CAJ | 학술논문

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。
목적：총결관절경하전교차인대（ACL）중건술후번수적원인급처리책략。방법2005년2월지2008년1월엄주군구엄주총의원수치14례인ACL중건실패이수요진행번수수술적환자，기중술후재차창상4례、이식물실효송치7례、슬관절점련활동수한2례、술후감염1례。대ACL완전단렬4례、송치실장력7례환자행일기ACL중건술，기중8례골수도위치정상，채용공심찬찬과원유가흡수라정，중신건립골수도；령3례골수도위치착오자중신정위수도。대2례슬관절점련환자행점련송해수술。대1례술후감염환자행관절경병조청리、관절강충세인류술급항생소치료。결과수방시간29～73개월，평균43.4개월。균미발생재차관절점련、상구감염、이식물단렬등병발증。IKDC평분유술전C급4례、D급10례개선위술후A급11례、B급2례、C급1례；술후Lysholm슬관절공능평분위（89±9）분，교술전적（62±10）분명현제고（P＜0.05）。결론관절경하ACL중건실패원인복잡，번수난도교대。상세적술전평고화수술방안적설계대우보증번수수술성공십분중요。
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 rebuilt; 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.