內(nèi)容貓跛行綜合

SmallAnimalSurgerySmallAnimalSurgeryLamenessinAndreasDiplomateECVS,Dr.med.vet.,Overviewofthelameness跛行Overviewofthelameness跛行檢HistoryofGeneralexamNeurologic神經(jīng)學(xué)ORTHOPEDIC––––推–––EvaluationofEvaluationofLamenessvisible?Where?病史和畜主的觀察結(jié)果很重明顯跛行？何處?Changeinbehavior(activity,sleeping,grooming)?行為改變（活動(dòng)，睡眠，舔毛貓是否仍然可以跳上它所喜歡的位DoesthecatstilljumponitsfavoritePhysicalNeurologicalexamOftennon-specificclinicalsignswithdiseasesofthemusculoskeletal常無(wú)肌肉骨骼系統(tǒng)的特異性臨床癥OrthopedicCalmenvironmentandminimalhandling平OrthopedicCalmenvironmentandminimalhandling平靜環(huán)境和最小的接Letthecatmovefreeintheexamination讓患貓?jiān)跈z查室內(nèi)自由活Placecatawayfromcarrier/box/placeto令患貓遠(yuǎn)離攜帶籠/盒子/藏匿Askownertofilmtheircatat可讓畜主拍攝患貓?jiān)诩抑???姿Liftinglegoffthegrounddespitenormal除了正常步態(tài)外是否有腿離開(kāi)地Standingorsitting??OrthopedicOrthopedicOrthopedicOrthopedicOrthopedicOrthopedicCanyoutellmewherethecatisOrthopedicOrthopedicCanyoutellmewherethecatisGradingofthelameness?GradeGradingofthelameness?Grade1:Low-grade1級(jí)：輕度跛hardlyvisibleornotvisible難以察覺(jué)或無(wú)法察butcatliftsfootwhensitting(frontlimbs)orisunableto但貓會(huì)在坐姿時(shí)提起患肢（前肢）或無(wú)法跳躍（后肢?Grade2:Medium-grade2級(jí)：中度跛clearlyvisible,butlegisusedinmost易于察覺(jué)，但大部分時(shí)候可用患?Grade3:High-gradeonlytoe-touchingornotweight-bearingat患肢僅用指/趾著地或完全3級(jí)：重度跛Moreobjectivegait-Forceplate力平板Moreobjectivegait-Forceplate力平板Describedinliterature(CCLD,文獻(xiàn)記載（CCLD，截爪術(shù)Mostcatsweretrainedandsettingwas大部分貓是受過(guò)訓(xùn)練的，且為實(shí)-Pressuresensitive壓力傳Walkingfreeandjumpingofheight,clientownedandnottrained,successin自由行走及跳高，客戶的貓且未受過(guò)訓(xùn)練，成功率為BilateralorthopedicDiffuculttodifferentiatefromneurological難以與BilateralorthopedicDiffuculttodifferentiatefromneurological難以與神經(jīng)學(xué)問(wèn)題--Inactiveandreluctantto不活躍或不愿-Morecommoninhind常發(fā)于Frequentcausesforbilateralpelviclimb常見(jiàn)的雙側(cè)后肢跛行的病------Patellar雙側(cè)前十字韌BilateralcranialcruciateligamentHip髖關(guān)節(jié)發(fā)育不Lumbarandlumbosacraldegenerative腰椎和腰骶椎退化Bilateralorthopedic雙側(cè)Bilateralorthopedic雙側(cè)骨Ifunabletostandorwalkandpossible如果無(wú)法站立或行走，可能的損傷-InjuriestomultiplePelvicSpinalfracturesand脊柱骨折和脫---1.Standing1.Standing站Fromheadtotail,limbsfromproximalto從頭至尾，肢體從近端至遠(yuǎn)Lookingformuscleatrophy,swelling,jointeffusion,symmetryofbonyprominencesorpainComparingsidestodetectsubtle對(duì)比對(duì)側(cè)檢查細(xì)微1.Standing1.Standing站Palpablebonyprominencesinthecat:觸診貓的骨1.Standing站Palpablebonyprominences1.Standing站Palpablebonyprominencesinthe觸診貓的骨突Scapular肩胛肱橈骨/尺M(jìn)etacarpiand1.Standing站Palpable1.Standing站Palpablebonyprominencesinthe觸診貓的骨突骨IliacTuberFibularheadCalcaneal髂骨大轉(zhuǎn)1.Standing站1.Standing站Example:coxofemoral例：髖骨關(guān)節(jié)FOTOSKELETTUND2Lateral2Lateral Startwithunaffected從健肢開(kāi)始檢Fromdistal(toes)to自遠(yuǎn)端（指/趾）Lookfor檢AxialTemperatureSwellingor腫脹或PalpationandLateralrecumbencyPalpationandLateralrecumbency側(cè)臥Sedationmaybe可能需-骨crepitation,instability,axialdeviations,changesincontour,andpain->fracture,neoplasia,other→骨折、增生和其PalpationandManipulation-PalpationandManipulation-關(guān)periarticularswellingorjoint關(guān)節(jié)周?chē)[脹effusion=unspecific(DJD,hemarthrosis,滲出=非特異（退行性關(guān)節(jié)病，關(guān)節(jié)出血，關(guān)節(jié)Rangeofmotion instabilitycrepitusorreducedROM失穩(wěn)、摩擦音或運(yùn)動(dòng)范圍減felinejointsmoreelasticvs與犬相比，貓的關(guān)節(jié)更具彈comparedtocontralateral與對(duì)側(cè)關(guān)節(jié)相knowledgeofligamentous韌帶解PalpationandPalpationandMediolateralrangeofmotioninthetarsal跗關(guān)節(jié)中間外側(cè)的運(yùn)動(dòng)范CATDOGPalpationandMediolateralPalpationandMediolateralrangeofmotioninthetarsal跗關(guān)節(jié)中間外側(cè)的運(yùn)動(dòng)范CATDOGPronationandsupinationPronationandsupination(Campbell掌向下及旋后（Campbell試驗(yàn)犬PronationandPronationandsupination(Campbell掌向下及旋后（Campbell試驗(yàn)CATPalpationand-SoftPalpationand-Soft軟組skin,muscles,claws,clawbedsand皮膚、肌肉、腱、爪、爪床和足markedcellulitisandpain:明顯的蜂窩織炎suspectabscessafterbite懷疑咬傷后的tendons:triceps,Achillesandpatellar肌腱：三頭肌、跟腱和髕CausesCausesoffrontlimblameness前肢跛行的病關(guān)節(jié)炎、DJD、外骨折、脫臼、外翻或內(nèi)翻時(shí)失穩(wěn)（腕伸展DJD，關(guān)節(jié)炎，滑關(guān)節(jié)炎、DJD、外骨折、脫臼、外翻或內(nèi)翻時(shí)失穩(wěn)（腕伸展DJD，關(guān)節(jié)炎，滑囊囊骨折、脫臼、DJD，脫臼、尺橈骨間存在骨性骨折、脫臼、DJD、DJD，脫臼、關(guān)節(jié)發(fā)育不良中間外側(cè)和前后向失穩(wěn)（抽屜試驗(yàn)CausesCausesofhindlimbCausesCausesofhindlimb關(guān)節(jié)炎，DJD，外DJD，關(guān)節(jié)脫DJD，關(guān)節(jié)炎，OC，外關(guān)節(jié)炎，DJD，外DJD，關(guān)節(jié)脫DJD，關(guān)節(jié)炎，OC，外Further?診斷影???Further?診斷影???超聲波Crosssectionalimaging(CTMRI)交叉面成?Blood血液學(xué)????Twoorthogonalview???Twoorthogonalview需要兩個(gè)正交Sedationanesthesiarecommended建議進(jìn)行鎮(zhèn)靜/麻X-raybeamcenteredofregionofinterestandstructureparalleltoplatePrinciplesof 影像解qualityofSystematicASofttissue,thenbones軟組織，然后B,Proximaltodistal/cranialtocaudal(axial近端至遠(yuǎn)端/頭側(cè)至尾側(cè)（軸心骨骼?Radiographsoflong長(zhǎng)骨的?Radiographsoflong長(zhǎng)骨的放射攝includebothadjacent包括兩側(cè)的臨Imagecontralaterallimbifindoubt,especiallyinyoung如果對(duì)影像有疑問(wèn)（尤其是年輕貓），需要拍攝對(duì)側(cè)的??Overviewaftertraumatoassessthorax,abdomen,外傷后要拍攝全身影像以評(píng)估胸腔、腹腔和脊?Stressviewsinvarus/valgusandflexion/extensiontoevaluate在掌內(nèi)翻/外翻以及伸展/屈曲的狀態(tài)下評(píng)估韌StressStressviews異物，膿腫，血腫??Musclesand肌肉和Smallsizeofstructureslimitsclinical小尺寸的結(jié)構(gòu)限制了這一方法的臨床應(yīng)?Computer???Computer???ImageswithoutApplicationofi.v.contrast無(wú)疊影可使用靜脈對(duì)Highersensitivityfordetectingbony對(duì)于骨損傷的檢測(cè)具有更高的敏感→→veryusefulforexaminationofneoplastic檢查腫瘤性疾病時(shí)非常有Computer???ImagesComputer???ImageswithoutApplicationofi.v.contrast無(wú)疊影可使用靜脈對(duì)Highersensitivityfordetectingbony對(duì)于骨損傷的檢測(cè)具有更高的敏感→→veryusefulforexaminationofneoplastic檢查腫瘤性疾病時(shí)非常有MagnetresonanceimagingMagnetresonanceimaging?→→imagingmodalityofchoiceforsofttissueespeciallythenervoussystem尤其適用于神經(jīng)系統(tǒng)的軟組織成EssentialtoEssentialtodiagnose診斷關(guān)節(jié)疾病的必Usuallyonlyonedropto0.25mlofsynovialfromnormalshoulder,stifleorhipjoint正常的肩關(guān)節(jié)、膝關(guān)節(jié)和髖關(guān)節(jié)只能收集到0.25ml~0.1mlfromcarpusand腕關(guān)節(jié)和跗關(guān)節(jié)大概22–or25-gaugeneedlewith2-3ml使用配有G22或G25的2-3mlMontavon,Voss,Langley-Hobbs:Montavon,Voss,Langley-Hobbs:?FelineOrthopedicSurgeryandMusculoskeletalDisease“;Saunders,Elsevier2009Tobias,Johnston:?VeterinarySurgery:SmallAnimal“;Saunders,Elsevier2011Johnson,Houlton,Vannini:?AOPriciplesofFractureManagementintheDogandCat“,Thieme2005LascellesBD,FindleyK,