分期植骨翻修重建治疗前交叉韧带重建失败伴骨隧道扩大  

Staged bone grafting and revision reconstruction for failed anterior cruciate ligament reconstruction accompanied with bone tunnel enlargement

作　　者：王林[1] 马天骏 罗丽婷 花奇凯[1] 姚军[1] WANG Lin;MA Tian-jun;LUO Li-ting;HUA Qi-kai;YAO Jun(The First Affiliated Hospital,Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院骨关节外科,530021 [2]广西医科大学第二附属医院骨科,530006

出　　处：《中国矫形外科杂志》2020年第12期1132-1135,共4页Orthopedic Journal of China

基　　金：广西医疗卫生适宜技术开发与推广运用项目(编号:S201655)。

摘　　要：[目的]介绍分期植骨翻修重建治疗前交叉韧带(ACL)重建失败伴骨隧道扩大的手术技术与初步临床结果。[方法] 2016年1月~2018年,本院对12例ACL重建术失败伴骨隧道扩大的患者采用一期植骨填充骨隧道骨缺损,3个月后再次行二期翻修重建ACL。[结果]二次手术均无严重并发症。所有患者随访6~36月,末次随访时,所有患者膝关节Lachman试验、前抽屉试验、轴移试验均为阴性。末次随访时Lysholm评分、Tegner评分、IKDC评分均明显高于翻修术前,差异具有统计学意义(P<0.05)。[结论]在ACL翻修的病例中,如果骨隧道有明显扩大,选择一期植骨+二期韧带重建的翻修方案,可以很好的解决骨缺损所导致的韧带固定位置不满意的问题,让韧带翻修达到初次重建的效果。[Objective]To introduce the surgical technique and primary clinical outcomes of staged bone grafting and revision reconstruction for failed anterior cruciate ligament(ACL)reconstruction accompanied with bone tunnel enlargement.[Methods]From January 2016 to January 2018,12 patients underwent bone grafting to fill bone defect of the enlarged bone tunnels in the first stage,and then revision ACL reconstruction with contralateral hamstring tendon graft or partial tendon graft of peroneus longus in the second stage in our hospital.[Results]No serious complications happened in the two stages of operation in anyone of them.All the patients were followed up for 6 to 36 months.At the latest follow up,all patients had negative results regarding Lachman test,anterior drawer test and pivot shift test.The Lysholm,Tegner and IKDC scores significantly increased at the latest interview compared with those before revision reconstruction(P<0.001).[Conclusion]This bone grafting in the first stage combined with revision ACL reconstruction in the second stage is sound solution to deal with improper location in revised ACL reconstruction due to bone defect to achieve similar condition to the primary operation for the failed ACL reconstruction with remarkable bone tunnel enlargement.

关 键 词：前交叉韧重建术失败 骨隧道扩大 植骨 翻修重建 

分 类 号：R687[医药卫生—骨科学]