中国儿童和青少年前十字韧带损伤诊疗指南:韧带实质部损伤  

Chinese clinical guideline for diagnosis and treatment of intrasubstance anterior cruciate ligament injuries in children and adolescents

作　　者：中华医学会小儿外科分会小儿骨科学组 中华医学会骨科学分会小儿创伤与矫形学组 冯超[2] 杨征[2] 胡永成 Pediatric Osteopathic Group,Pediatric Surgery Branch of Chinese Medical Association;Pediatric Trauma and Orthopaedic Group,Orthopaedic Branch of Chinese Medical Association;Yang Zheng;Hu Yongcheng

机构地区：[1]不详 [2]北京积水潭医院

出　　处：《中华骨科杂志》2022年第16期1009-1027,共19页Chinese Journal of Orthopaedics

基　　金：北京市卫生健康委员会国际合作择优资助项目(国际合作处2021年19号)。

摘　　要：前十字韧带(anterior cruciate ligament,ACL)损伤在儿童和青少年中越来越常见。因为骺板尚未闭合,ACL重建在这个年龄段独具特点。但目前国内临床医生在儿童和青少年ACL损伤诊疗上还缺乏统一的规范,规范化的ACL损伤诊疗对临床工作和社会发展均有重要意义。指南由中华医学会小儿外科分会小儿骨科学组、中华医学会骨科学分会小儿创伤与矫形学组以及中华骨科杂志编辑部发起,采用推荐意见分级的评估、制订及评价(Grading of Recommendations Assessment,Development and Evaluation,GRADE)分级体系和国际实践指南报告标准(Reporting Items for Practice Guidelines in Healthcare,RIGHT),遴选出骨科医生最为关注的25个临床问题,最终形成25条循证医学推荐意见。推荐条目1~6为儿童和青少年ACL损伤的预防和诊断,条目7~17为手术指征、时机、方法选择、操作要领及手术效果,条目18~22为合并损伤及手术并发症的处理原则,条目23~25为保守和手术治疗后康复、重返运动标准及防护支具使用相关问题。指南制订旨在提高儿童及青少年ACL损伤诊疗的科学性并最终提升以患者为中心的医疗服务质量。Anterior cruciate ligament(ACL)injuries have been recognized and treated with increasing frequency in children and adolescents.ACL reconstruction in skeletally immature patients has unique considerations and there is a large practice variation in the management of these injuries.Thus,standardized diagnosis and treatment of ACL injuries are of great significance to clinical work and social development.This guideline was initiated by the Pediatric Osteopathic Group,Pediatric Surgery Branch of Chinese Medical Association,Pediatric Trauma and Orthopaedic Group,Orthopaedic Branch of Chinese Medical Association,and the editorial office of the Chinese Journal of Orthopaedics.The Grading of Recommendations Assessment,Development and Evaluation(GRADE)approach and the Reporting Items for Practice Guidelines in Healthcare(RIGHT)checklist were adopted.Finally,25 evidence-based recommendations were formulated based on 25 most concerned clinical problems among orthopaedic surgeons in China.Recommendations 1-6 are recommended for the prevention and diagnosis of ACL injury in children and adolescents,entries 7-17 for the surgical indications,timing,method selection,operational essentials and surgical effect,entries 18-22 for the treatment principles of combined injury and surgical complications,and entries 23-25 for conservative and surgical rehabilitation,return to sport standards and brace usefulness.This guideline was intended to improve the scientific nature of ACL injuries diagnosis and treatment and ultimately improve the quality of patient centered medical services.

关 键 词：中华医学会 小儿外科 骨科医生 循证医学 中华骨科杂志 小儿骨科 合并损伤 推荐意见 

分 类 号：R726.8[医药卫生—儿科]