同种异体肌腱混合自体肌腱双束重建法行前交叉韧带重建失败翻修手术  

Double-bundle With Allogeneic Tendon Mixed With Autogenous Tendon for Revision for Anterior Cruciate Ligament Reconstruction Failure

作　　者：陈国飞[1,2] 江长青 崔磊[1] 陈鹏 尤田[1] 张文涛[1] 刘岗[1,2] Chen Guofei;Jiang Changqing;Cui Lei(Department of Sport Medicine,Peking University Shenzhen Hospital,Shenzhen 518035,China)

机构地区：[1]北京大学深圳医院运动医学科,深圳518035 [2]中国科学院大学深圳医院创伤骨关节科,深圳518106

出　　处：《中国微创外科杂志》2019年第12期1096-1099,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：深圳市重点学科提升项目(201606007);深圳市科技创新委员会资助项目(JCYJ20150403091443323)

摘　　要：目的 探讨双束重建技术对前交叉韧带重建失败翻修的效果。方法 2012年6月~2016年7月收治前交叉韧带重建失败34例。首次重建采用同种异体肌腱13例,自体肌腱21例;双骨道重建11例,单骨道重建23例。重建失败原因:单束骨道直径<8 mm 6例,骨道位置错误28例。均使用同种异体肌腱混合自体肌腱在关节镜下行双束重建技术翻修。随访采用国际膝关节文献委员会(International Knee Documentation Committee,IKDC) 2000膝关节主观评价问卷、Lysholm膝关节评分和Tegner膝关节运动评分进行膝关节功能评估;采用KT-2000关节测量评估移植物稳定性。结果34例随访时间24~36个月,平均29个月。翻修术后2年,IKDC评分从术前(54. 3±10. 0)分提高至(81. 8±6. 6)分,Lysholm膝关节评分从术前(62. 0±5. 8)分提高至(88. 2±3. 7)分,Tegner膝关节运动评分从术前(3. 9±1. 3)分提高至(7. 6±1. 0)分。KT-2000从术前(6. 8±1. 2) mm降低至(1. 9±0. 6) mm。均在翻修术后2年恢复体育锻炼活动,其中22例(64. 7%)达到受伤前水平。结论 对前交叉韧带初次重建失败的病例,同种异体肌腱混合自体肌腱双束翻修可明显恢复膝关节的稳定性。Objective To assess the effect of double-bundle revision for anterior cruciate ligament(ACL)reconstruction failure.Methods A total of 34 patients who underwent double-bundle ACL revision surgeries between June 2012 and July 2016 were included in this retrospective study.The primary ACL reconstruction used autologous graft in 13 cases and allogeneic graft in 21 cases.There were 11 cases of double bundle reconstruction and 23 cases of single bundle reconstruction.The reasons for the failure of reconstruction were:the diameter of single bone canal was less than 8 mm in 6 cases,and the position of bone canal was wrong in 28 cases.The patients were repaired by double bundle reconstruction under arthroscopy.In the follow-up,the International Knee Documentation Committee(IKDC)2000 knee joint subjective evaluation questionnaire,Lysholm knee score and Tegner knee joint movement score were used to evaluate the knee joint function.The KT-2000 arthrometry measurement was used to evaluate the graft stability.Results All the 34 cases were followed up for 24-36 months,with an average of 29 months.Two years after revision,the IKDC score was increased from(54.3±10.0)to(81.8±6.6),Lysholm knee joint score from(62.0±5.8)to(88.2±3.7),and Tegner knee joint movement score from(3.9±1.3)to(7.6±1.0).The KT-2000 was decreased from(6.8±1.2)mm to(1.9±0.6)mm.All of them resumed physical exercise 2 years after the revision,and 22 of them(64.7%)reached the level before injury.Conclusion The double-bundle revision of ACL reconstruction is effective in rescuing failed primary ACL reconstruction and re-introducing patients to physical exercise.

关 键 词：前交叉韧带 断裂 重建 翻修 

分 类 号：R68[医药卫生—骨科学]