Jagow Devin M, Garcia Branden J, Yacoubian Stephan V, Yacoubian Shahan V
Orthopaedic Surgery Specialists, Burbank, CA.
Am J Orthop (Belle Mead NJ). 2015 May;44(5):E153-5.
Various complications after intramedullary (IM) nailing of the tibia have been reported, the most common of which are anterior knee pain and symptoms similar to patella tendonitis. Complete rupture of the patellar tendon after IM nailing of the tibia has been reported on 2 occasions, in conjunction with predisposing patient factors, such as systemic disease or a proud tibial nail. Patellar tendon ruptures are disabling injuries that can be technically difficult to repair because of the poor quality of remaining tendon tissue, quadriceps muscle atrophy and/or contracture, and scar-tissue formation. Many methods have described the surgical reconstruction of the knee extensor mechanism, which is most commonly performed after total knee arthroplasty. We report the successful surgical and clinical outcome of patellar tendon reconstruction using an Achilles tendon allograft in a patient subject to late and recurrent ruptures after IM nailing of the tibia through a mid-patellar tendon-splitting approach. Seven months after tendon reconstruction, the patient exhibited full knee flexion, an extension lag of 10º, 4/5 quadriceps strength, and return to her baseline ambulatory status.
胫骨髓内钉固定术后的各种并发症已有报道，其中最常见的是膝前疼痛和类似髌腱炎的症状。胫骨髓内钉固定术后髌腱完全断裂已有2例报道，同时存在一些易感患者因素，如全身性疾病或胫骨钉外露。髌腱断裂是致残性损伤，由于剩余腱组织质量差、股四头肌萎缩和/或挛缩以及瘢痕组织形成，修复技术上可能很困难。许多方法描述了膝关节伸肌机制的手术重建，这在全膝关节置换术后最为常见。我们报告了1例胫骨髓内钉固定术后晚期复发性髌腱断裂患者，采用经髌腱中部劈开入路，使用跟腱同种异体移植物成功进行髌腱重建的手术及临床结果。腱重建7个月后，患者膝关节完全屈曲，伸直滞后10°，股四头肌肌力4/5，并恢复到基线行走状态。
