新一代人工韧带重建前交叉韧带的临床疗效及应用优势:中国专家共识

Clinical efficacy and application advantages of anterior cruciate ligament reconstruction using the new generation artificial ligaments:The consensus of Chinese specialists

目的:中华医学会运动医疗分会与中国医师协会骨科医师分会基于最新的循证医学证据制订一项中国专家共识,旨在就新一代人工韧带重建前交叉韧带(anterior cruciate ligament,ACL)的临床疗效和应用优势提供客观科学的指导意见。方法:共识采用改良Delphi方法分三轮调查(包括两轮在线调查和一轮面对面会议)完成。来自中国医师协会骨科医师分会和中华医学会运动医疗分会的31名运动医学专家参加工作,他们来自16个省市的大学教学医院。执业时间方面,专家平均从业25年,膝关节手术为17年,ACL重建为13年。其中,58.1%的专家相关手术量超过100例,90.3%的专家至少发表一篇相关论文。共识起草小组根据最新循证依据编写共识一稿,以Sprague法完成问卷化。二稿根据在线调查反馈信息编制并在面对面会议中讨论。待共识条目经过面对面会议的讨论、修改和投票,赞成率大于等于85%被认定为达成共识。结果:26位专家完成两轮问卷调查并最终参加面对面会议。5项待共识条目达成共识(赞成率为100%),1项未能达成共识(赞成率为19.2%)。结论:相较于采用自体移植物和同种异体移植物的ACL重建,采用新一代人工韧带重建ACL具有康复进程快,恢复周期短的特点,并在短期和中期随访中关节稳定性和早期功能恢复有明显优势。经过规范康复训练,患者通常能在术后5个月内重返运动。采用新一代人工韧带进行ACL重建为术后快速康复提供了基础,对于希望早期恢复运动的患者是值得考虑的选项。

Objective To develop a Chinese specialist consensus based on the latest evidences,aiming to provide objective and scientific guidance regarding the anterior cruciate ligament(ACL)reconstruction using the new-generation artificial ligaments(NGAL).Methods The consensus was found using the modified Delphi method,including two rounds of online expert consultation and one face-to-face meeting.The experts selected were thirty-one sports medicine specialists from the Chinese Society of Sports Medicine and the Chinese Association of Orthopaedic Surgeons,working on university teaching hospitals across 16 provinces and municipalities.On the average,they had 25 years of practice experience,with 17 years in knee surgery and 13 years in ACL reconstruction.Among them,58.1%had performed over 100 ACL surgeries,and 90.3%had published at least one related paper.The draft came into being according to the latest evidence and was converted into a questionnaireusing the Sprague method.The second draft was compiled after two-round online surveys and discussed in a face-to-face meeting.Consensus items were discussed,modified,and voted on during the face-to-face meeting,with consensus reached when the agreement rate was no less than 85%.Results Twenty-six specialists completed the two rounds of questionnaire surveys and attended the face-to-face meeting.Consensus was reached on 5 items with an agreement rate of 100%,while 1 item did not achieve consensus with the agreement rate of 19.2%.Conclusion Compared to autografts and allografts,ACL reconstruction with NGAL can achieve faster rehabilitation and quicker recovery,as well as significantly better joint stability and early functional recovery in the short and mediumterm.After standardized rehabilitation training,patients typically return to sport within 5 months postoperatively.Therefore,ACL reconstruction with NGAL lays foundation for faster postoperative recovery and is a valuable option for patients seeking early return to sport.