膝关节前交叉韧带重建术后失败及移植物松弛的原因分析

Analysis of the Causes of Failure and the Relaxation of Graft After Reconstruction of Anterior Cruciate Ligament of Knee Joint

目的分析膝关节前交叉韧带重建术后失败及移植物松弛的原因。方法回顾性分析2014年2月~2017年5月17例因膝关节前交叉韧带重建术后失败的100例患者的临床资料,其中男76例,女24例,平均年龄(35.93±8.25)岁,首次重建手术至翻修平均时间为(26.54±4.37)个月。分析失败原因并在关节镜下进行处理。结果 16例重建韧带完全断裂与吸收,24例虽尚有连接但明显松驰,均须行一期前交叉韧带翻修重建术,并用挤压可吸收螺钉固定,其中18例骨隧道偏前或偏后需重新定位隧道;35例膝关节粘连功能受限,均行粘连松解,术中见第一次重建的韧带尚可,故未进行翻修;18例挤压螺钉位置不当未起到固定作用,行一期前交叉韧带翻修重建手术;6例术后感染,行关节镜下关节清理术及关节腔反复冲洗、抗生素抗感染。患者术后随访时间平均为(27.66±5.35)个月,采用Lysholm评分评价,膝关节功能恢复正常55例,尚可24例,差21例,平均为(84.76±11.25)分;采用IKDC评分标准A级76例,B级24例。结论造成膝关节前交叉韧带重建术后失败的原因较多,其中以移植物的来源与固定、骨隧道位置不当、术后粘连相对常见。

Objective To analyze the failure of anterior cruciate ligament(ACL)reconstruction and the cause of graft relaxation.Methods A retrospective analysis of the clinical data of17cases out of100cases of failure of the anterior cruciate ligament reconstruction after the knee joint reconstruction from February2014to May2017were performed.There were76male and24female,with an average age of(35.93±8.25)years.The average time for the first reconstructive surgery to refurbishment was(26.54±4.37)months.The causes of failure were analyzed and treated under the arthroscope.Results16cases of reconstruction of ligaments were completely broken and absorbed.24cases were connected,but they were obviously relaxed.Ⅰstage refurbishment and reconstruction of anterior cruciate ligament with extrusion absorbable screw fixation was performed.18of them need to relocate the tunnel before or after the deviation.35cases of knee joint adhesion function were limited which received adhesion release.The first reconstruction of the ligament was still available,so no revision was carried out.18cases of improper position of extrusion screw did not play a fixed role,which receivedⅠstage refurbishment and reconstruction of anterior cruciate ligament.6cases of postoperative infection were treated by arthroscopic debridement,repeated joint cavity rinsing and antibiotic infection.The average follow-up time of the patients was(27.66±5.35)months.According to Lysholm score,55cases(55%)of knee function had a good recovery,24cases(24%)had a well recovery,21cases(21.05%)had a bad recovery.The average was(84.76±11.25);76cases(76%)was grade A and24cases(24%)was grade B according to the IKDC score standard.Conclusion Therewere many reasons for the failure of anterior cruciate ligament reconstruction,including the source and fixation of allograft,improper position of bone tunnel and postoperative adhesions.