.Samsar E, Akın F; Anteplioğlu H: Özel Şirurji. 2. Baskı. Medisan, Ankara, 643-649, 1986.
21.Schrader SC: Pelvic osteotomy as a treatment for obstipation in cats with acquired stenosis of the pelvic canal: Six cases (1978-1989). JAVMA, 200: 208-214, 1992.
22.Unsaldı E: Kedilerde pelvis kırıklarının osteosentez ile sağaltımı. Ankara Üniv Vet Fak Dergisi, 42: 129-137, 1995.
23.Yücel R: Veteriner Özel Cerrahi. 2. Baskı. Pethask Veteriner Hekimliği Yayınları, İstanbul, 333-335, 1998.
24.Betts CV: Pelvic fracture. In, Slatter D (Ed): Textbook of Small Animal Surgery. Vol-2. 2nd ed. WB Saunders Co. Pennsylvania, 1769-178, 1993.
25.Fossum TW, Hedlund CS, Hulse DA, Johnson AL, Seim HB, Willard MD, Carroll GL: Small Animal Surgery. Mosby, Missouri, 834-865, 1997.
26.Houlton J, Dyce J: Management of pelvic fractures in the dog and cat. Waltham Focus, 4: 17-25, 1994.
27.Innes J, Butterworth S: Decision making in the treatment of pelvic fractures in small animals. In Practice, 18: 215-221, 1996.
28.Bookbinder PF, Flanders JA: Characteristics of pelvic fracture in the cat. VCOT, 5: 122-127, 1992.
29.Chambers JN, Hardie EM: Localization and management of sciatic nerve injury due to ischial or acetabular fracture. JAAHA, 22: 539-544, 1986.
30.Lewis DD, Beale BS, Pechman RD, Ellison GW: Rectal perforations associated with pelvic fractures and sacroiliac fracture-separations in four dogs. JAAHA, 28: 175-181, 1992.
31.Muir P: Rectal perforation associated with pelvic fracture in a cat. VetRec, 142:371-372, 1998.
32.Radasch RM, Merkley DF, Hoefle WD, Peterson J: Static strength evaluation of sacroiliac fracture-seperation repairs. Vet Surg, 19: 155-161, 1990.
33.Tobias KMS: Rectal perforation, rectocutaneous fistula formation, and enterocutaneous fistula formation after pelvic trauma in a dog. JAVMA, 205: 1292-1296, 1994.
34.Hiltbrand D, Huber ED: Elargissement du diametre tranversal pelvien chez un chat. Schweiz. Arch Tierheilk, 132: 65-67, 1990.
35.Aslanbey D, Candaş A: Veteriner Operasyon. 1. Baskı. Medisan Yayınevi, Ankara, 772-784, 1994.
36.Devecioğlu Y: Köpeklerde collumna vertebralis ve medulla spinalis lezyonlarının klinik değerlendirilmesi. Istanbul Üniversitesi Sağlık Bilimleri Enstitüsü Cerrahi Anabilim Dalı, Doktora Tezi, İstanbul 1990.
37.Meier HT, Biller DS, Lora-Michiels M, Hoskinson JJ: Additional Radiographic views of the pelvis and pelvic limb in dogs. Compend Contin Educ Pract Vet, 23 (10): 871-877, 2001.
38.Samsar E, Akın F, Anteplioğlu H: Klinik Tanı Yöntemleri ve Genel Cerrahi. 6. Baskı. Tamer Matbacılık, Ankara, 53-54, 1996.
39.Whittick VG: Canine Orthopedics. Lea & Febiger, Philadelphia, 418-440, 1974.
40.Aslanbey D: Veteriner Ortopedi ve Travmatoloji. Maya matbaacılık, Ankara, 128-140, 1990.
41.Aslanbey D: Ortopedi. İmren HY (Ed): Kedi ve Köpek Hastalıkları. 1. Baskı. Medisan Yayınevi, Ankara, 704-709, 1998.
42.Lewis DD, Parker RB, Bloomberg MS: Self-Assessment Colour Review of Small Animal Orthopaedics. Manşon Publishing, London, 185-187, 1998.
43.Averill SM, Johnson AL, Schaeffer DJ: Risk factors associated with development of pelvic canal stenosis secondary to sacroiliac separation: 84 cases (1985-1995). JAVMA, 211: 75-78, 1997.
44.Denny HR: Pelvic fractures in the dog: a review of 123 Cases. J Small Anim Pract, 19:151 -166, 1978.
45.Hurov L: Surgery, using plates, nuts and bolts, for pelvic fracture reductions in two cats. Can Vet J, 25: 417-420, 1984.
46.Graehler RA, Weigel JP, Pardo AD: The effects of plate type, angle of ilial osteotomy, and degree of axial rotation on the structural anatomy of the pelvis. Vet Surg, 23: 13-20,
47.Lanz OI, Lewis DD, Madison JB, Miller GJ, Martin DE: A biomechanical omparison of screw and wire fixation with and without polymethylmethacrylate reenforcement for acetabular osteotomy stabilization in dogs. Vet Surg, 28: 161-170, 1999.
48.Sardinas JC, Kraus KH, Sisson RD: Comparison of the holding power of 3.5-mm cortical versus 4.0-mm cancellous orthopedic screws in the pelvis of immature dogs (cadavres). Am J Vet Res, 56: 248-251,1995.
49.Lanz OI, Lewis DD, Madison LB, Blaeser LL: A biomechanical comparison of composite fixation and veterinary acetabular plates for stabilization of acetabular osteotomies in dogs loaded in three-point-bending fashion. VCOT, 11: 152-157,1998.
50.Gentry SJ, Taylor RA, Dee JF: The use of veterinary cuttable plates: 21 cases. JAAHA, 29: 455-459, 1993.
51.Anderson GM, Cross AR, Lewis DD, Lanz OI: The effect of plate luting on reduction accuracy and biomechanics of acetabular osteomies stabilized with 2.7-mm reconstruction plates. Vet Surg, 31: 3-9,2002.
52.Lenehan TM, Tarvin GB: Fractures of the hind limb. In, Bojrab ML (Ed): Current Techniques in Small Animal Surgery. 4th ed. Williams & Wilkins, Baltimore, 1998.
53.Lewis DD, Stubbs WP, Neuwirth L, Bertrand SC, Parker RB, Stalhngs JT, Murphy ST: Results of screw/wire/ polymethylmethacrylate composite fixation for acetabular fracture repair in 14 dogs. Vet Surg, 26: 223-234,1997.
54.Hardie RJ, Bertram JEA, Todhunter RJ, Trotter EJ: Biomechanical comparison of two plating techniques for fixation of acetabular osteotomies in dogs. Vet Surg, 28: 148-153, 1999.
55.Butterworth SJ, Gribben S, Skerry TM, Denny HR, Barr ARS, Gregory SP: Conservative and surgical treatment of canine acetabular fractures: A review of 34 cases. j Small Anim Pract, 35: 139-143,1994.
56.Piermattei DL, Greeley RG: An Atlas of Surgical Approaches to the Bones of the Dog and Cat. 2nd ed. WB Saunders Company, Philadelphia, 127-157, 1979.
57.Brinker WO, Olmstead ML, Summer-Smith G, Prieur WD: Manual of Internal Fixation in Small Animals. 2nd ed. Springer-Verlag, Berlin, 148-155, 1998.
58.Tomlinson JT, Cook JL, Payne JT, Anderson CC, Johnson JC: Closed reduction and lag screw fixation of sacroiliac luxations and fractures. Vet Surg, 28: 188-193, 1999.
59.Situma JN: Beckenfrakturen beim hund in Den Jahren 1970-1977. Inaugural Dissertation Zur erlangung der Tiermedizinischen Doktorvvürde des Facbereichs Tiermedizin der Ludwig-Maximilians-Universitat, Miinchen, 1979.
60.Payne JT: Selecting a method for managing pelvic fractures in dogs and cats. Veterinary Medicine, 88: 969-973, 1993.
61.Altunatmaz K, Aksoy Ö, Özsoy S: Kedi ve köpeklerde ossa coxae kırıkları ve bunlarla eş zamanlı şekillenen ortopedik lezyonların radyografik olarak değerlendirilmesi (1992-2002). Sekizinci Ulusal Veteriner Cerrahi Kongresi. Bildiri Özetleri. Yüzüncü Yıl Üniversitesi Veteriner Fakültesi-Van, 25-26, 2002.
62.Yanık K, Altıkardeşler-İlman A, Gül NY, Tan H, Salcı H: Köpek ve kedilerde kalça kırık ve çıkıklarının toplu değerlendirilmesi: 277 olgu (1997-2002). ikinci Ulusal Küçük Hayvan Hekimliği Kongresi. Kongre Bildiri Özetleri, Bursa, 162, 2003.