前十字韧带重建翻修术专家共识:手术指征和术前评估  

Chinese expert consensus on anterior cruciate ligament revision reconstruction:indications and preoperative evaluation

作　　者：中华医学会运动医疗分会膝关节学组 中国医师协会运动医学医师分会 徐卫东 王健全 冯建豪 徐一宏 李彦林 陈德生 Knee Group of Chinese Society of Sports Medicine;Sports Medicine Doctor Society of Chinese Medical Doctor Association;Xu Weidong;Wang Jianquan

机构地区：[1]不详

出　　处：《中华骨科杂志》2024年第23期1516-1524,共9页Chinese Journal of Orthopaedics

基　　金：上海市体育科技“备战攻关”项目(24J001)。

摘　　要：随着前十字韧带(anterior cruciate ligament,ACL)损伤发生率的不断增高以及ACL重建手术的广泛普及,ACL重建手术失败并需要二次翻修的患者数量呈上升趋势。与初次ACL重建相比,重建翻修的技术难度更大,因膝关节可能伴有骨隧道扩大和半月板及关节软骨损伤。因此,术前需通过病史采集、体格检查和影像学检查全面评估;重建翻修在手术策略和操作技巧,如移植物的选择和骨道定位等方面都需要进行术前规划。尽管国内医生在ACL重建翻修方面积累了丰富的临床经验,但目前关于ACL重建翻修的原因、手术指征、诊断、影像学检查等方面仍存在较多争议,且尚无ACL重建翻修的专家共识。因此,由中华医学会运动医疗分会膝关节学组和中国医师协会运动医学医师分会共同发起,采取改良Delphi法制定了《前十字韧带重建翻修术专家共识:手术指征和术前评估》,最终形成11条推荐意见。其中推荐意见1~3为翻修原因和手术指征、推荐意见4~6为临床诊断内容,推荐意见7~11为影像学检查。共识的制订旨在帮助医生准确把握ACL重建翻修的手术指征,全面做好术前评估工作。With the increasing incidence of anterior cruciate ligament(ACL)injuries and the widespread popularity of ACL reconstructive surgery,the number of patients with failed ACL reconstructive surgery and the need for a second revision is on the rise.Compared with primary ACL reconstruction,revision reconstruction is technically more difficult because the knee may be accompanied by bone tunnel enlargement and meniscus and articular cartilage damage.Therefore,it is necessary to conduct a comprehensive evaluation by history collection,physical examination and imaging examination before operation.Revision surgery requires preoperative planning in terms of surgical strategies and skills,such as graft selection and bone tunnel positioning.Although domestic surgeons have accumulated rich clinical experience in ACL reconstruction revision,there are still many controversies about the causes,surgical indications,diagnosis,imaging examination,and there is no expert consensus on ACL reconstruction revision.Therefore,the expert consensus on the revision of ACL reconstruction:surgical indications and preoperative evaluation was developed by the Knee Group of Chinese Society of Sports Medicine and Sports Medicine Doctor Society of Chinese Medical Doctor Association through a modified Delphi method,and 11 recommendations were finally formulated.Among them,recommendations 1 to 3 were the reasons for revision and surgical indications,recommendations 4 to 6 were for clinical diagnosis,and recommendations 7 to 11 were for imaging examination.The consensus was developed to help physicians accurately grasp the surgical indications for ACL reconstruction and revision,and to perform a comprehensive preoperative evaluation.

关 键 词：膝关节 前交叉韧带重建 关节镜检查 再手术 共识 

分 类 号：R687.4[医药卫生—骨科学]