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使用双骨-髌腱-骨同种异体移植物分期重建感染性髌腱断裂:一例三年随访的罕见病例报告

Staged patellar tendon reconstruction using doubled bone-patellar tendon-bone allograft for infected patellar tendon rupture: a rare case report of three years follow-up.

作者信息

Choi Hyung Suk, Jang Byung-Woong, Chun Dong-Il, Kim Yong Beom, Seo Gi-Won, Hwang Jinyeong, Lee Byung Ill

机构信息

Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, Korea.

Department of Orthopaedic Surgery, Soonchunhyang University Hospital Gumi, Gumi, Korea.

出版信息

J Exp Orthop. 2021 Feb 18;8(1):13. doi: 10.1186/s40634-021-00334-1.

Abstract

BACKGROUND

Patellar tendon rupture is a relatively rare injury that usually requires surgical treatment. The optimal therapeutic strategy is still controversial, especially when either concomitant patellar tendon infection or soft tissue infection surrounds the patellar tendon. Until recently, most reported reconstruction methods are extensive and difficult to apply because of the poor condition of the soft tissue surrounding the patellar tendon.

CASE PRESENTATION

A 19-year-old male patient presented to our clinic three weeks following a motorcycle accident. There was a 5 x 4 cm sized skin defect with soft tissue infection below the inferior pole of patella. We performed a staged patellar tendon reconstruction using a doubled bone-patellar tendon-bone allograft (BPTB) to the infected patellar tendon rupture, following local random fasciocutaneous flap and split-thickness skin graft. Three months following surgery, the patient was able to perform an active knee motion with no extension lag and excellent clinical functional result.

DISCUSSION AND CONCLUSIONS

Our technique introduced in this specific case is a relatively simple method to reconstruct chronic patellar tendon defects with limited incision exposing only the patellar tendon areas. We expect it can be less invasively performed on patients who have a soft tissue problem and cannot have extensive surgery.

摘要

背景

髌腱断裂是一种相对罕见的损伤,通常需要手术治疗。最佳治疗策略仍存在争议,尤其是当髌腱伴有感染或髌腱周围存在软组织感染时。直到最近,由于髌腱周围软组织状况不佳,大多数报道的重建方法都较为复杂且难以应用。

病例介绍

一名19岁男性患者在摩托车事故三周后前来我院就诊。髌骨下极下方有一个5×4厘米大小的皮肤缺损并伴有软组织感染。我们在局部随意筋膜皮瓣和中厚皮片移植后,使用双股骨-髌腱-骨同种异体移植物(BPTB)对感染的髌腱断裂进行了分期髌腱重建。术后三个月,患者能够主动屈膝,无伸直滞后,临床功能结果良好。

讨论与结论

我们在该特定病例中介绍的技术是一种相对简单的方法,用于重建慢性髌腱缺损,切口有限,仅暴露髌腱区域。我们期望对于存在软组织问题且无法进行广泛手术的患者,可以采用这种侵入性较小的方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1f09/7892650/37bdce882f52/40634_2021_334_Fig1_HTML.jpg

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