Until today equine flexor tendon injuries represent a major entity within the scope of equine medicine. Since their response to treatment is often poor, they remain an important therapeutic challenge for researchers as well as clinicians. It is of great importance to emphasize the tedious nature of the natural healing response within the tendon. This inevitably ends in a repair including scar tissue formation which is inferior to the original tendon tissue especially regarding its biomechanical properties and therefore, predisposing to reinjury. The wide range of treatment strategies for tendinopathies or suspensory ligament pathologies reflects the tenacious nature of the disease as well as lack of universal therapeutic effectiveness. The use of regenerative treatment strategies opened up new prospects for the treatment of tendon injuries and showed promising results. However, research efforts are still warranted to objectively asses their efficacy. At the same time basic science concerning aetiopathogenesis and pathophysiology of equine tendon injuries is still a factor of major importance regarding the development of effective strategies for therapy and prevention. Recently, the use of regenerative medicine has rapidly increased, progressively upstaging traditional surgical treatment options for equine tendon or suspensory ligament pathologies. The aim of the present study on the one hand was the analysis of the results and evaluation of the surgical treatment options percutaneous desmoplasty and osteostixis at the origin of the suspensory ligament by means of retrospective clinical case studies. On the other hand, success of these techniques was evaluated depending on different success parameters. These included the age of the horse, duration of lameness prior to surgery, observance of a given controlled exercise program by the owners and ground conditions. In case of percutaneous osteostixis also presence of a hindlimb conformation predisposing for proximal suspensory desmitis was investigated. Part of the first retrospective study examining percutaneous desmoplasty (tendon splitting) as a single surgical treatment were 71 horses (n=85). Desmoplasty was performed at the origin of the suspensory ligament (41 cases), inferior check ligament (21 cases), superficial flexor tendon (13 cases), branch of the suspensory ligament (6 cases) or at the body of the suspensory ligament (4 cases). The second retrospective study investigated the implementation of percutaneous osteostixis at the origin of the suspensory ligament in 14 horses (n=16). Percutaneous osteostixis was carried out alone (1 case), in conjunction with desmoplasty at the origin of the suspensory ligament (7 cases) and combined with desmoplasty, neurectomy of the deep branch of the lateral plantar nerve and plantar fasciotomy (8 cases). Concerning percutaneous osteostixis overall successful outcome was achieved in 11 horses (78.6 %) respectively 12 cases (75.0 %). The various evaluated parameters showed no statistically significant influence on the success of treatment. For percutaneous desmoplasty overall successful outcome was achieved in 55 cases (67.9 %, n=81). Observance of the controlled exercise program showed a statistically significant influence on the success of treatment (n=79, p<0.05). In summary the present paper illustrates the important role of percutaneous desmoplasty in nowadays` management of tendon and suspensory ligament injuries in the horse. Furthermore, percutaneous osteostixis proved to be a valuable alternative to conservative treatment for osseous as well as soft tissue injuries at the origin of the suspensory ligament, specifically in case of recurring lesions not responding to desmoplasty alone. Therefore, despite the rapidly increasing significance of regenerative treatment strategies these traditional surgical approaches should not fall into oblivion for they still have unchanged effectiveness. Especially postoperative implementation of a controlled and gradually increasing exercise program represents an essential part of rehabilitation, highlighted by the significant connection with successfull outcome of desmoplasty shown in the present paper, as a key factor greatly contributing to the success of each form of therapy:1 EINLEITUNG 1
2 LITERATURÜBERSICHT 3
2.1 Einführung in die Thematik der equinen Sehnenerkrankungen 3
2.1.1 Anatomische Grundlagen 3
2.1.2 Histologie der Sehne 4
2.1.3 Biomechanik der Sehne 7
2.1.4 Ätiologie und Pathogenese von Sehnenerkrankungen 11
2.1.5 Mechanismus der Sehnenheilung 20
2.1.6 Grundsätzliches zur Therapie von Sehnenerkrankungen 29
2.1.7 Definitionen 32
2.2 Das perkutane Sehnensplitting beim Pferd 33
2.2.1 Grundprinzip und Indikationen 33
2.2.2 Bedeutung des postoperativen Managements 35
2.3 Einsatzgebiete der perkutanen Osteostixis im Bereich des Fesselträgerursprungs 38
2.3.1 Allgemeines zur Methodik der Osteostixis 38
2.3.2 Anatomische Verhältnisse im Bereich des FTRU 40
2.3.3 Klinisches Erscheinungsbild der PSD 42
2.3.4 Sonographische Untersuchung 43
2.3.5 Röntgenologische Untersuchung 46
2.3.6 Szintigraphische Untersuchung 47
2.3.7 Magnetresonanztomographische Untersuchung 48
2.3.8 Innervation des FTRU 49
2.3.9 Diagnostische Anästhesien 49
2.3.10 Begleitoperationen zur Osteostixis: Faziotomie, Neurektomie und Splitting 50
2.3.11 Knochenschmerz 55
2.3.12 Prädispositionen für die Entwicklung einer PSD 55
3 TIERE, MATERIAL UND METHODEN 57
3.1 Sehnensplitting 57
3.1.1 Material 57
3.1.1.1 Einschlusskriterien 57
3.1.1.2 Alters-, Geschlechts-, Nutzungs- und Rassenverteilung 57
3.1.1.3 Erkrankte Gliedmaßen und Strukturen 57
3.1.1.4 Begleitende Eingriffe 58
3.1.1.5 Vorbehandlung 58
3.1.1.6 Begleitende Behandlung 58
3.1.1.7 Folgeinformationen 58
3.1.2 Methoden 58
3.1.2.1 Diagnostik 58
3.1.2.1.1 Klinische Lahmheitsuntersuchung 58
3.1.2.1.2 Befunderhebung mittels bildgebender Verfahren 59
3.1.2.2 Durchführung 60
3.1.2.2.1 Methodik des Sehnensplittings 60
3.1.2.2.2 Postoperatives Management 61
3.1.2.2.3 Kontrolliertes Bewegungsprogramm 61
3.1.2.3 Statistik 62
3.2. Osteostixis 63
3.2.1 Material 63
3.2.1.1 Einschlusskriterien 63
3.2.1.2 Alters-, Geschlechts-, Nutzungs- und Rassenverteilung 64
3.2.1.3 Erkrankte Gliedmaßen und begleitende Eingriffe 64
3.2.1.4 Vorbehandlung 64
3.2.1.5 Begleitende Behandlung 64
3.2.1.6 Folgeinformationen 64
3.2.2 Methoden 65
3.2.2.1 Diagnostik 65
3.2.2.1.1 Klinische Lahmheitsuntersuchung 65
3.2.2.1.2 Befunderhebung mittels bildgebender Verfahren 66
3.2.2.2 Durchführung 66
3.2.2.2.1 Methodik der perkutanen Osteostixis sowie der Begleitoperationen 66
3.2.2.2.2 Postoperatives Management 68
3.2.2.2.3 Kontrolliertes Bewegungsprogramm 68
3.2.2.3 Statistik 69
4 ERGEBNISSE 70
4.1 Ergebnisse Sehnensplitting 70
4.1.1 Sehnenübergreifende Ergebnisse 70
4.1.2 Sehnenspezifische Ergebnisse 72
4.1.2.1 Splitting des Fesselträgerkörpers (FTRK, 4 Fälle) 72
4.1.2.2 Splitting des Fesselträgerschenkels (FTRS, 6 Fälle) 72
4.1.2.3 Splitting der oberflächlichen Beugesehne (OBS, 13 Fälle) 73
4.1.2.4 Splitting des Unterstützungsbandes der tiefen Beugesehne (UB-TBS, 21 Fälle) 74
4.1.2.5 Splitting des Fesselträgerursprungs (FTRU, 41 Fälle) 75
4.2 Ergebnisse Osteostixis 78
4.2.1 Fallbetrachtungen Osteostixis 79
4.2.1.1 Osteostixis ohne Begleitoperationen (1 Fall) 79
4.2.1.2 Osteostixis mit Splitting des FTRU (7 Fälle) 79
4.2.1.3 Osteostixis mit Splitting sowie Fasziotomie und Neurektomie (8 Fälle) 81
5 DISKUSSION 84
5.1. Anmerkungen zum Studienaufbau 84
5.2 Beurteilung der Ergebnisse des perkutanen Sehnensplittings 84
5.3 Beurteilung der Ergebnisse der perkutanen Osteostixis 88
5.4 Schlussfolgerungen 91
6 ZUSAMMENFASSUNG 93
7 SUMMARY 95
8 LITERATURVERZEICHNIS 97
9 DANKSAGUNG 110
| Identifer | oai:union.ndltd.org:DRESDEN/oai:qucosa:de:qucosa:36667 |
| Date | 19 December 2019 |
| Creators | Staubach, Pia |
| Contributors | Universität Leipzig |
| Source Sets | Hochschulschriftenserver (HSSS) der SLUB Dresden |
| Language | German |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, doc-type:doctoralThesis, info:eu-repo/semantics/doctoralThesis, doc-type:Text |
| Rights | info:eu-repo/semantics/openAccess |
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