新一代人工韧带重建前十字韧带的手术适应证选择——基于改良Delphi法制订的中国专家共识

The indication of new generation artificial ligaments in anterior cruciate ligament reconstruction:consensus of Chinese specialists based on a modified Delphi method

采用新一代人工韧带的前十字韧带(anterior cruciate ligament,ACL)重建术在中国有超过15年的临床应用和数万例病例积累。大量文献报道证实其短中期临床疗效不亚于采用生物移植物的ACL重建术,且具备允许患者早期重返运动的优势。但新一代人工韧带的超适应证使用甚至滥用以及与之相关的手术失败在临床上并不少见,应引起重视。本研究采用改良Delphi法,经两轮问卷沟通和一轮圆桌会议,就新一代人工韧带在ACL重建术中的适应证选择达成共识。共识起草小组依据最新循证医学证据,按Sprague专业调查法设计问卷,在线完成收集。共识专家遴选自中国医师协会骨科医师分会和中华医学会运动医学分会。共识制订小组就八项条款达成高度共识、两项条款达成普遍共识。共识制订目的是规范采用新一代人工韧带重建ACL的手术适应证选择。共识指出:新型人工韧带可用于初次ACL重建,不仅适用于急性ACL损伤,也适用于慢性ACL损伤,有ACL残端的患者可能效果更佳;对运动员、肥胖、超重和需要重返运动的患者效果可能更好,对骨骺未闭和翻修病例需谨慎使用。

New generation artificial ligaments have been applied in anterior cruciate ligament(ACL)reconstruction for more than 15 years in China.The shortor mid-term clinical outcomes of ACL reconstruction with the new generation artificial ligaments were no less than those with biological grafts.In addition,using new generation artificial ligaments allowed return to sports early after ACL reconstruction.However,it should be noted that the extended indication and even abuse of new generation artificial ligaments was uncommon in ACL reconstruction,which could lead to surgical failure.In the present study,we adopted a modified Delphi method to reach a consensus on the indication of new generation artificial ligaments in ACL reconstruction through two rounds of communication and one round of face-to-face meeting.The consensus development group designed an evidence-based questionnaire according the orthopedic survey strategy introduced by Sprague el al.and fulfilled the online collection.All special-ists were the members of Chinese Association of Orthopaedic Surgeons and Chinese Society of Sports Medicine.The specialist group reached the strong consensus on eight items and the moderate consensus on two items,which aimed to standardize the new generation artificial ligaments application in ACL reconstruction.The consensus indicates that the new generation artificial ligaments can be applied in primary ACL reconstruction including acute and chronic cases,especially for those with preserved remnants.The ACL reconstruction with the new generation artificial ligaments are likely to achieve better outcomes for athletes,over-weight patients,and those need to return to sports.For skeletal immature patients and revision cases,the new generation artificial ligaments should be applied with caution.