中国儿童和青少年前十字韧带损伤诊疗指南:胫骨髁间棘骨折

Chinese clinical guideline for diagnosis and treatment of anterior cruciate ligament injury in children and adolescents:tibial spine avulsion fractures

胫骨髁间棘骨折(tibial spine avulsion fractures,TSAFs)是一种特殊类型的前十字韧带(anterior cruciate ligament,ACL)损伤,在儿童和青少年中少见,但发生率有逐渐增加趋势。因为骨骺尚未闭合,这个年龄段TSAFs在诊断和治疗上独具特点。但目前国内临床医生在儿童和青少年TSAFs诊疗上还缺乏统一的认识,而规范化的诊疗对临床工作和社具有重要意义。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21个临床问题,最终形成21条循证医学推荐意见。推荐条目1~4为儿童青少年TSAFs的分型及手术指征,条目5~14为保守和手术治疗方法及合并损伤的处理原则,条目15~16为保守和手术治疗后康复方法及重返运动标准,条目17~21为并发症的发生原因及处理原则。指南制订旨在提高儿童和青少年TSAFs诊疗的科学性,并最终提升以患者为中心的医疗服务质量。

Tibial spine avulsion fractures(TSAFs)is a particular type of anterior cruciate ligament(ACL)injury that is rare in children and adolescents,but has a trend toward gradually increasing incidence.Because the epiphysis has not yet closed,TSAFs at this age group are unique in diagnosis and treatment.However,at present,domestic clinicians still lack of unified norms in the diagnosis and treatment of TSAFs in children and adolescents,and the standardized diagnosis and treatment is of great significance to both 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 Society,and the editorial department 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,21 evidence-based recommendations were formulated based on 21 most concerned clinical problems among orthopaedic surgeons in China.Recommended entries 1-4 are the typing and surgical indications of TSAFs in children and adolescents,entries 5-14 are conservative and surgical treatment and combined injuries treatment principles,entries 15-16 are conservative and surgical rehabilitation methods and return to sports criteria,and entries 17-21 are the causes and treatment principles of complications.This guideline is intended to improve the scientific nature of TSAFs diagnosis and treatment in children and adolescents and ultimately improve the quality of patient centered medical services.