推 apparr:我也推薦愛屋動物醫院 08/28 10:53
: 動手術對狗狗來說會很傷嗎?
首先，先讓你對這個病，有些許的瞭解。
後腳的膝關節脫臼.這是因為膝蓋骨卡不穩股骨的滑車窩中,向內或向外滑掉而造成行動異常
的現象.
一般膝關節脫臼可以分成四種等級:
第一級:膝蓋骨可以用手推而造成脫臼,然後壓力減緩之後,膝蓋骨會自己滑回原位.
第二級:膝蓋骨可以用手推而造成脫臼,或是彎曲膝關節時膝蓋骨自行滑開而造成脫臼,膝蓋
骨不會自行滑回原處,直到用手推回或是狗狗伸展關節或是向脫臼的相反方向旋轉
脛骨時,才會回到原位.
第三級:膝蓋骨大部分的時間都是呈現脫臼的狀態,但是伸直膝關節時可以用手推回,伸直或
彎曲膝關節時會導致膝蓋骨再度脫臼.
第四級:膝蓋骨一直呈現脫臼的狀態,而且不能用手推回,可能導致脛骨平台呈現90度的旋轉,
股骨的滑車窩非常淺或是不見了,四頭肌向脫臼的方向異位.
治療時,第一級可能開些止痛藥物來治療,大部分第二級以及所有的第三級與第四級患者,都
會建議實施手術來矯正.(90%患者手術後症狀都可改善,但是以後可能復發的機率高達48%)
這種疾病可能是遺傳而來的.出現症狀之後,可能隨著時間發展而愈來愈嚴重(例如從第一級
變成第二級...),另外此病幾乎都會發展出退化性關節炎(所以會建議服用軟骨素之類的藥物
).另外此病也容易造成前十字韌帶疾病的出現(例如突然出現急性後腳完全無法負重的現象
時,就有可能是因為前十字韌帶傷害之故).
Reference:
http://203.204.6.124/vet/eNews21.asp?num=109
另一篇
Luxating Patella
Race Foster, DVM
Marty Smith, DVM
Drs. Foster & Smith, Inc.
A dog from one of the smaller breeds runs across the yard chasing a tossed
ball. In mid-stride, he yelps in pain and pulls his left hind leg off of the
ground. After a second, he continues limping on in a three-legged fashion.
After ten minutes, the rear leg drops back down to the ground and he uses it
normally. This episode occurs maybe once a week. It never really seems to
bother him that much – a yelp of pain, a short period of lameness, and in a
few minutes he is back to his old self. Typically, he is a small or toy breed
such as a Lhasa Apso, Pekingese, Pomeranian, Poodle, or Boston Bull.
A luxating patella may affect some animals much more severely. They may hold
the leg up for several days and show considerable discomfort. Dogs who have a
luxating patella on both hind legs may change their entire posture, by dropping
their hindquarters and holding the rear legs farther out from the body as they
walk. Those most severely affected may not even use their rear legs, walking by
balancing themselves on their front legs like a circus act, or holding their
hindquarters completely off the ground.
Normal knee anatomy
The patella is the bone we know as the knee cap. A groove in the end of the
femur allows the patella to glide up and down when the knee joint is bent back
and forth. In doing so, the patella guides the action of the quadriceps muscle
in the lower leg. The patella also protects the knee joint.
Looking at the lower front portion of the femur (the thigh bone) in a normal
dog, you will notice two bony ridges that form a fairly deep groove in which
the patella is supposed to slide up and down. These structures limit the patella
’s movement to one restricted place, and in doing so, control the activity of
the quadriceps muscle.
The entire system is constantly lubricated by joint fluid. It works so that
there is total freedom of motion between the structures.
What occurs when the patella is luxated?
In some dogs, because of malformation or trauma, the ridges forming the
patellar groove are not prominent, and a too-shallow groove is created. In a
dog with shallow grooves, the patella will luxate (jump out of the groove)
sideways, especially toward the inside. This causes the leg to 'lock up' with
the foot held off the ground.
When the patella luxates from the groove of the femur, it usually cannot return
to its normal position until the quadriceps muscle relaxes and increases in
length. This explains why the affected dog may be forced to hold his leg up for
a few minutes or so after the initial incident. While the muscles are
contracted and the patella is luxated from its correct position, the joint is
held in the flexed or bent position. The yelp is from the pain caused by the
knee cap sliding across the bony ridges of the femur. Once out of position, the
animal feels no discomfort and continues his activity.
Which dogs are at risk of having a luxated patella?
Smaller breeds of dogs, especially Miniature and Toy Poodles, have the highest
incidence of patella luxation. Genetics can play a role.
In certain breeds that have extremely short legs such as the Basset Hound or
Dachshund, patellar luxation is thought to be secondary to the abnormal shape
of the femur and tibia. The curvatures of the bones in these breeds work in
conjunction with the forces of the quadriceps muscles to displace the patella
to the inside. Please do not misunderstand – not all members of these breeds
are affected with patellar luxation, only a small portion.
What are the symptoms?
Most dogs are middle-aged, with a history of intermittent (on-again-off-again)
lameness in the affected rear leg(s). An affected dog commonly stops and cries
out in pain as he is running. The affected leg will be extended rearward, and
for a while, the dog is unable to flex it back into the normal position.
What are the risks?
Uncorrected, the patellar ridges will wear, the groove will become even
shallower and the dog will become progressively more lame. Arthritis will
prematurely affect the joint, causing a permanently swollen knee with poor
mobility. Therefore, a good evaluation needs to be done by your veterinarian
early in the condition to prevent long-term arthritic crippling.
Treatment for luxating patellas
As would be expected, medical therapy has little corrective ability in this
disorder and surgery is therefore required and is the treatment of choice. A
surgical treatment is not necessary in every individual with this condition.
Surgery can alter both the affected structures and the movement of the patella.
The groove at the base of the femur may be surgically deepened to better
contain the knee cap. The knee cap itself may be 'tied down' laterally (on the
outside) to prevent it from deviating medially (toward the inside). The bony
protuberance at the site of the attachment of the quadriceps tendon on the
tibia, may be cut off and then re-attached in a more lateral position. All of
these procedures work well and the type performed depends on the individual
case and the clinician. The animal should respond quickly after surgery and is
usually completely recovered within thirty days, using his legs in normal
fashion.
Breeding considerations
Because of the strong genetic relationships, we really feel that animals with
this disorder should not be used for breeding. They can still be excellent pets
- and those that do require surgery will usually lead perfectly normal lives
without any restrictions on activity.
Reference:
http://www.peteducation.com/article.cfm?cls=2&cat=1569&articleid=457
因此這個病，用內科療法，其實成效不大。
僅能用外科手術來給予治療，至於治療的必要性。
需要多方面的評估，包括你，包括動物的身體狀況等情況來衡量。
動手術以中醫的理論來說，絕對是傷害。
但是以西醫來說，卻是術後能追求更好生活品質的一個機會。
手術的必要性，真的很難在版上，甚至是一人動物醫院來做出衡量。
我會建議你可以選擇由較多獸醫師所組成的動物醫院。
或是直接帶去台大，中興，嘉大，屏科大的獸醫教學醫院來衡量。
當然，這只是個建議。
--
※ 發信站: 批踢踢實業坊(ptt.cc)
◆ From: 219.81.205.219