Köpeklerde Medial Koronoid Hastalığının Klinik ve Radyografik Olarak Değerlendirilmesi: 20 Olgu

Bu çalışmada İstanbul Üniversitesi Veteriner Fakültesi Cerrahi Anabilim Dalı’na ön bacakta topallık şikayetiyle getirilip, medial koronoid hastalığı (MKH) tanısı konulan 20 adet köpeğin klinik durumları ve sağaltım sonuçları değerlendirilmiştir. MKH’nın tanısı 16 hastada direkt radyografi, 2 hastada artroskopi ve 2 hastada bilgisayarlı tomografi ile konulmuştur. MKH’na bağlı medial koronoid prosesin kırık parçasının uzaklaştırılması ve bölgenin debridmanına yönelik artrotomi işlemi toplam 20 dirsek eklemine uygulanmıştır. Artrotomi sonrasında fonksiyonel iyileşme ortalama 31 gün, postoperatif 30. gün topallık dereceleri 8 olguda “1”, 12 olguda “0” olarak belirlenmiş olup 60. gün sonunda iyileşmeleri 9 olguda vasat, 5 olguda “iyi”, 6 olguda ise “çok iyi” olarak değerlendirildi. Sunulan bu çalışmada medial koronoid hastalığı olan köpeklere uygulanan sağaltım yöntemleri değerlendirilmiş olup sonuçlarının meslek pratiğine aktarılması amaçlanmıştır.

The Clinical and Radiological Evaluation of Medial Coronoid Diasease in Dogs: 20 Cases

In this study, clinical status and treatment outcomes of 20 dogs, which were referred to Istanbul University, Faculty of Veterinary Medicine,and Department of Surgery with the complaint of forelimb lameness and diagnosed with medial coronoid disease (MCD), were assessed. Thediagnosis was made based on radiographic findings in 16 patients, on arthroscopic findings in 2 and on computed tomographic findingsin other 2 patients. Arthrotomy aimed at removal of fragmented medial coronoid process and debridement of the surrounding tissues wascarried out on a total of 20 elbow joints. Average functional recovery period after arthrotomy was 31 days and postoperative lameness scoreson day 30 were “1” and “0” in 8 and 12 cases, respectively. Recovery rates on postoperative day 60 were detected to be moderate, good andvery good in 9, 5 and 6 dogs, respectively. In the current study, treatment options were evaluated in the dogs with medial coronoid diseaseand the outcomes were aimed to be a contribution to veterinary practice.

PDF

___

Galindo-Zamora V, Dziallas P, Wolf DC, Kramer S, Abdelhadi J, Lucas K, Nolte I, Wefstaedt P: Evaluation of thoracic limb loads, elbow movement, and morphology in dogs before and after arthroscopic management of unilateral medial coronoid process disease. Vet Surg, 43 (7): 819-828, 2014. DOI: 10.1111/j.1532-950X.2014.12250.x
Evans RB, Gordon-Evans WJ, Conzemius MG: Comparison of three methods for the management of fragmented medial coronoid process in the dog. A systematic review and meta-analysis. Vet Comp Orthop Traumatol, 21, 106-109, 2008.
Meyer-Lindenberg A, Langhann A, Fehr M, Nolte I: Arthrotomy versus arthroscopy in the treatment of the fragmented medial coronoid process of the ulna (FCP) in 421 dogs. Vet Comp Orthop Traumatol, 16 (4): 204-210, 2003. DOI: 10.1055/s-0038-1632780
Meyer-Lindenberg A, Fehr M, Nolte I: Co-existence of ununited anconeal process and fragmented medial coronoid process of the ulna in the dog. J Small Anim Pract, 47 (2): 61-65, 2006. DOI: 10.1111/j.1748- 5827.2006.00051.x
Meyer-Lindenberg A, Staszyk C, Gasse H, Fehr M, Nolte I: Caudomedial approach for removal of an ununited anconeal process and assessment of the medial coronoid process of the ulna. J Vet Med A Physiol Pathol Clin Med, 49 (5): 277-280, 2002. DOI: 10.1046/j.1439- 0442.2002.00421.x
Villamonte-Cevalier A, Van Bree H, Broeckx BJG, Dingemanse W, Soler M, Van Ryssen B, Gielen I: Assesment of medial coronoid disease in 180 canine lame elbow joints: A sensitivity and specificity comparison of radiographic, computed tomographic and arthroscopic findings. BMC Vet Res, 11, 243, 2015. DOI: 10.1186/s12917-015-0556-9
Hazewinkel HAW: Elbow dysplasia: Introduction, clinical investigation and force plate evaluation. International Elbow Working Group Annual Meeting WSAVA Congress, Bangkok Thailand. 2015. http://www.vetiewg.org/wp-content/uploads/2017/02/proceedings2015.pdf, Accessed: 10.10.2017.
Cogar SM, Cook CR, Curry, SL, Grandis A, Cook JL: Prospective evaluation of techniques for differentiating shoulder pathology as a source of forelimb lameness in medium and large breed dogs. Vet Surg, 37 (2): 132-141, 2008. DOI: 10.1111/j.1532-950X.2007.00364.x
Fitzpatrick N, Caron A, Solano MA: Bi-oblique dynamic proximal ulnar osteotomy in dogs: Reconstructed computed tomographic assessment of radioulnar congruence over 12 weeks. Vet Surg, 42 (6): 727- 738, 2013. DOI: 10.1111/j.1532-950X.2013.12014.x
Puccio M, Marino DJ, Stefanacci JD, McKenna B: Clinical evaluation and long term follow-up of dogs having coronoidectomy for elbow incongruity. J Am Anim Hosp Assoc, 39 (5): 473-478, 2003. DOI: 10.5326/0390473
Ness MG: Treatment of fragmented coronoid process in young dogs by proximal ulnar osteotomy. J Small Anim Pract, 39, 15-18, 1998. DOI: 10.1111/j.1748-5827.1998.tb03663.x
Caron A, Fitzpatrick N: Bi-Oblique dynamic proximal ulnar osteotomy: Surgical technique and clinical outcome in 86 dogs. Vet Surg, 45 (3): 356-363, 2016. DOI: 10.1111/vsu.12464
Carpenter LG, Schwarz PD, Lowry JE, Park RD, Steyn PF: Comparison of radiologic imaging techniques for diagnosis of fragmented medial coronoid process of the cubital joint in dogs. J Am Vet Med Assoc, 203 (1): 78-83, 1993.
Lau SF, Wolschrijn CF, Hazewinkel HAW, Siebelt M, Voorhout G: The early development of medial coronoid disease in growing Labrador retrievers: Radiographic, computed tomographic, necropsy and microcomputed tomographic findings. Vet J, 197, 724-730, 2013. DOI: 10.1016/j. tvjl.2013.04.002
Franklin SP, Burke EE, Holmes SP: Utility of MRI for characterizing articular cartilage pathology in dogs with medial coronoid process disease. Front Vet Sci, 4 (25): 1-9. 2017. DOI: 10.3389/fvets.2017.00025
Cook CR, Cook JL: Diagnostic imaging of canine elbow dysplasia: A review. Vet Surg, 34 (2): 144-153, 2009. DOI: 10.1111/j.1532-950X. 2008.00481.x
Narojek T, Fiszdon K, Hanyzs E: Canine elbow dysplasia in diffferent breeds. Bull Vet Inst Pulowy, 52, 169-173, 2008.
Vermote KAG, Bergenhuyzen ALR, Gielen I, van Bree H, Duchateau L, Van Ryssen B: Elbow lameness in dogs of six years and older: Arthroscopic and imaging findings of medial coronoid disease in 51 dogs. Vet Comp Orthop Traumatol, 23 (1): 43-50, 2010. DOI: 10.3415/ VCOT-09-03-0032
Olsson SE: The early diagnosis of fragmented coronoid process and osteochondritis dissecans of the canine elbow joint. J Am Anim Hosp Assoc, 19, 616-626, 1983.
Michelsen J: Canine elbow dysplasia: Aetiopathogenesis and current treatment recommendations. Vet J, 196 (1): 12-19, 2013. DOI: 10.1016/j. tvjl.2012.11.009
Hazewinkel HAW, Meij BP, Theyse LFH: Surgical treatment of elbow dysplasia. Vet Q, 20 (Suppl.1): 29-31, 1998.
Coppieters E, Seghers H, Verhoeven G, Gielen I, Samoy Y, De Bakker E, Van Ryssen B: Arthroscopic, computed tomography, and radiographic findings in 25 dogs with lameness after arthroscopic treatment of medial coronoid disease. Vet Surg, 45, 246-253, 2016. DOI: 10.1111/vsu.12443
Griffon DJ: Surgical diseases of the Elbow. In, Tobias MK, Johnston AS (Eds): Veterinary Surgery Small Animal. 736-749, Saunders, Missouri, 2012.
Lau SF: Development of medial coronoid disease in Labrador retrievers: Diagnostic and pathologic studies. PhD Thesis, Utrecht University, Netherlands, 2013.
Grøndalen J, Grøndalen T: Arthrosis in the elbow joint of young rapidly growing dogs. V. A pathoanatomical investigation. Nord Vet Med, 33 (1): 1-16, 1981.
Gemill TJ, Clements DN: Fragmented coronoid process in the dog: Is there a role for incongruency? J Small Anim Pract, 48, 361-368, 2007. DOI: 10.1111/j.1748-5827.2007.00320.x
Wavreille V, Fitzpatrick N, Drost WT, Russell D, Allen MJ: Correlation between histopathologic, arthroscopic, and magnetic resonance imaging findings in dogs with medial coronoid disease. Vet Surg, 44 (4): 501-510, 2015. DOI: 10.1111/j.1532-950X.2014.12233.x
Temwichitr J, Leegwater PAJ, Hazewinkel HAW: Fragmented coronoid process in the dog: A heritable disease. Vet J, 185 (2): 123-129. 2010. DOI: 10.1016/j.tvjl.2009.06.022
Morgan JP, Wind A, Davidson AP: Hereditary bone and joint diseases in the dog: Osteochondroses, hip dysplasia, elbow dysplasia. 77-78, Hannover: Schlütersche GmbH&Co. KG, 2000.
Fitzpatrick N, Smith TJ, Evans RB, Yeadon R: Radiographic and arthroscopic findings in the elbow joints of 263 dogs with medial coronoid disease. Vet Surg, 38, 213-223, 2009. DOI: 10.1111/j.1532- 950X.2008.00489.x
Boulay JP: Fragmented medial coronoid process of the ulna in the dog. Vet Clin North Am: Small Anim Pract, 28 (1): 51-74, 1998. DOI: 10.1016/ S0195-5616(98)50004-6