Double plating technique for fixing tibial plateau leveling osteotomy and modified cranial closing wedge ostectomy of the tibia in a dog with cranial cruciate ligament disease and excessive plateau angle: case report

ABSTRACT Tibial plateau leveling osteotomy (TPLO) associated to cranial wedge closing ostectomy (CCWO) has been one of the best options to manage cranial cruciate ligament (CCL) disease and excessive tibial plateau angle (TPA) in large dogs, however, the complication rate is potentially high. It is believed that a more robust fixation is necessary to stabilize them and decrease the risk of implant failure. A 6-year-old male American Pit Bull, weighing 36kg, with 90-day history of right hind limb lameness, was diagnosed with CCL disease. Due to the excessive tibial plateau angle (42°), TPLO was associated with a modified CCWO using a double plating technique. A final TPA of 12⁰ was accomplished, and a restricted level of exercises and physiotherapy were recommended. The patient was followed monthly until the fifth month postoperatively, when radiographic bone consolidation and no lameness were observed. By the date of this submission, 3 years after the procedure, the owner has reported no complications. The double plating technique for fixing TPLO and modified CCWO proved to be effective for the treatment of CrCL deficiency in a large dog with an excessive TPA.

【摘要】 联合颅侧楔形闭合截骨术（cranial wedge closing ostectomy, CCWO）的胫骨平台水平截骨术（tibial plateau leveling osteotomy, TPLO）是当前治疗大型犬颅侧十字韧带（cranial cruciate ligament, CCL）疾病及过度胫骨平台角（tibial plateau angle, TPA）的优选方案之一，但该术式潜在并发症发生率较高。学界普遍认为，需采用更牢固的固定方式以稳定术区、降低植入物失效风险。
本次病例为一只6岁雄性美国比特犬，体重36kg，右后肢跛行病史长达90天，经确诊患有CCL疾病。因患犬胫骨平台角过度（42°），遂采用双钢板固定技术实施改良CCWO联合TPLO术。术后最终胫骨平台角纠正至12°，并为患犬制定了受限运动及物理治疗方案。术后每月随访一次，直至术后第5个月，影像学检查显示骨愈合良好，且未再出现跛行症状。截至本文投稿当日，术后已过去3年，主人反馈未出现任何并发症。本病例证实，双钢板固定技术用于联合改良CCWO与TPLO的术式，可有效治疗大型犬过度TPA伴发的颅侧十字韧带缺损病症。