背景:尽管常规进行肘部和腕部的图像引导介入手术,关于这种治疗的文献证据很少.我们的目的是就肘部和腕部周围的图像引导介入手术的已发表证据达成基于Delphi的共识,并提供有关该主题的临床适应症。
方法:来自欧洲肌肉骨骼放射学学会的45名图像引导介入肌肉骨骼手术专家参与了这项基于Delphi的共识研究。根据牛津循证医学中心的证据水平,所有小组成员都对2018年9月更新的关于肘部和腕部周围图像引导介入程序的已发表论文进行了审查和评分。当超过95%的小组成员同意时,对小组成员起草的关于临床适应症的声明的共识被认为是“有力”,如果超过80%的小组成员同意,则被认为是“广泛”。
结果:起草了18份声明,12关于肌腱手术,6关于关节内手术。只有声明#15达到了最高水平的证据(超声引导的类固醇腕部注射导致更大的疼痛减轻和更大的获得临床上重要的改善的可能性)。十七个声明获得了强烈共识(94%),而其中一人获得广泛共识(6%)。
结论:关于肘部和腕部周围的图像引导介入手术的已发表论文的证据仍然不足。在17/18(94%)关于临床适应症的小组提供的声明中已经达成了强烈共识。需要大型前瞻性随机试验来更好地定义这些程序在临床实践中的作用。
结论:•专家组提供了18种基于证据的关于肘部和腕部周围图像引导介入手术的临床适应症的陈述。•只有15号声明达到了最高水平的证据:超声引导的类固醇腕部注射导致更大的疼痛减轻和更大的获得临床上重要的改善的可能性。•十七个声明获得了强烈共识(94%),而一份声明(6%)获得了广泛共识。
BACKGROUND: Although image-guided interventional procedures of the elbow and wrist are routinely performed, there is poor evidence in the literature concerning such treatments. Our aim was to perform a Delphi-based
consensus on published evidence on image-guided interventional procedures around the elbow and wrist and provide clinical indications on this topic.
METHODS: A board of 45 experts in image-guided interventional musculoskeletal procedures from the European Society of Musculoskeletal Radiology were involved in this Delphi-based
consensus study. All panelists reviewed and scored published papers on image-guided interventional procedures around the elbow and wrist updated to September 2018 according to the Oxford Centre for Evidence-based Medicine levels of evidence.
Consensus on statements drafted by the panelists about clinical indications was considered as \"strong\" when more than 95% of panelists agreed and as \"broad\" if more than 80% agreed.
RESULTS: Eighteen statements were drafted, 12 about tendon procedures and 6 about intra-articular procedures. Only statement #15 reached the highest level of evidence (ultrasound-guided steroid wrist injections result in greater pain reduction and greater likelihood of attaining clinically important improvement). Seventeen statements received strong
consensus (94%), while one received broad
consensus (6%).
CONCLUSIONS: There is still poor evidence in published papers on image-guided interventional procedures around the elbow and wrist. A strong consensus has been achieved in 17/18 (94%) statements provided by the panel on clinical indications. Large prospective randomized trials are needed to better define the role of these procedures in clinical practice.
CONCLUSIONS: • The panel provided 18 evidence-based statements on clinical indications of image-guided interventional procedures around the elbow and wrist. • Only statement #15 reached the highest level of evidence: ultrasound-guided steroid wrist injections result in greater pain reduction and greater likelihood of attaining clinically important improvement. • Seventeen statements received strong consensus (94%), while broad
consensus was obtained by 1 statement (6%).