后交叉韧带重建后翻修原因分析

Clinical research for reason analysis of posterior cruciate ligament reconstruction revision

目的 对后交叉韧带（PCL）重建失败原因进行分析。方法回顾2001年11月至2007年5月8例PCL翻修病例，分析PCL重建失败的原因。结果8例翻修手术中发现1例双束重建韧带的后内束断裂；7例单束重建者中4例重建的PCL已完全断裂、吸收，另3例重建韧带有部分连接性，但已明显松弛失用。8例患者中，1例双束重建的上下骨道位置正确，其他7例骨道位置均不正确，股骨端上骨道明显偏后，胫骨端下骨道位置明显偏上向前。8例均行一期翻修重建手术，其中应用自体半腱股薄肌腱移植物单束重建2例、双束重建1例、后内束重建1例，自体骨-髌腱-骨（B—T—B）单束重建2例，同种异体B-T-B单束与双束重建各1例。结论PCL重建手术失败的原因与手术骨道位置异常有关。临床重建应注重选择正确骨道位置。

Objectives To study and analyze the clinical factors contributing to the failure of primary posterior cruciate ligament （PCL） reconstruction and to guide our clinical treatment. Methods From November 2001 to May 2007, 8 patients underwent PCL reconstruction revision because of pathological instability after primary PCL reconstruction. And the clinical failure factors of the primary reconstruction were analyzed. Results One case was reconstructed with bone-patellar tendon-bone （B-T-B） autografts, 7 cases with hamstring tendon autograft. The most probable causes of failure were improper graft placement in 7 cases （both femoral bone tunnels were behind the predicted one and tibial tunnels were in front of the predicted one）. The reconstructed PCL in 4 cases ruptured absolutely and had been absorbed. Three eases had obviously loosen but still partly linked reconstructed ligament. These 8 cases all received primary PCL revision reconstruction. Among them, 6 cases were reconstructed with autograft （using a single-bundle quardruple hamstring graft in 3 cases, double-bundle quardruple hamstring graft in 1 case, single-bundle B- T-B autograft in 2 case）, and 2 cases were reconstructed with allograft （using a single-bundle and a doublebundle B-T-B allograft reconstruction）. Conclusions Incorrect bone tunnel placement is the major factor contributing to the surgical failure in many reasons for the failure of PCL reconstruction. So, it might be suggested that there is a great need for a more precise anatomical bone tunnel placement.