膝关节多发韧带损伤诊疗临床指南

Clinical practice guideline for the diagnosis and treatment of multiple ligament knee injuries

膝关节多发韧带损伤(multiple ligament knee injuries,MLKI)是一种严重的膝关节创伤,常累及多个系统,关节结构破坏严重,其诊断和治疗具有一定难度。MLKI病情复杂、个体差异大、病例多散发,导致现有文献报道中其诊疗方法、技术及疗效存在差异,因此MLKI的诊疗观念尚不统一。为汇总最新研究进展,帮助临床医生了解MLKI诊疗原则和技术现状,提高诊疗的规范化与标准化水平,中国研究型医院学会运动医学专业委员会、中华医学会骨科学分会和中华骨科杂志编辑部组织国内膝关节重建领域的临床专家,遵循科学性、实用性和先进性原则,采用推荐意见分级的评估、制订及评价(Grading of Recommendations Assessment,Development and Evaluation,GRADE)分级体系和卫生实践指南报告标准(Reporting Items for Practice Guidelines in Healthcare,RIGHT),遴选出32个临床问题。通过证据检索、证据体质量评价以及确立推荐意见方向和强度等步骤,最终形成32条推荐意见,涉及MLKI的病情评估(条目1~4)、治疗原则及方法(条目5~23)、手术并发症(条目24~27)以及术后康复(条目28~32)等内容。

Multiple ligament knee injuries(MLKI)is a serious knee injury that often involves multiple systems and causes severe structural damage to the knee joint.The diagnosis and treatment are still challenging.Recently,with the development of comprehensive researches and minimally invasive techniques,significant progress has been made in the evaluation and treatment of MLKI.However,there are some discrepancies in its diagnosis and treatment,due to the complexity of MLKI,individual variations and limited number of cases.There is no clinical guideline in the diagnosis and treatment of MLKI.In order to summarize the latest advances in its diagnosis and treatment,to help clinicians understand principles in treating MLKI,and to improve the treatment efficacy of MLKI,the Sports Medicine Society of Chinese Research Hospital Association,the Chinese Orthopaedic Association and the Editorial Office of Chinese Journal of Orthopaedics organized domestic experts in the field of knee reconstruction to develop 32 clinical questions and formulate recommendations for MLKI.The clinical practice guideline was developed through evidence summarization,evidence body evaluation and establishment of direction and intensity of recommendations according to the principle of scientificity,practicability and advancement and based on the Grading of Recommendations Assessment,Development and Evaluation approach and the Reporting Items for Practice Guidelines in Healthcare(RIGHT)checklist.The guideline consists of 32 recommendations,with items 1 to 4 regarding the diagnosis of MLKI,items 5 to 23 regarding the treatment and management,items 24 to 27 regarding surgical complications,and items 28 to 32 regarding postoperative rehabilitation.The present guideline aims to improve the standardization of diagnosis and treatment of MLKI in China.