内容猫跛行综合

SmallAnimalSurgerySmallAnimalSurgeryLamenessinAndreasDiplomateECVS,Dr.med.vet.,Overviewofthelameness跛行Overviewofthelameness跛行检HistoryofGeneralexamNeurologic神经学ORTHOPEDIC––––推–––EvaluationofEvaluationofLamenessvisible?Where?病史和畜主的观察结果很重明显跛行？何处?Changeinbehavior(activity,sleeping,grooming)?行为改变（活动，睡眠，舔毛猫是否仍然可以跳上它所喜欢的位DoesthecatstilljumponitsfavoritePhysicalNeurologicalexamOftennon-specificclinicalsignswithdiseasesofthemusculoskeletal常无肌肉骨骼系统的特异性临床症OrthopedicCalmenvironmentandminimalhandling平OrthopedicCalmenvironmentandminimalhandling平静环境和最小的接Letthecatmovefreeintheexamination让患猫在检查室内自由活Placecatawayfromcarrier/box/placeto令患猫远离携带笼/盒子/藏匿Askownertofilmtheircatat可让畜主拍摄患猫在家中•••姿Liftinglegoffthegrounddespitenormal除了正常步态外是否有腿离开地Standingorsitting••OrthopedicOrthopedicOrthopedicOrthopedicOrthopedicOrthopedicCanyoutellmewherethecatisOrthopedicOrthopedicCanyoutellmewherethecatisGradingofthelameness•GradeGradingofthelameness•Grade1:Low-grade1级：轻度跛hardlyvisibleornotvisible难以察觉或无法察butcatliftsfootwhensitting(frontlimbs)orisunableto但猫会在坐姿时提起患肢（前肢）或无法跳跃（后肢•Grade2:Medium-grade2级：中度跛clearlyvisible,butlegisusedinmost易于察觉，但大部分时候可用患•Grade3:High-gradeonlytoe-touchingornotweight-bearingat患肢仅用指/趾着地或完全3级：重度跛Moreobjectivegait-Forceplate力平板Moreobjectivegait-Forceplate力平板Describedinliterature(CCLD,文献记载（CCLD，截爪术Mostcatsweretrainedandsettingwas大部分猫是受过训练的，且为实-Pressuresensitive压力传Walkingfreeandjumpingofheight,clientownedandnottrained,successin自由行走及跳高，客户的猫且未受过训练，成功率为BilateralorthopedicDiffuculttodifferentiatefromneurological难以与BilateralorthopedicDiffuculttodifferentiatefromneurological难以与神经学问题--Inactiveandreluctantto不活跃或不愿-Morecommoninhind常发于Frequentcausesforbilateralpelviclimb常见的双侧后肢跛行的病------Patellar双侧前十字韧BilateralcranialcruciateligamentHip髋关节发育不Lumbarandlumbosacraldegenerative腰椎和腰骶椎退化Bilateralorthopedic双侧Bilateralorthopedic双侧骨Ifunabletostandorwalkandpossible如果无法站立或行走，可能的损伤-InjuriestomultiplePelvicSpinalfracturesand脊柱骨折和脱---1.Standing1.Standing站Fromheadtotail,limbsfromproximalto从头至尾，肢体从近端至远Lookingformuscleatrophy,swelling,jointeffusion,symmetryofbonyprominencesorpainComparingsidestodetectsubtle对比对侧检查细微1.Standing1.Standing站Palpablebonyprominencesinthecat:触诊猫的骨1.Standing站Palpablebonyprominences1.Standing站Palpablebonyprominencesinthe触诊猫的骨突Scapular肩胛肱桡骨/尺Metacarpiand1.Standing站Palpable1.Standing站Palpablebonyprominencesinthe触诊猫的骨突骨IliacTuberFibularheadCalcaneal髂骨大转1.Standing站1.Standing站Example:coxofemoral例：髋骨关节FOTOSKELETTUND2Lateral2Lateral Startwithunaffected从健肢开始检Fromdistal(toes)to自远端（指/趾）Lookfor检AxialTemperatureSwellingor肿胀或PalpationandLateralrecumbencyPalpationandLateralrecumbency侧卧Sedationmaybe可能需-骨crepitation,instability,axialdeviations,changesincontour,andpain->fracture,neoplasia,other→骨折、增生和其PalpationandManipulation-PalpationandManipulation-关periarticularswellingorjoint关节周围肿胀effusion=unspecific(DJD,hemarthrosis,渗出=非特异（退行性关节病，关节出血，关节Rangeofmotion instabilitycrepitusorreducedROM失稳、摩擦音或运动范围减felinejointsmoreelasticvs与犬相比，猫的关节更具弹comparedtocontralateral与对侧关节相knowledgeofligamentous韧带解PalpationandPalpationandMediolateralrangeofmotioninthetarsal跗关节中间外侧的运动范CATDOGPalpationandMediolateralPalpationandMediolateralrangeofmotioninthetarsal跗关节中间外侧的运动范CATDOGPronationandsupinationPronationandsupination(Campbell掌向下及旋后（Campbell试验犬PronationandPronationandsupination(Campbell掌向下及旋后（Campbell试验CATPalpationand-SoftPalpationand-Soft软组skin,muscles,claws,clawbedsand皮肤、肌肉、腱、爪、爪床和足markedcellulitisandpain:明显的蜂窝织炎suspectabscessafterbite怀疑咬伤后的tendons:triceps,Achillesandpatellar肌腱：三头肌、跟腱和髌CausesCausesoffrontlimblameness前肢跛行的病关节炎、DJD、外骨折、脱臼、外翻或内翻时失稳（腕伸展DJD，关节炎，滑关节炎、DJD、外骨折、脱臼、外翻或内翻时失稳（腕伸展DJD，关节炎，滑囊囊骨折、脱臼、DJD，脱臼、尺桡骨间存在骨性骨折、脱臼、DJD、DJD，脱臼、关节发育不良中间外侧和前后向失稳（抽屉试验CausesCausesofhindlimbCausesCausesofhindlimb关节炎，DJD，外DJD，关节脱DJD，关节炎，OC，外关节炎，DJD，外DJD，关节脱DJD，关节炎，OC，外Further•诊断影•••Further•诊断影•••超声波Crosssectionalimaging(CTMRI)交叉面成•Blood血液学••••Twoorthogonalview•••Twoorthogonalview需要两个正交Sedationanesthesiarecommended建议进行镇静/麻X-raybeamcenteredofregionofinterestandstructureparalleltoplatePrinciplesof 影像解qualityofSystematicASofttissue,thenbones软组织，然后B,Proximaltodistal/cranialtocaudal(axial近端至远端/头侧至尾侧（轴心骨骼•Radiographsoflong长骨的•Radiographsoflong长骨的放射摄includebothadjacent包括两侧的临Imagecontralaterallimbifindoubt,especiallyinyoung如果对影像有疑问（尤其是年轻猫），需要拍摄对侧的••Overviewaftertraumatoassessthorax,abdomen,外伤后要拍摄全身影像以评估胸腔、腹腔和脊•Stressviewsinvarus/valgusandflexion/extensiontoevaluate在掌内翻/外翻以及伸展/屈曲的状态下评估韧StressStressviews异物，脓肿，血肿••Musclesand肌肉和Smallsizeofstructureslimitsclinical小尺寸的结构限制了这一方法的临床应•Computer•••Computer•••ImageswithoutApplicationofi.v.contrast无叠影可使用静脉对Highersensitivityfordetectingbony对于骨损伤的检测具有更高的敏感→→veryusefulforexaminationofneoplastic检查肿瘤性疾病时非常有Computer•••ImagesComputer•••ImageswithoutApplicationofi.v.contrast无叠影可使用静脉对Highersensitivityfordetectingbony对于骨损伤的检测具有更高的敏感→→veryusefulforexaminationofneoplastic检查肿瘤性疾病时非常有MagnetresonanceimagingMagnetresonanceimaging•→→imagingmodalityofchoiceforsofttissueespeciallythenervoussystem尤其适用于神经系统的软组织成EssentialtoEssentialtodiagnose诊断关节疾病的必Usuallyonlyonedropto0.25mlofsynovialfromnormalshoulder,stifleorhipjoint正常的肩关节、膝关节和髋关节只能收集到0.25ml~0.1mlfromcarpusand腕关节和跗关节大概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,