前交叉韧带翻修重建的临床研究.docx

前交叉韧带翻修重建的临床研究

马勇敖英芳崔国庆余家阔肖健龚熹闫辉杨渝平程序谢兴

【摘要】目的探讨前交叉韧带（AnteriorCruciateLigament,ACL）翻修重建的处理原则及影响手术效果的因素。方法2001年11月～2006年7月收治ACL翻修的病例12人；其中男性9例，女性3例，年龄16～39岁，平均28岁，均在关节镜下行探查与翻修手术。结合上述病例分析翻修的适应症、术中处理以及临床效果。结果本组病例翻修术前患膝关节有明显不稳症状。2例因骨道骨质严重缺损行一期植骨术。其余10例一期行ACL翻修手术，重建移植物用同侧腘绳肌腱（STG）4例，对侧STG4例，同侧骨-髌腱-骨（B-PT-B）1例，髂胫束1例。ACL翻修术后KT-2000检查平均差值在膝关节屈曲90°位和30°位分别为1.6mm和3.1mm；术后IKDC、Lysholm及Tegner评分平均分别为72.8、78.3、4.9，较术前有明显改善。结论ACL翻修重建后患膝的主观功能和客观稳定性可获明显改善；但因原有手术不足及再次手术等多种因素作用，会影响最终临床效果。
【关键词】前交叉韧带；重建；翻修；关节镜

Revisionanteriorcruciateligamentreconstructionandclinicalresearch.MAYong,AOYing-fang,CUIGuo-qing,YUJia-kuo,XIAOJian,GONGXi,YANHui,YANGYu-ping,CHENGXU,XIEXing.InstituteofSportsMedicine,ThirdHospitalofPekingUniversity,Beijing100083,China
Correspondingauthor：AOYing-fang，Email：[e-mail]
【Abstract】ObjectiveToanalyzethemanagementprincipleofACLrevisionreconstructionandthefactorscontributingtoitsresult.Methods12patientsreceivedACLrevisionreconstructionsfromNovember2001toJuly2006werestudiedretrospectively.Weanalyzetheindicationoftheoperation,themanagementduringtheprocedureandtheclinicalresultsaccordingtothedataabove.ResultsAllthepatientshadpathologicalinstabilityafterprimaryACLreconstructions.Inthisgroup,2casesreceivedprimarybonetransplantation.Theother10casesreceivedprimaryACLrevisionreconstructions.Amongthem,4caseswerereconstructedwithSTGobtainedfromthesamelateral,4caseswereobtainedfromtheoppositelateral,1casewasreconstructedwithB-PT-Bobtainedfromthesamelateraland1casewasreconstructedwithiliotibialitractus.Oneyearlater,themeanside-to-sidedifferenceofKT-2000examinationwere1.6mmand3.1mmat90°and30°.ThemeanIKDC,LysholmandTegnerscoreswere72.8,78.3and4.9.ConclusionThefunctionalresultsandobjectivestabilitycouldbeobtainedthroughrevisionACLreconstruction.However,outcomeswerelessfavorablethanthosewithprimaryreconstructions,whichmightberelatedtothefactorsincludingdeficiencyofprevioussurgeryandimpactofrevisionprocedure.
【Keywords】Anteriorcruciateligament,Reconstruction，Revision,Ar