Intra-articular anaesthesia of the equine stifle improves foot lameness.
Intra-articular anaesthesia of the equine stifle improves foot lameness.
复制标题
马膝关节的关节内麻醉可改善足部跛行。
DOI：
10.1111/evj.13135
复制
发表时间：
2020
影响因子：
2.2
通讯作者：
Delco,ML
中科院分区：
文献类型：
--
作者：
Radtke,A;Fortier,LA;Regan,S;Kraus,S;Delco,ML
背景：在跛行检查中，诊断麻醉是一个有用的工具。然而，麻醉剂会随着时间扩散，导致关节周围结构的非特异性脱敏。将感觉从远端肢体传递到中枢神经系统的神经经过近尾关节囊。因此，关节内（IA）麻醉药的扩散可能导致远端肢体的无意脱敏，从而导致误诊断为膝关节跛行。目的探讨IA窒息麻醉是否能减轻远端肢体的跛行。研究设计交叉实验。方法9匹马采用环形马蹄钳诱导单侧中重度后肢跛行。在90分钟的试验中，使用惯性传感器系统每10分钟评估一次步态。通过分别测量骨盆最大高度和最小高度之间的平均跨步差来评估跛行的推离和着陆成分。采用Wilcoxon符号秩检验比较差异。结果总的来说，马蹄钳引起足部疼痛的马在IA窒息麻醉后蹬蹬跛行发生率降低。实验组90 min时diffmax的平均变化为- 4.3 mm (P = 0.005)，对照组为- 2.3 mm （P = 0.2）。跛行随着时间的推移而减少，30分钟平均改善23%，60分钟平均改善33%，90分钟平均改善38%。马间差异很大；3/9的马在30分钟内改善了~50%，2/9的马改善了~30%，4/9的马跛行改善很小（<10%）或没有改善。IA窒息麻醉后的改善与基线跛行严重程度无关（P = 0.3-0.7）。主要局限性我们的跛行诱导模型临床适用性有限。结论：在30分钟内，膝关节麻醉可使三分之一的马的足部跛行率降低50%。在临床上，在提出治疗建议之前，应根据这些发现考虑IA窒息麻醉的结果，因为可能需要额外的诊断来排除源自远端肢体的疼痛。
BackgroundEquine diagnostic anaesthesia can be a useful tool in challenging lameness examinations. However, anaesthetics diffuse over time leading to nonspecific desensitisation of periarticular structures. Nerves that convey sensation from the distal limb to the central nervous system pass in close proximity to the caudal stifle joint capsule. Therefore, diffusion of intra‐articular (IA) anaesthetics could cause inadvertent desensitisation of the distal limb resulting in a false diagnosis of stifle lameness.ObjectivesTo determine if IA stifle anaesthesia can alleviate lameness originating in the distal limb.Study designCrossover experiment.MethodsNine horses were fitted with a circumferential hoof clamp to induce a moderate unilateral hindlimb lameness. Intra‐articular stifle anaesthesia was performed and gait was evaluated every 10 min during the 90‐min trial using an inertial sensor system. Push‐off and landing components of the lameness were assessed by measuring the mean inter‐stride difference between the maximum and minimum heights of the pelvis respectively. Differences were compared using a Wilcoxon signed‐rank test.ResultsOverall, horses with hoof clamp‐induced foot pain had a reduction in push‐off lameness after IA stifle anaesthesia. The mean change in diffmax at 90 min was −4.3 mm (P = 0.005) for the experimental group vs. −2.3 mm (P = 0.2) for the control group. Lameness decreased over time, with an average improvement of 23% at 30 min, 33% at 60 min and 38% at 90 min. There was high inter‐horse variability; 3/9 horses improved by ~50% within 30 min, while 2/9 improved by ~30% and 4/9 had minimal (<10%) or no improvement in lameness. Improvement after IA stifle anaesthesia was not related to the severity of baseline lameness (P = 0.3–0.7).Main limitationsLimited clinical applicability of our lameness induction model.ConclusionsIntra‐articular stifle anaesthesia reduces foot lameness in a third of horses by up to 50% within 30 min. Clinically, the results of IA stifle anaesthesia should be considered in the light of these findings before treatment recommendations are made, as additional diagnostics may be required to rule out pain originating in the distal limb.