目的:本研究的目的是通过改良的德尔菲诊断方法建立共识声明,非手术管理,和Bankart修复前肩关节不稳.
方法:使用改良的德尔菲技术进行了关于治疗的共识过程,来自5大洲14个国家的65名肩部外科医生参加了会议。专家被分配到9个工作组之一,这些工作组由肩前不稳定中感兴趣的特定子主题定义。
结果:在诊断和非手术治疗中达成一致的2个陈述中确定的独立因素是年龄,性别,损伤机制,不稳定事件的数量,是否需要减少,职业,运动/位置/水平发挥,碰撞运动,关节盂或肱骨骨丢失,和过度松弛。在Bankart修复中达成一致的3份声明中,其他因素包括高架运动参与,之前的肩部手术,病人的期望,并有能力遵守术后康复。此外,一致认为Bankart修复后并发症很少见,并且通过明确的康复方案可以减少复发率,下锚钉位置(间隔5-8mm),多个小锚固定点,伴随病理的治疗,小心的囊膜清创/重新附着,和适当的适应症/风险因素评估。
结论:总体而言,84%的声明达成一致或强烈共识。达成一致共识的陈述是应在急性不稳定患者中评估患者病史的方面,非手术治疗的预后因素,和Bankart修复。此外,在减少Bankart修复并发症的步骤上达成了一致共识,以及间隔5-8毫米的锚钉的放置。最后,对于肩关节固定的最佳位置没有达成共识。
方法:V级,专家意见。
OBJECTIVE: The purpose of this study was to establish
consensus statements via a modified Delphi process on the diagnosis, nonoperative management, and Bankart repair for anterior shoulder instability.
METHODS: A
consensus process on the treatment using a modified Delphi technique was conducted, with 65 shoulder surgeons from 14 countries across 5 continents participating. Experts were assigned to one of 9 working groups defined by specific subtopics of interest within anterior shoulder instability.
RESULTS: The independent factors identified in the 2 statements that reached unanimous agreement in diagnosis and nonoperative management were age, gender, mechanism of injury, number of instability events, whether reduction was required, occupation, sport/position/level played, collision sport, glenoid or humeral bone-loss, and hyperlaxity. Of the 3 total statements reaching unanimous agreement in Bankart repair, additional factors included overhead sport participation, prior shoulder surgery, patient expectations, and ability to comply with postoperative rehabilitation. Additionally, there was unanimous agreement that complications are rare following Bankart repair and that recurrence rates can be diminished by a well-defined rehabilitation protocol, inferior anchor placement (5-8 mm apart), multiple small-anchor fixation points, treatment of concomitant pathologies, careful capsulolabral debridement/reattachment, and appropriate indications/assessment of risk factors.
CONCLUSIONS: Overall, 84% of statements reached unanimous or strong
consensus. The statements that reached unanimous consensus were the aspects of patient history that should be evaluated in those with acute instability, the prognostic factors for nonoperative management, and Bankart repair. Furthermore, there was unanimous
consensus on the steps to minimize complications for Bankart repair, and the placement of anchors 5-8 mm apart. Finally, there was no
consensus on the optimal position for shoulder immobilization.
METHODS: Level V, expert opinion.