【作者】 沈灏蒋； 赵金忠； 邵俊杰； 何耀华；

【Author】 SHEN Hao, JIANG Yao, ZHAO Jin-zhong, et al. Department of Orthopaedics, Shanghai the 6th Peoples Hospital, Jiaotong University, Shanghai 200233, China

【机构】 上海交通大学附属第六人民医院骨科；

【摘要】 目的:回顾性分析前十字韧带(anterior cruciate ligament,ACL)重建术中的各种失误并提出解决办法,为临床治疗提供参考。方法:自1995年1月-2002年6月对194例陈旧性ACL损伤患者行关节镜下ACL重建术固定方法包括88例Kurosaka挤压螺钉固定和106 例Aesculap内扣式缝线钢板固定,其中86例使用自体中1／3骨-髌韧带-骨移植,19例应用异体髌韧带移植,89例为自体半腱肌腱与股薄肌腱移植。结果:36例发生术中失误,其中2例不可挽救,术中失误的原因可分为隧道问题、移植物问题、固定问题等。术中最常见的失误是导针位置和方向不佳,与移植物和固定方式选择无关。Aesculap内扣式缝线钢板法固定自体半腱肌腱与股薄肌腱修复ACL时最常遇到的问题是取下的移植物过短或分叉。结论:只有掌握各种ACL重建方法的操作要点并加以灵活运用才能减少和正确处理各种术中失误。更多还原

【Abstract】 Objective Of all the knee ligament, the anterior cruciate was totally disrupted the most frequently. Although a high degree of success and satisfactory results of replacement of anterior cruciate ligament with autograft tendon by arthroscopy were demonstrated, the objective of the investigation was to retrospectively analyze miscellaneous pitfalls in anterior cruciate ligament reconstruction procedure and present its treatment. Methods Between January 1995 and June 2002, consecutive 194 male and female patients between thirteen and fifty-eight years of age who sought treatment for a chronic tear of the anterior cruciate ligament were treated by arthroscopic assisted anterior cruciate ligament reconstruction. The time-interval between the index injury and the surgery was from 1.5 to 37 months. The diagnosis of anterior cruciate ligament injury was established by Lachman test, pivot-shift examination and MRI. The procedures included autograft bone-patellar tendon-bone replacement fixed with Kurosaka interference screws in 75 cases, allograft bone-patellar tendon-bone with Kurosaka interference screws in 13 cases, autograft bone-patellar tendon-bone fixed with Aesculap Endobutton suture plates in 11 cases, allograft bone-patellar tendon-bone with Aesculap Endobutton suture plates in 6 cases, hamstring autografts fixed by Aesculap Endobutton suture plate in 89 cases. Results There were 39 intraoperative pitfalls happened in 36 cases, in which 2 intraoperative complications were unsalvageable. The causes of pitfalls could be classified into tunnel, graft materials, fixation and other problems. The most common pitfalls were the mistakes of position and direction of guide wires for bone tunnel occurred in 8 cases. The interference screw was loosened in 2 cases. Bending of the guide wire happened in 3 cases. Short and bifurcated of harvested grafts were the most common problem in reconstruction with hamstring autografts and Aesculap Endobutton suture plate technique.In the present,there were no complications of patellar fracture and breakage of reconstructive materials. Conclusion A deep knowledge and technique are necessary to determine and perform in anterior cruciate ligament reconstruction procedure, only if mastering the essentials of different anterior cruciate ligament reconstruction methods and handling flexibly, could an orthopedist cope with miscellaneous pitfalls rightly.更多还原