摘要目的 探讨前交叉韧带(anterior cruciate ligament, ACL)翻修重建的手术适应证、手术方法和临床疗效.方法 2001年11月至2006年7月收治ACL重建后失稳接受翻修患者12例,其中男性9例,女性3例,年龄16～39岁,平均28岁,均在关节镜下行探查与翻修手术.结合上述病例分析翻修的适应证、术中处理方法.术后应用KT-2000、IKDC、Lysholm及Tegner评分系统对临床疗效进行评价.结果 本组患者术前膝关节明显不稳.2例因骨道骨质严重缺损行一期植骨术.其余10例一期行ACL翻修手术,重建移植物采用同侧腘绳肌腱(STG)4例,对侧STG 4例,同侧骨-髌腱-骨(B-PT-B)1例,髂胫束1例.ACL翻修术后KT-2000检查平均差值在膝关节屈曲90°位和30°位分别为1.6 mm和3.1 mm;术后IKDC、Lysholm及Tegner评分平均分别为72.8、78.3、4.9分,较术前有明显改善.结论 ACL翻修重建后患膝的主观功能和客观稳定性可获明显改善.

abstractsObjective To analyze the management principle of anterior cruciate ligament (ACL) revision reconstruction and the factors contributing to its result. Methods Twelve patients received ACL revision reconstructions from November 2001 to July 2006 were studied retrospectively.The indication of the operation, the management during the procedure and the clinical results were analyzed. Results All the patients had pathological instability after primary ACL reconstructions. In this group, 2 cases received primary bone transplantation. The other 10 cases received primary ACL revision reconstructions. Among them, 4 cases were reconstructed with STG obtained from the same lateral, 4 cases were obtained from the opposite lateral, 1 case was reconstructed with B-PT-B obtained from the same lateral and 1 case was reconstructed with iliotibiali tractus. One year later, the mean side-to-side difference of KT-2000 examination were 1.6mm and 3.1mm at 90°and 30°.The mean IKDC, Lysholm and Tegner scores were 72.8, 78.3 and 4.9. Conclusion The functional results and objective stability could be obtained through revision ACL reconstruction. However, outcomes are less favorable than those with primary reconstructions, which might be related to the factors including deficiency of previous surgery and impact of revision procedure.