关节镜下前十字韧带重建术术中失误原因的分析与对策

Analysis and countermeasure of intraoperative pitfalls in arthroscopic assisted anterior cruciate ligament re-construction

目的回顾性分析前十字韧带(anteriorcruciateligament,ACL)重建术中的各种失误并提出解决办法,为临床治疗提供参考。方法自1995年1月～2002年6月对194例陈旧性ACL损伤患者行关节镜下ACL重建术。固定方法包括88例Kurosaka挤压螺钉固定和106例Aesculap内扣式缝线钢板固定。其中86例使用自体中1/3骨-髌韧带-骨移植,19例应用异体髌韧带移植,89例为自体半腱肌腱与股薄肌腱移植。结果36例发生术中失误,其中2例不可挽救。术中失误的原因可分为隧道问题、移植物问题、固定问题等。术中最常见的失误是导针位置和方向不佳,与移植物和固定方式选择无关。Aesculap内扣式缝线钢板法固定自体半腱肌腱与股薄肌腱修复ACL时最常遇到的问题是取下的移植物过短或分叉。结论只有掌握各种ACL重建方法的操作要点并加以灵活运用才能减少和正确处理各种术中失误。

Objective Of all the knee ligament,the anterior cruciate was totally disrupted the most frequently.Although a high degree of success and satisfactory results of replacement of anterior cruciate liga-ment with autograft tendon by arthroscopy were demonstrated,the objective of the investigation was to retro-spectively analyze miscellaneous pitfalls in anterior cruciate ligament reconstruction procedure and present its treatment.Methods Between January1995and June2002,consecutive194male and female patients between thirteen and fifty-eight years of age who sought treatment for a chronic tear of the anterior cruciate ligament were treated by arthroscopic assisted anterior cruciate ligament reconstruction.The time-interval between the index injury and the surgery was from1.5to37months.The diagnosis of anterior cruciate liga-ment injury was established by Lachman test,pivot-shift examination and MRI.The procedures included au-tograft bone-patellar tendon-bone replacement fixed with Kurosaka interference screws in75cases,allograft bone-patellar tendon-bone with Kurosaka interference screws in13cases,autograft bone-patellar tendon-bone fixed with Aesculap Endobutton suture plates in11cases,allograft bone-patellar tendon-bone with Aesculap Endobutton suture plates in6cases,hamstring autografts fixed by Aesculap Endobutton suture plate in89cases.Results There were39intraoperative pitfalls happened in36cases,in which2intraop-erative complications were unsalvageable.The causes of pitfalls could be classified into tunnel,graft materi-als,fixation and other problems.The most common pitfalls were the mistakes of position and direction of guide wires for bone tunnel occurred in8cases.The interference screw was loosened in2cases.Bending of the guide wire happened in3cases.Short and bifurcated of harvested grafts were the most common problem in reconstruction with hamstring autografts and Aesculap Endobutton suture plate technique.In the present,there were no complications of patellar fracture and breakage of reconstructive materials.Conclusion A deep knowledge and technique are necessary to determine and perform in anterior cruciate ligament recon-struction procedure,only if mastering the essentials of different anterior cruciate ligament reconstruction methods and handling flexibly,could an orthopedist cope with miscellaneous pitfalls rightly.