CAJ | 학술논문

背景：前交叉韧带重建失败可由多种因素引起，需要进行翻修手术治疗。国内关于前交叉韧带翻修的报道较少。目的：分析前交叉韧带重建失败后行翻修治疗的主要原因、适应证、方法及效果。方法：前交叉韧带重建后失稳需要接受翻修患者30例，均在关节镜下行探查与翻修治疗。翻修后应用KT-2000、国际膝关节评分委员会评分标准(IKDC)、Lysholm及Tegner评分系统进行评价。结果与结论：30例患者中，初次手术选用自体骨-髌腱-骨移植物9例，自体半腱股薄肌腱14例，同种异体腘绳肌腱7例，翻修原因上、下两端骨道均偏前8例，上骨道偏前12例，下骨道偏前8例，其中1例合并关节强直；自体骨-髌腱-骨重建固定上骨道内骨块的挤压螺钉位置异常1例；内侧副韧带股骨止点撕脱骨折未予修复1例。翻修术中重建的前交叉韧带完全断裂和吸收12例，韧带有部分连接但已明显松弛失张力18例。无骨道骨质严重缺损，均一期行前交叉韧带翻修手术，重建移植物采用同侧腘绳肌腱(STG)10例，对侧腘绳肌腱14例，人工韧带6例。前交叉韧带翻修后KT-2000检查膝关节屈曲90°和30°平均差值，以及IKDC、Tegner和Lysholm评分均较翻修前有明显改善。前交叉韧带重建手术失败的原因较多，但主要与手术骨道位置异常、固定失效、复合韧带损伤处理不当、关节强直等有关。前交叉韧带翻修后膝关节的主观功能和客观稳定性可获得明显改善。
배경：전교차인대중건실패가유다충인소인기，수요진행번수수술치료。국내관우전교차인대번수적보도교소。목적：분석전교차인대중건실패후행번수치료적주요원인、괄응증、방법급효과。방법：전교차인대중건후실은수요접수번수환자30례，균재관절경하행탐사여번수치료。번수후응용KT-2000、국제슬관절평분위원회평분표준(IKDC)、Lysholm급Tegner평분계통진행평개。결과여결론：30례환자중，초차수술선용자체골-빈건-골이식물9례，자체반건고박기건14례，동충이체객승기건7례，번수원인상、하량단골도균편전8례，상골도편전12례，하골도편전8례，기중1례합병관절강직；자체골-빈건-골중건고정상골도내골괴적제압라정위치이상1례；내측부인대고골지점시탈골절미여수복1례。번수술중중건적전교차인대완전단렬화흡수12례，인대유부분련접단이명현송이실장력18례。무골도골질엄중결손，균일기행전교차인대번수수술，중건이식물채용동측객승기건(STG)10례，대측객승기건14례，인공인대6례。전교차인대번수후KT-2000검사슬관절굴곡90°화30°평균차치，이급IKDC、Tegner화Lysholm평분균교번수전유명현개선。전교차인대중건수술실패적원인교다，단주요여수술골도위치이상、고정실효、복합인대손상처리불당、관절강직등유관。전교차인대번수후슬관절적주관공능화객관은정성가획득명현개선。
BACKGROUND:Failure of anterior cruciate ligament reconstruction can be caused by multiple factors, which requires a revision surgery. However, there are few studies about the revision of anterior cruciate ligament. OBJECTIVE:To investigate the primary cause, indication, methods and effectiveness of revision after the failure of anterior cruciate ligament reconstruction. METHODS: Thirty patients with instability undergoing anterior cruciate ligament reconstructions were subjected to revision under arthroscopy. After revision, a systemic analysis was performed based on KT-2000 examination, the International Knee Documentation Committee (IKDC) scale, Lysholm and Tegner scores. RESULTS AND CONCLUSION:Of the 30 cases, 9 cases were reconstructed with bone-patelar tendon-bone autograft, 14 cases with hamstring tendon autograft, 7 cases with hamstring tendon alograft. Twelve cases had a femoral tunnel in the front of the predicted one, 1 case had knee stiffness, 8 cases had a tibial tunnel in the front of the predicted one, and 8 cases had both the femoral and tibial tunnels in the front of the predicted ones. One case had a malposited interference screw which reconstructed with bone-patelar tendon-bone autograft; one case complicated by posteromedial corner injury was not reconstructed. The reconstructed anterior cruciate ligament was absolutely ruptured and absorbed in 12 cases, and 18 cases had obviously loosen but stil partly linked reconstructed ligament. None had severe incompletion of spongy bone. Al cases received primary revision. Ten cases reconstructed with ipsilateral hamstring tendon, 14 cases reconstructed with contralateral hamstring tendon, and 6 cases with LARS ligament. The mean side-to-side difference of KT-2000 examination at 90° and 30°, the mean IKDC, Tegner and Lysholm scores were significantly improved after revision. There were many reasons leading to failure of anterior cruciate ligament reconstruction, such as malposition of the bone tunnel, invalid fixation, adhesion, compound ligament injuries, and ankylosis. The functional results and objective stability could be obtained through revision folowing anterior cruciate ligament reconstruction.