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原位保留肌腱移植重建前交叉韧带和后外侧角的病例报告

A case report of anterior cruciate ligament and posterolateral corner reconstruction using tendon graft preserved in situ.

作者信息

Mpatswenumugabo Bosco, Bukara Emmanuel, Semakula Muhammed, Nzayisenga Albert, Mukezamfura Rene, Dusingizimana Lambert, Habumugisha Basile, Kamarampaka Salvador, Mutesa Leon, Butera Alex

机构信息

Orthopedic Department/University of Rwanda, King Faisal Hospital, Kigali, Rwanda.

Rwanda Biomedical Center, Kigali, Rwanda.

出版信息

Int J Surg Case Rep. 2018;44:42-46. doi: 10.1016/j.ijscr.2018.02.018. Epub 2018 Feb 17.

Abstract

INTRODUCTION

Combined anterior cruciate ligament (ACL) and posterolateral corner (PLC) reconstruction are a rare clinical entity in orthopedic literature, whose management requires different types of tendon grafts. Missed PLC injury leads to the failure of ACL repair due to the joint instability.

PRESENTATION OF CASE

We are presenting a case of posttraumatic right ACL, PLC and lateral meniscus injury. The patient was taken to theatre for arthroscopic meniscectomy, ACL and PLC reconstruction. We had to harvest bilateral Gracilis and semitendinosus tendon grafts. Intraoperatively, we used a pump and after meniscectomy and ACL reconstruction the knee was quite swollen; we opted to offer a two-staged procedure for PLC reconstruction. Hence we had to preserve the graft in situ for the next procedure. Posterolateral corner reconstruction was done in a week's time and preserved ligament was found to be intact.

DISCUSSION

The fact that we did not have a tissue bank or facilities for cryopreservation of the harvested tendons at -80 °C or with liquid nitrogen at -179 °C yet we had to keep the harvested tendons safe.

CONCLUSION

In case of absence of graft and bone bank, tendon graft was in situ and found intact and ready to be used after seven days.

摘要

引言

前交叉韧带(ACL)和后外侧角(PLC)联合重建在骨科文献中是一种罕见的临床情况,其治疗需要不同类型的肌腱移植物。漏诊的PLC损伤会因关节不稳定导致ACL修复失败。

病例介绍

我们报告一例创伤后右ACL、PLC和外侧半月板损伤的病例。患者被送往手术室进行关节镜下半月板切除术、ACL和PLC重建。我们不得不采集双侧股薄肌和半腱肌肌腱移植物。术中,我们使用了灌注泵,在半月板切除和ACL重建后,膝关节肿胀明显;我们选择分两期进行PLC重建。因此,我们不得不将移植物原位保留以备后续手术使用。一周后进行了后外侧角重建,发现保留的韧带完好无损。

讨论

我们没有组织库或在-80°C用液氮在-179°C冷冻保存采集肌腱的设备,但我们必须确保采集的肌腱安全。

结论

在没有移植物和骨库的情况下,肌腱移植物原位保留,七天后发现完好无损且可供使用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/de0e/5927806/af39b7dbf477/gr1.jpg

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