Orhan BALTA, Murat AŞCI, Harun ALTINAYAK, Bora BOSTAN

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Travmatik Diz Çıkığında Multipl Primer Bağ Onarımı: Olgu Sunumu

Bu yazıda medial tibial plato kırığı, derin ve yüzeyel MCL(medial kollateral ligaman) rüptürü, ÖÇB(ön çapraz bağ), AÇB(arka çapraz bağ) ve medial menisküs yırtığı olan hastaya uygulanan primer tamirlerin klinik, radyolojik ve fonksiyonel sonuçları bildirilmektedir.26 yaşında kadın hasta bisikletten düşme sonucu sol dizinde gelişen şişlik ve ağrı şikayeti ile kliniğimize başvurdu. Yapılan muayenesinde dizinde efüzyon olan hastanın diz hareketleri kısıtlı ve ağrılı idi. Radyolojik tetkiklerinde medial tibial plato kırığı, derin ve yüzeyel MCL rüptürü, AÇB ve ÖÇB rüptürü ve medial menisküs yırtığı saptandı.Cerrahi sırasında öncelikle medial longitudinal insizyonla plato kırığı başsız vidalarla tespit edildi. Derin ve yüzeyel MCL tamiri dikişli çapalar ve post vidası ile tamamlandı. Sonrasında midline longitudinal insizyon kullanılarak parapatellar artrotomi yapıldı. Medial menisküsün ön kök kısmının kopmuş olduğu, AÇB'ın femoral yapışma yerinden, ÖÇB'ın ise tibial yapışma yerinden kopmuş olduğu görüldü. AÇB’dan Krackow sütürler geçilerek bir adet düğümsüz çapa ile femoral yapışma yerine tespit edildi. ÖÇB ise Krackow sütürleri geçilerek pull-out tekniği ile tespit edildi. Medial menisküs ön boynuzu ise 1 adet çapa ile tamir edildi. 6. haftadan sonra tedrici olarak yük ve ROM başlandı. Ancak diz hareketinin kısıtlı kalması nedeni ile 8. haftada artroskopik artroliz yapıldı. Genel olarak akut tamir sonuçları, kronik rekonstrüksiyonlardan daha iyidir. Bu tür vakalarda yoğun rehabilitasyon gerekmekte ve ancak uygun rehabilite edilen hastalarda yüz güldürücü sonuçlar alınabilmektedir. Bu yazıda sunulan vakada; multiple bağ yaralanmalarının eş zamanlı primer tamirinin 18 aylık takibi sonucunda başarılı olduğunu düşünmekteyiz.
Anahtar Kelimeler:

Diz çıkığı, multipl ligamant rüptürü, primer onarım

Primary Multiple Ligament Repair in Traumatic Knee Dislocation: Case Report

In this article, clinical, radiological and functional results of primary repair of medial tibial plateau fracture, deep and superficial MCL (medial collateral ligament) rupture, ACL (anterior cruciate ligament), ACB (posterior cruciate ligament) and medial meniscus rupture are reported. A 26-year-old female patient admitted to our clinic with complaints of swelling and pain in the left knee resulting from falling from the bicycle. The knee motion of the patient with knee effusion was restricted and painful. In the case of the patient without neurovascular pathology, the forward drawer and the back drawer tests were positive. Also grade 3 opening was present on the medial side of the valgus stratum. Radiological examinations revealed medial tibial plateau fracture, deep and superficial MCL rupture, rupture of the ACL and ACL, and rupture of the medial meniscus.During surgery, the plateau fracture was first detected with a medial longitudinal incision with headless screws. The deep and superficial MCL are finished with a fully stitched anchor and post screw. Parapatellar arthrotomy was performed using a midline longitudinal incision. It was seen that the anterior part of the medial meniscus had been broken and that it was disconnected from the femoral attachment site of the ACL and the tibial attachment site of the ACL. Krackow sutures from the ICU were passed through and one femoral anchor was fixed instead of femoral adhesion. In the ACL, Krackow sutures were passed and pull-out technique was used. Medial meniscus anterior horn was repaired with 1 anchor. After 6 weeks, the load was loaded and the ROM started. However, arthroscopic arthroplasty was performed at 8 weeks due to limited knee motion. The arthroscopic examination revealed that the ACL, ACL, and medial meniscus were healed. In general, acute repair results are better than chronic reconstructions. In such cases, intensive rehabilitation is needed and only good rehabilitating patients can get good results. In this paper, We believe that multiple ligament injuries are successful following 18 month follow-up of simultaneous primer repair.
Keywords:

Knee dislocation, multiple ligament rupture, primary repair,

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Gaziosmanpaşa Üniversitesi Tıp Fakültesi Dergisi-Cover
  • ISSN: 1309-3320
  • Başlangıç: 2009
  • Yayıncı: Tokat Gaziosmanpaşa Üniversitesi
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