4. 馬的內直膝蓋韌帶切斷術適用於下列何種疾病？
(A) 骨性飛節關節腫
(B) 急性膝蓋骨上方固定
(C) 脛前肌腱內支腱下黏液囊炎
(D) 後肢運動後痙攣性屈曲

medial patellar ligament的功能 

• 內側膝韌帶medial patellar ligament和中間膝韌帶medial patellar ligement是將膝蓋骨固定在股骨末端的必要結構之一(圖)。
• Proximal patellar hesitation (PPH) 和intermittent upward patellar fixation (IUPF) 會導致馬無法及時將髕骨與股骨內側滑車分離。參考網址

Medial Patellar Desmotomy 內直膝蓋韌帶切斷術 (turner and mcilwraiths techniques in large animal surgery,p113)
使用時機:

• Upward fixation of the patella occurs when the patellar fibrocartilage and medial patellar ligament fix over the medial trochlear ridge of the femur, inhibiting flexion of the hock and stifle
• should be considered a “last-resort” treatment for recurrent upward fixation of the patella

併發症

• 影像上spurring or fragmentation of the distal patella is noted
• 可能是因為內側的張力消失後膝蓋骨往外側移動 造成膝蓋骨的位置不正(maltracking)

術式
ab

c. 此時bistoury刀鋒轉向外側
d. 開始切(鋸的動作)