背景:迄今为止,肱骨近端骨折(PHF)的治疗决策过程仍存在争议,没有既定或常用的治疗方案。识别影响治疗决策的骨折和患者相关因素对于开发此类治疗算法至关重要。这项研究的目的是为临床应用和科学研究确定PHF的临床相关骨折和患者相关因素的德尔菲共识。
方法:在一个由预选的有经验的肩关节外科医师组成的国际小组中进行了一项在线调查。产生影响PHF后治疗结果的骨折相关和患者相关因素的循证列表,并由委员会成员通过在线调查进行审查。对拟议的因素进行了定义修订,自由文本中提到的第一轮建议被列为第二轮调查的可能因素。共识被定义为至少有三分之二多数同意。
结果:Delphi共识小组由18名肩部外科医生组成,他们完成了2轮在线调查。在PHF的情况下,对于影响治疗决定的三个与骨折相关的因素,超过三分之二的小组达成了一致:头部劈裂骨折,脱臼结节,和骨折脱位。在所有与患者相关的因素中,三分之二的共识是两个因素:年龄和肩袖撕裂性关节病.
结论:这项研究成功地就影响肱骨近端骨折治疗决策的因素进行了德尔菲共识。记录的因素将有助于未来研究的临床评估和科学验证。
BACKGROUND: Hitherto, the decision-making process for treatment of proximal humerus fractures (PHF) remains controversial, with no established or commonly used treatment regimens. Identifying fracture- and patient-related factors that influence treatment decisions is crucial for the development of such treatment algorithms. The objective of this study was to define a Delphi
consensus of clinically relevant fracture- and patient-related factors of PHF for clinical application and scientific research.
METHODS: An online survey was conducted among an international panel of preselected experienced shoulder surgeons. An evidence-based list of fracture-related and patient-related factors affecting treatment outcome after PHF was generated and reviewed by the members of the committee through online surveys. The proposed factors were revised for definitions, and suggestions from the first round mentioned in the free text were included as possible factors in the second round of surveys.
Consensus was defined as having at least a two-thirds majority agreement.
RESULTS: The Delphi
consensus panel consisted of 18 shoulder surgeons who completed 2 rounds of online surveys. There was an agreement of more than two-thirds of the panel for three fracture-related factors affecting treatment decision in the case of PHF: head-split fracture, dislocated tuberosities, and fracture dislocation. Of all patient-related factors, a two-thirds
consensus was reached for two factors: age and rotator cuff tear arthropathy.
CONCLUSIONS: This study successfully conducted a Delphi
consensus on factors influencing decision-making in the treatment of proximal humeral fractures. The documented factors will be useful for clinical evaluation and scientific validation in future studies.