Sinfisiodese púbica juvenil associada à miectomia do pectíneo para tratamento de displasia coxofemoral em cão / Juvenile pubic symphysiodesis associated with pectineus myectomy for treatment of hip dysplasia in dog

Background: Hip dysplasia (HD) is the most common non-traumatic orthopedic disease in large breed dogs. Treatment is chosen according to the severity of the condition, the age of the dog and the involvement of osteoarthritis (OA). For puppies up to 20-weeks-old, surgical treatment by the juvenile pubic symphysiodesis (JPS) technique can be performed. This procedure promotes the ventrolateral rotation of the acetabulum over the femoral head, which improves hip joint congruence and stability. The objective of this study is to report the case of a young dog with HD treated with JPS and pectineus myectomy. Clinical and radiographic outcomes were assessed for up to one year after surgery. Case: A 17-week-old Saint Bernard puppy was attended at the University Veterinary Hospital showing abnormal weight bearing and lameness in pelvic limbs, without history of previous trauma. On orthopedic examination, there was a marked hypotrophy of the pelvic limb muscles, severe pain and laxity in the hip joints, and positive feature in the Ortolani test. The hip joint subluxation angle (SA) and reduction angle (RA) were measured. A radiographic study was carried out to evaluate the hip joints and measure the Norberg angle (NA), distraction index (DI), acetabular angle (AA) and dorsal acetabular rim angle (DARA). The 20-week-old dog underwent surgical treatment by JPS technique. A ventral surgical approach to the pubis was performed and the pubic symphysis was cauterized with electrocautery. Partial pectineus myectomy technique was also performed. Drug therapy and restriction of physical activities were indicated in the early postoperative. The dog was evaluated by clinical and radiographic examinations at 4 months and 1 year after the surgical procedure. In the reassessment after 4 months of surgical treatment, the patient showed improvement in clinical signs, with mild lameness and absence of painful sensitivity in the movement of the hip joints. Radiographically, hip joint incongruity was observed, but with progressive improvement in the values of the measured variables. In the clinical examination 1 year after the procedure, the dog showed satisfactory weight bearing with slight lameness in pelvic limbs in the running gait. There was improvement in the thigh muscles and no painful signs were observed in the hip joints, but a positive result was detected in the Ortolani test. In the radiographic examination, bilateral articular incongruity was still observed, however, there was a mild improvement in the coverage of the acetabulum over the femoral head. The measured angles and indices showed favorable results regarding the recovery of hip joint stability and proper development. Discussion: Studies evaluating the JPS technique for the treatment of HD have shown to be a relatively simple and effective procedure, which allows altering the acetabular coverage, reducing the development of HD and the progression of OA. The need for an early diagnosis of this condition is essential, so that the JPS technique can be used in young dogs and offer effective results. In the present report, in the late postoperative period, the dog showed improvement in clinical signs, with favorable weight bearing and ambulation in pelvic limbs, recovery of limb muscles, absence of pain in the hip joints and decrease in RA and SA. Radiographically, the reduction in joint subluxation, improvement in acetabular coverage over femoral heads, increase in NA and AA, reduction in DI and DARA are evidence of the favorable outcome of ventrolateral rotation of the acetabulum after surgical treatment. The surgical technique used was effective, which enabled the dog to recover the functional use of the pelvic limbs and improve the quality of life.

CORRELAÇÃO ENTRE AS PRESSÕES INTRA-ABDOMINAL E INTRAVESICAL DE EQUINOS EM POSIÇÃO SUPINA OU DECÚBITO LATERAL

Por meio do presente estudo, buscou-se correlacionar a pressão intra-abdominal (PIA) com a pressão intravesical (PIV), em equinos em posição supina ou decúbito lateral, submetidos a procedimentos cirúrgicos eletivos, no setor de clínica cirúrgica do Hospital Veterinário Governador Laudo Natel, da Universidade Estadual Paulista Júlio de Mesquita Filho Unesp, Câmpus de Jaboticabal/SP. Ao longo de dois anos, foram mensurados dados de 20 cavalos adultos, sendo 11 machos (inteiros ou castrados) e 09 fêmeas, com peso corpóreo entre 350 e 500 kg e idade entre 3.5 a 12 anos, divididos em dois grupos: decúbito lateral (n=10) e posição supina (n=10). A pressão intra-abdominal foi registrada por abdominocentese, utilizando-se cânula intraperitoneal conectada a sistema preenchido por fluído (equipo de pressão venosa central), calibrado na altura de inserção da cânula. Já a pressão intravesical foi obtida a partir de sondagem vesical, utilizando-se sistema preenchido por fluído, calibrado ao nível da tuberosidade isquiática de cada animal (posição supina) ou sínfise púbica (decúbito lateral). O decúbito influenciou diretamente nos valores da PIA. Houve diferença expressiva (p < 0.001) e ausência de correlação entre a PIA registrada em posição supina e decúbito lateral, tanto à inspiração (rs = 0.127, p = 0.209) quanto à expiração (rs = - 0.0393, p = 0.697). Em posição supina foi observada diferença (p < 0.05) entre a PIA e PIV, ao final da inspiração e expiração, tanto para a PIV obtida com a vesícula urinária vazia quanto distendida com os volumes predeterminados. Pôde-se observar correlação e concordância desprezíveis entre ambas nesta posição corporal. Em decúbito lateral, ao final da inspiração, houve diferença (p < 0.05) entre a PIA e a PIV registrada com insuflação com 25ml. Já, ao final da expiração, esse fato foi evidenciado para a PIV obtida com 25ml e 50ml. A PIV obtida após distensão vesical de 100ml foi a única a não diferir da PIA, independentemente do lado o qual o paciente havia sido posicionado. Da mesma forma, para este valor, observou-se alta correlação e concordância entre as pressões. Quando o decúbito lateral for dividido em esquerdo e direito, a correlação e concordância entre as pressões mantiveram-se, independentemente do volume de insuflação vesical utilizado para obtenção da PIV e do lado o qual o paciente estava posicionado, sendo mais representativos para o volume de 100ml, com os pacientes mantidos em decúbito lateral esquerdo e a PIV registrada ao final da inspiração. Assim, a posição supina se mostrou inadequada na obtenção indireta da PIA. Esta deve ocorrer, preferencialmente com o paciente mantido em decúbito lateral esquerdo, mediante insuflação da vesícula urinária com 100ml e os valores da PIV registrados ao final da inspiração.

We sought to correlate intra-abdominal pressure (IAP) with intravesical pressure (IBP) of horses in supine position or lateral recumbency. For that purpose, patients admitted at our hospital for elective surgical procedures not related to the gastrointestinal or genitourinary tract, during a two-year period were included on our study. During that time, 11 adult male (stallions or geldings) and 09 female horses, weighting from 350 to 500 kg, and from 3.5 to 12 years of age were selected. Patients were divided into two distinct groups (n=10) according to body position requested for surgical procedure. Intra-abdominal pressure was recorded by intraperitoneal cannula connected to a fluid-filled system (central venous pressure water column system), zeroed at the level of insertion of the cannula. Intravesical pressure was obtained from bladder catheterization, by using the same fluid-filled system, individually zeroed at the level of the tuber ischii (supine position) or pubic symphysis (lateral recumbency). Body position directly influenced IAP values. A difference (p < 0.001) between intra-abdominal and intravesical pressures, at end-inspiration (rs = 0.127, p = 0.209) and end-expiration (rs = - 0.0393, p = 0.697) was perceived when comparing supine position with lateral recumbency. Similarly, both pressures differed, with no distinct correlation between them, regardless the saline volume used for bladder distension and the moment of pressure recordings (end-inspiration or end-expiration). In addition, difference (p < 0.05) between both pressures was also noticed at patients in lateral recumbency, when IBP was obtained end-inspiration, following bladder distension with 25 ml of saline solution. At end-expiration, similar results were obtained for IBP recorded with 25 ml and 50 ml insufflation volumes. Correlation values between both pressures maintained within previous standards as lateral recumbency was divided into right and left, regardless insufflation volume used for IBP recordings. Therefore, supine position should not be used for purposes of indirect assessment of IAP. To that purpose, the patient should be kept in left lateral recumbency, the bladder should be distended with 100 ml of saline solution, and IBP readings should occur at end-inspiration.