关节镜下前交叉韧带重建术后翻修的原因分析和治疗对策

摘要

Objective To analyze the failure reasons of arthroscopic anterior cruciate ligament (ACL) reconstruction, and to summarize surgical strategies for the ACL revision surgery. Methods From February 2005 to January 2008, a total of 14 patients who were suffered from ACL reconstruction failures underwent ACL revision surgery, including reinjury in 4 cases, graft tension-losing and laxity in 7 cases, knee joint adhesion with restricted activities in 2 cases, and infection in 1 case. Eleven patients with ACL complete rupture or graft tension loss and laxity were treated by one-stage ACL reconstruction, in which for 8 cases with correct bone tunnel, hollow drilling was passed through the original absorbable screws and bone tunnel was rebui while for other 3 patients whose bone tunnel placement was incorrect, femoral and tibial tunnels were repositioned. Two patients with knee joint adhesion underwent arthroscopic adhesion release. Infection in 1 case was cured by arthroscopic debridement, irrigation, drainage and antibiotics therapy. Results All patients had no complications such as further joint adhesion, wound infection, graft rupture and so on. According to IKDC score, there were A grade in 11 cases, B grade in 2 cases and C grade in 1 case at postoperation, while there were C grade in 4 cases and D grade in 10 cases at preoperation.; Lysholm score was improved from preoperative (62 ± 10) to postoperative (89 ± 8.7), the difference between preoperation and postoperation had statistical significance (P <0.05). Conclusions The failure reasons of ACL reconstruction were complex with high difficulty of revision surgery. Detailed preoperative evaluation and procedure design is very important to safeguard the success of ACL revision operation.%目的：总结关节镜下前交叉韧带（ACL）重建术后翻修的原因及处理策略。方法2005年2月至2008年1月广州军区广州总医院收治14例因ACL重建失败而需要进行翻修手术的患者，其中术后再次创伤4例、移植物失效松驰7例、膝关节粘连活动受限2例、术后感染1例。对ACL完全断裂4例、松驰失张力7例患者行一期ACL重建术，其中8例骨隧道位置正常，采用空心钻钻过原有可吸收螺钉，重新建立骨隧道；另3例骨隧道位置错误者重新定位隧道。对2例膝关节粘连患者行粘连松解手术。对1例术后感染患者行关节镜病灶清理、关节腔冲洗引流术及抗生素治疗。结果随访时间29～73个月，平均43.4个月。均未发生再次关节粘连、伤口感染、移植物断裂等并发症。IKDC评分由术前C级4例、D级10例改善为术后A级11例、B级2例、C级1例；术后Lysholm膝关节功能评分为（89±9）分，较术前的（62±10）分明显提高（P＜0.05）。结论关节镜下ACL重建失败原因复杂，翻修难度较大。详细的术前评估和手术方案的设计对于保证翻修手术成功十分重要。