前交叉韧带双束重建联合前外侧韧带重建在前交叉韧带翻修中的应用  

Effectiveness of double-bundle anterior cruciate ligament reconstruction combined with anterolateral ligament reconstruction for revision

作　　者：毛云鹤 孙伟豪 付维力[1] 李箭[1] MAO Yunhe;SUN Weihao;FU Weili;LI Jian(Department of Orthopaedics,Orthopaedics Institute,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China)

机构地区：[1]四川大学华西医院骨科四川大学华西医院骨科研究所,成都610041

出　　处：《中国修复重建外科杂志》2021年第3期330-336,共7页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨前交叉韧带(anterior cruciate ligament,ACL)双束重建联合前外侧韧带(anterolateral ligament,ALL)重建的翻修术式治疗ACL重建失败的效果。方法2018年1月—2019年6月,采用ACL双束重建联合ALL重建对15例初次ACL重建失败患者行翻修术。男12例,女3例;年龄17~49岁,平均30.1岁。初次ACL重建术式:单束重建13例,双束重建2例;自体肌腱重建14例,同种异体肌腱重建1例。ACL重建失败原因:9例创伤再断裂;6例非创伤因素失败,其中2例移植物吸收、3例移植物松弛。初次ACL重建至该次翻修时间为8~60个月,平均28.5个月。比较术前及末次随访时膝关节功能主、客观评价指标以评定疗效。其中,主观评价指标包括国际膝关节文献委员会(IKDC)评分、Lysholm评分以及Tegner评分;客观评价指标包括胫骨前向松弛度的静态、动态移位距离及双侧松弛度差值(side-to-side difference,SSD)、轴移试验、Lachman试验、患侧伸膝肌力丢失比、单足跳跃试验差值。结果术后切口均Ⅰ期愈合,未出现切口感染、下肢静脉血栓形成、神经血管损伤等并发症;患者均获随访,随访时间12~30个月,平均19.1个月。末次随访时,患者均恢复至伤前运动水平,IKDC评分、Lysholm评分、Tegner评分均较术前明显改善(P<0.05)。胫骨前向松弛度的静态、动态移位距离均较术前明显改善(P<0.05),且恢复至正常生理范围;SSD、Lachman试验、轴移试验、单足跳跃试验差值、患侧伸膝肌力丢失比也明显优于术前(P<0.05)。随访期间均未发生移植物再断裂,无膝关节僵硬及活动度受限;1例出现股骨端挤压螺钉突出,局麻下经原切口取出。结论采用ACL双束重建联合ALL重建术式对初次ACL重建失败患者进行翻修,能明显改善患者膝关节功能、减少胫骨前向松弛度,有效防止膝关节旋转不稳定。Objective To investigate the effectiveness of double-bundle anterior cruciate ligament (ACL) reconstruction combined with anterolateral ligament(ALL)reconstruction in the treatment of revision patients with ACL graft failure.Methods Between January 2018 and June 2019,15 patients underwent ACL revision with double-bundle ACL reconstruction combined with ALL reconstruction.There were 12 males and 3 females with an average age of 30.1 years(range,17-49 years).The technique of primary ACL reconstruction included single-bundle reconstruction in 13 cases and double-bundle reconstruction in 2 cases.These reconstructions applied autografts in 14 cases and allograft in1 case.The causes of ACL reconstruction failure were identified as traumatic rupture in 9 cases and non-traumatic failure in 6 cases,including 2 cases of graft absorption and 3 cases of graft laxity.The average time from the primary ACL reconstruction to revision was 28.5 months(range,8-60 months).The subjective and objective indicators of knee joint function were compared before operation and at last follow-up to evaluate the effectiveness.The subjective indicators included International Knee Documentation Committee(IKDC)score,Lysholm score,and Tegner score.The objective indicators included anterior tibial translation(dynamic and static)and side-to-side difference(SSD),pivot-shift test,Lachman test,the difference of single-legged hop test,and the loss ratio of extensor muscle strength on the affected side.Results All incisions healed by first intetion,and no complications such as infection,venous thrombosis of lower extremity,or neurovascular injury occurred.All patients were followed up for an average of 19.1 months(range,12-30 months).At last follow-up,all patients had returned to pre-injury sports level.The IKDC score,Lysholm score,and Tegner score were significantly improved(P<0.05);anterior tibial translations(dynamic and static)significantly decreased when compared with preoperative one(P<0.05)and returned to the physiological range.The SSD,Lachman te

关 键 词：前交叉韧带 前外侧韧带 韧带重建 韧带翻修 双束重建 

分 类 号：R687.4[医药卫生—骨科学]