Estudo digital comparativo de dois métodos de rotação craniana de fragmento proximal no planejamento da osteotomia de nivelamento baseada no centro de rotação de angulação com diferentes eixos anatômicos distais tibiais
DOI:
https://doi.org/10.11606/issn.1678-4456.bjvras.2023.209837Palavras-chave:
Ângulo, Canino, Ligamento cruzado cranial, Eixo mecânico, JoelhoResumo
A técnica da osteotomia de nivelamento baseada no centro de rotação de angulação (CORA) chamada CBLO foi desenvolvida para o tratamento da ruptura do ligamento cruzado cranial (RLCCr), visando modificar o ângulo mecânico-anatômico (AMA), o qual é descrito como fator de risco preditivo para a doença e é recomendado que seja levado em consideração na escolha do procedimento cirúrgico para alteração da inclinação do platô tibial. A identificação de um eixo anatômico distal da tíbia (EAD) é um passo fundamental no planejamento cirúrgico da CBLO e para avaliar a amplitude do AMA. O objetivo deste estudo foi: avaliar dois métodos de rotação craniana do fragmento proximal utilizando quatro eixos anatômicos distais tibiais diferentes para o planejamento digital da técnica CBLO, comparando sua eficácia para atingir o ângulo do platô tibial desejado (TPAd) e no fechamento do AMA. As medidas tibiais foram feitas no software vPOP pro usando 30 radiografias medio-laterais de joelhos caninos. Foi utilizado o EAD descrito por quatro autores diferentes, baseada na quantidade de Rotação concluída (Rc) para cada um deles. Os métodos de rotação avaliados foram: 1) tabela comercial de CBLO (RT) e 2) sobreposição da ponta da eminência intercondilar com a linha EAD correspondente (RE). O TPAd a ser obtido foi fixado em 10° e o AMA final a ser alcançado em 0º. A média e o desvio padrão do TPA final e AMA final com o método de rotação: TPA(RT)f(%TPAd), TPA(RE)f(%TPAd), AMA(RT)f(%AMAzero), AMA(RE)f(%AMAzero) e o resultado de cada autor foram Hulse 10,0 ± 0,3(46,6%), 9,9 ± 0,1(60%), 0,3 ± 0,3(33,3%), 0,3 ± 0,3(13,3%), Osmond 10,1 ± 0,2(75%), 10,1 ± 0,2(83,3%), 0,4 ± 0,4(33,3%), 0,4 ± 0,3(8,3%), Miles 10,0 ± 0,1(66,6%), 10,0 ± 0,1(75%), 0,2 ± 0,1(16,6%), 0,2 ± 0,1(8,3%), Tudury 9,6 ± 0,6(31,2%), 9,5 ± 0,2(31,2%), 1,0 ± 0,7(18,7%), 1,0 ± 0,6(12,5%) respectivamente. O RT inicialmente descrito obteve um percentual maior de AMA em zero graus, portanto, o método RE é descartado para utilizá-lo como alternativa no planejamento CBLO.
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