IF 0.9 Q4 RHEUMATOLOGY
Eiji Kinoshita, Naoki Kondo, Osamu Tanifuji, Rika Kakutani, Nariaki Hao, Hiroyuki Kawashima
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引用次数: 0

摘要

髌腱断裂是全膝关节置换术后的一种严重并发症。我们遇到一例类风湿性关节炎患者在全膝关节置换术后出现髌腱不完全断裂。一名 84 岁的妇女被诊断为右膝全膝关节置换术后 3 个月右侧髌腱不完全断裂。患者在全膝关节置换术后 6 个月出现 45° 的伸展滞后,必须进行重建手术。术中发现髌骨肌腱不完全断裂,并被拉长,诊断为髌骨肌腱不完全断裂。由于膝关节外翻不稳(被动膝关节外翻显示为20°),胫骨内芯的厚度从11毫米调整到15毫米,从而改善了外翻不稳。髌骨肌腱瘢痕区被切除至 10 毫米长,并使用超高分子量聚乙烯电缆(Nesplon 电缆)和 Krackow 缝合线对肌腱进行了修复。用缆线形成 "8 "字形固定修复处。重建手术后,膝关节在伸展0°的状态下固定3周,然后开始活动范围锻炼。三个月后,伸展滞后减小到-15°,患者可以在没有矫形器的情况下行走,术后 8 个月时既无不稳定性,也无手术部位感染。总之,本病例的显著特点是全膝关节置换术后髌腱不完全断裂(伸直)的罕见性,并证明了 Nesplon 线缆与 Krackow 缝合线在重建手术中的有效性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effective Use of Ultra-High Molecular Weight Polyethylene Cable and Krackow Suture for Stretched Out Patellar Tendon due to Scarring in a Case with Rheumatoid Arthritis Post-Total Knee Arthroplasty.

Patellar tendon rupture is a severe complication following total knee arthroplasty. We encountered a case of rheumatoid arthritis with an incomplete rupture of the patellar tendon post-total knee arthroplasty. An 84-year-old woman was diagnosed with an incomplete rupture of the right patellar tendon 3 months post-total knee arthroplasty of her right knee. The patient exhibited a 45° extension lag 6 months post-total knee arthroplasty, necessitating reconstruction surgery. Intraoperative findings revealed incomplete rupture of the patellar tendon that was stretched out, diagnosed as incomplete patellar tendon rupture. Due to knee valgus instability (passive knee valgus showed 20°), the thickness of the tibial insert was adjusted from 11 mm to 15 mm, resulting in improved valgus instability. The scarring region of the patellar tendon was resected to 10 mm in length, and the tendon was repaired using an ultra-high molecular weight polyethylene cable (Nesplon cable) and Krackow suture. The repair was secured by making a figure-8 pattern with the cable. After the reconstruction surgery, the knee was immobilized at 0° extension for 3 weeks, followed by the initiation of range-of-motion exercises. Three months later, the extension lag was reduced to -15°, and the patient could walk without orthosis and reported neither instability nor surgical site infection at 8 months after the surgery. In conclusion, this case is notable due to the rarity of incomplete (stretched out) patellar tendon rupture post-total knee arthroplasty and demonstrates the effectiveness of Nesplon cable with Krackow suture in reconstruction surgery.

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