Blasco Alejandro, Baixauli Emilio
Orthopedic Surgery, Hospital Universitari i Politecnic La Fe, Valencia, Spain.
BMJ Case Rep. 2018 May 12;2018:bcr-2017-222854. doi: 10.1136/bcr-2017-222854.
The aim of this study is to describe a case of delayed granuloma formation associated with tendon necrosis in response to Ethibond confirmed by histopathological examination and to review and discuss the related literature. A 40-year-old woman underwent a patellar tendon repair with Krakow-like #5 Ethibond sutures. Four years after the repair, she noticed progressive soreness with knee extension and swelling. An ultrasound examination revealed a proximal partial patellar tendon rupture. Based on these findings, the patient was advised to undergo surgical intervention due to a diagnosis of re-rupture. Tendinosis, fibrosis and necrosis scar tissue surrounding the previous suture were observed and excised, and samples were sent for histopathological and microbiological examination. Stripping of the patellar paratenon was performed. Surprisingly, a giant cell foreign body reaction surrounding the synthetic refringent material, as well as polymorphonuclear cells surrounding the necrotic tendon, was reported.
本研究的目的是描述一例经组织病理学检查证实与Ethibond缝线相关的肌腱坏死导致的延迟性肉芽肿形成病例，并回顾和讨论相关文献。一名40岁女性接受了使用Krakow样#5 Ethibond缝线的髌腱修复术。修复术后四年，她注意到膝关节伸展时逐渐出现酸痛和肿胀。超声检查显示髌腱近端部分断裂。基于这些发现，由于诊断为再次断裂，建议患者接受手术干预。观察到并切除了先前缝线周围的肌腱退变、纤维化和坏死瘢痕组织，并将样本送去进行组织病理学和微生物学检查。进行了髌腱旁组织剥离。令人惊讶的是，报告了合成折光材料周围的巨细胞异物反应以及坏死肌腱周围的多形核细胞。
