膝关节重建外科的进展与争议

Advances and controversies in adult reconstructive surgery of the knee

膝关节炎外科治疗涵盖运动医学、矫形外科及关节置换术等多个领域,存在相当程度的交叉。围绕膝关节炎的外科治疗,美国骨科医师协会已发表了相关的临床指南,形成一定的共识,但仍存在相当多的争议。其中,膝关节镜在膝关节炎患者疼痛缓解、改善功能上存在较大的不确定性,目前不在一线治疗选择之列[1-2]。目前,膝关节外科医师关注的焦点集中于如何根据膝关节疾病所处阶段及患者的个体需求,综合决策选择最适合的治疗技术及假体。

Adult knee reconstructive surgery covers sports medicine, osteotomy, arthroplasty and others, which is expected to provide appropriate treatment options for patients at a specific stage. However, it is still controversial on the option of most suitable treatment for individualized needs. Several kinds of surgical procedures have been developed for decades spanning osteotomy, unicompartmental knee arthroplasty, total knee arthroplasty( TKA). TKA has always been the gold standard for the treatment of end-stage knee diseases up to now, pain, loss of functions, complication related revisions still exist though. Therefore, clarification of indications, advances of surgical techniques and designs of prostheses and instruments, individualized perioperative management are the common goals of knee surgeries to facilitate accurate diagnosis and treatment, reduce related complications, improve patients’ satisfaction, and prolong postoperative survival rate. The advances and controversies in knee reconstruction are reflected in the discussion of surgical indications to clearly select the most appropriate surgical techniques individually, minimally invasive surgery to reduce tissue trauma and benefit postoperative recovery, computer-aided surgery to improve the accuracy and reliability of implantation, innovative designs of prostheses for better function and survival rate, and perioperative management to improve the clinical outcomes and control the complications.