目的:本研究的目的是通过改良的Delphi方法对肩关节假性麻痹和假性轻瘫的定义建立共识。
方法:使用改良的Delphi技术对假性麻痹的诊断进行了一致的定义,和来自11个国家的26名肩部/运动外科医生,根据他们在该领域的专业知识水平选择,参与了这些共识声明。共识被定义为达成80-89%的协议,而强烈的共识被定义为90-99%的共识,与拟议的声明达成了100%的一致意见。
结果:关于假麻痹诊断的三个陈述达成了强烈(>89%)共识:被动运动范围(ROM)应不受影响,如果注射利多卡因能显著改善活动范围,则不应考虑被动外展范围,并应排除诊断.此外,达成共识(>79%),不应考虑外部旋转的活动范围进行诊断,必须排除作为活动受限原因的疼痛,并且限制主动屈曲和外部旋转之间的区别应该通过ROM而不是撕裂特性来进行。关于规模的声明无法达成共识,肌腱数量或袖口撕裂的慢性。对于允许的有效屈曲范围或假性麻痹和假性轻瘫之间的差异也没有达成共识。
结论:采用改良的Delphi方法对肩关节假性麻痹和假性轻瘫的定义达成共识。不幸的是,几乎一半的声明没有达成共识,在RCT设置中,对于假麻痹诊断的统一定义,未能在所有领域达成一致.此外,对于如何或是否应将假性麻痹与假性轻瘫区分开来,目前尚未达成一致意见.基于对这些术语缺乏共识,研究应明确报告这些术语在使用时是如何定义的。
BACKGROUND: The purpose of this study was to establish
consensus statements via a modified Delphi process on the definition of shoulder pseudoparalysis and pseudoparesis.
METHODS: A
consensus process on the definition of a diagnosis of pseudoparalysis utilizing a modified Delphi technique was conducted, and 26 shoulder/sports surgeons from 11 countries, selected based on their level of expertise in the field, participated in these consensus statements.
Consensus was defined as achieving 80%-89% agreement, whereas strong
consensus was defined as 90%-99% agreement, and unanimous
consensus was indicated by 100% agreement with a proposed statement.
RESULTS: Three statements regarding the diagnosis of pseudoparalysis reached strong (>89%) consensus: passive range of motion should be unaffected, the passive range of abduction should not be considered, and diagnosis should be excluded if lidocaine injection produces a substantial improvement in range of motion. Additionally, consensus (>79%) was reached that the active range of external rotation should not be considered for diagnosis, pain as a cause of restricted motion must be excluded, and that distinctions between restricted active flexion and external rotation should be made by range of motion rather than tear characteristics. No
consensus could be reached on statements regarding the size, number of tendons or chronicity of cuff tears. Nor was there agreement on the active range of flexion permitted or on the difference between pseudoparalysis and pseudoparesis.
CONCLUSIONS: A modified Delphi process was utilized to establish consensus on the definition of shoulder pseudoparalysis and pseudoparesis. Unfortunately, almost half of the statements did not reach consensus, and agreement could not be reached across all domains for a unifying definition for the diagnosis of pseudoparalysis in the setting of rotator cuff tears. Furthermore, it was not agreed how or whether pseudoparalysis should be differentiated from pseudoparesis. Based on the lack of a consensus for these terms, studies should report explicitly how these terms are defined when they are used.