关注膝关节伤病诊疗难点误区与对策的研究（开放获取）

Pay attention to the research on the difficulties, misunderstandings and countermeasures in the diagnosis and treatment of knee injuries

摘要:

随着膝关节镜手术技术和器械发展，膝关节伤病诊疗水平提高，但出现重视手术操作、轻视诊断能力的不良现象常常导致误诊误治。《中国矫形外科杂志》本期重点刊出膝关节伤病诊疗相关内容：一是关注临床基础工作避免误诊漏诊，要重视病史采集等基础工作，减少因基础知识不牢、盲目自信等导致的误诊漏诊，以膝关节多韧带损伤为例分析了诊疗进展与误区，强调加强年轻医生培训、各级专家传帮带、临床医生贴近临床细致工作的重要性。结合后交叉韧带损伤诊断困难，介绍了屈曲 90°位磁共振影像将常规后交叉韧带“?”状影像变成直线状，使诊断更直观、更精确；二是关注手术适应证与标准化操作避免术中术后并发症，持续研究膝关节伤病手术适应证等标准化流程，本期对外侧半月板缝合术中损伤神经血管、镜下腘窝囊肿术如何减少术后复发等热点争议问题进行分析总结；三是关注创新与新技术开展，避免手术进入误区，正确理解创新内涵， 开展新技术要符合多方面原则，结合外侧半月板缝合和后交叉韧带术中损伤腘窝血管神经等严重并发症，强调未认真评估手术能力盲目开展新技术的风险，提醒医生依据自身条件循序渐进开展手术；四是关注临床基础研究提高膝关节伤病诊疗水平，重点是生物力学、解剖病理学、影像学、新材料、新术式的基础研究。本期刊出了膝前交叉韧带修复及重建术后再次损伤翻修等热点难点问题的一些手术方式选择，并强调加强围手术期康复护理研究。

Abstract:

With the development of arthroscopic knee surgery techniques and instruments, the diagnosis and treatment level of knee joint injuries has improved. However, the undesirable phenomenon of emphasizing surgical operations while neglecting diagnostic capabilities has emerged, resulting in misdiagnosis and mistreatment. This issue of the Orthopedic Journal of China features key content related to the diagnosis and treatment of knee injuries: First, pay attention to clinical basic work to avoid misdiagnosis and missed diagnosis. It is necessary to attach importance to basic work such as medical history collection, and reduce misdiagnosis and missed diagnosis caused by weak basic knowledge and blind confidence. Taking multiple ligament injuries of the knee as an example, this paper analyzes the progress and misunderstandings in diagnosis and treatment, and emphasizes the importance of strengthening the training of young doctors, the mentorship and guidance of experts at all levels, and the meticulous work of clinical doctors close to clinical practice. Combined with the difficulty in diagnosing posterior cruciate ligament injury, this paper introduces the application of MRI at 90° flexion position to change the "?"- shaped PCL sign in conventional examination into a "straight lines", making the diagnosis more intuitive and accurate. Second, pay attention to surgical indications and standardized operations to avoid intraoperative and postoperative complications. Continuously study standardized procedures such as surgical indications for knee injuries. This issue analyzes and summarizes hot and controversial events, such as nerve and blood vessel injury during lateral meniscus suture and how to reduce postoperative recurrence during arthroscopic popliteal cyst surgery. Third, pay attention to innovation and the development of new technologies to avoid surgical misunderstandings. Correctly understand the connotation of innovation. The development of new technologies should comply with multiple principles. Considering serious complications, such as intraoperative injury to the popliteal vessels and nerves during lateral meniscus suture, and posterior cruciate ligament surgery, emphasize the risks of blindly developing new technologies without carefully assessing surgical capabilities, and remind doc-tors to carry out surgeries step by step based on their own conditions. Fourth, focus on clinical basic research to improve the diagnosis and treatment level of knee diseases, with an emphasis on basic research in biomechanics, anatomical pathology, imaging, new materials, and new surgical methods. This issue publishes some surgical approach options for hot and difficult issues, such as revision of re-injured anterior cruciate ligament after repair and reconstruction, and emphasizes strengthening the research on perioperative rehabilitation nursing.