Department of Orthopaedic Surgery and Sportsmedicine, Valiant Clinic/Houston Methodist, Dubai, United Arab Emirates.
University of Texas Health Science Centre, San Antonio, Texas, U.S.A.
Arthroscopy. 2022 Apr;38(4):1051-1065. doi: 10.1016/j.arthro.2021.09.031. Epub 2021 Oct 14.
To perform a Delphi consensus for the treatment of patients with shoulder impingement with intact rotator cuff tendons, comparing North American with European shoulder surgeon preferences.
Nineteen surgeons from North America (North American panel [NAP]) and 18 surgeons from Europe (European panel [EP]) agreed to participate and answered 10 open-ended questions in rounds 1 and 2. The results of the first 2 rounds were used to develop a Likert-style questionnaire for round 3. If agreement at round 3 was ≤60% for an item, the results were carried forward into round 4. For round 4, the panel members outside consensus (>60%, <80%) were contacted and asked to review their response. The level of agreement and consensus was defined as 80%.
There was agreement on the following items: impingement is a clinical diagnosis; a combination of clinical tests should be used; other pain generators must be excluded; radiographs must be part of the workup; magnetic resonance imaging is helpful; the first line of treatment should always be physiotherapy; a corticosteroid injection is helpful in reducing symptoms; indication for surgery is failure of nonoperative treatment for a minimum of 6 months. The NAP was likely to routinely prescribe nonsteroidal anti-inflammatory drugs (NAP 89%; EP 35%) and consider steroids for impingement (NAP 89%; EP 65%).
Consensus was achieved for 16 of the 71 Likert items: impingement is a clinical diagnosis and a combination of clinical tests should be used. The first line of treatment should always be physiotherapy, and a corticosteroid injection can be helpful in reducing symptoms. The indication for surgery is failure of no-operative treatment for a minimum of 6 months. The panel also agreed that subacromial decompression is a good choice for shoulder impingement if there is evidence of mechanical impingement with pain not responding to nonsurgical measures.
Level V, expert opinion.
针对肩袖完整的肩峰下撞击症患者的治疗进行德尔菲共识研究，比较北美和欧洲肩关节外科医生的偏好。
19 名来自北美的外科医生（北美小组[NAP]）和 18 名来自欧洲的外科医生（欧洲小组[EP]）同意参与，并在第 1 轮和第 2 轮回答了 10 个开放式问题。第 1 轮和第 2 轮的结果用于为第 3 轮开发李克特式问卷。如果第 3 轮的某一项的共识度≤60%，则将结果带入第 4 轮。对于第 4 轮，未达成共识的小组外部成员（>60%，<80%）被联系并要求审查他们的回复。定义的共识水平为 80%。
在以下项目上达成了一致：撞击症是一种临床诊断；应结合临床检查；必须排除其他疼痛源；影像学检查必须是检查的一部分；磁共振成像（MRI）有帮助；一线治疗应始终是物理治疗；皮质类固醇注射有助于减轻症状；非手术治疗至少 6 个月失败是手术的指征。北美小组（NAP）可能会常规开具非甾体类抗炎药（NAP 89%；EP 35%），并考虑使用类固醇治疗撞击症（NAP 89%；EP 65%）。
对 71 个李克特项目中的 16 个达成了共识：撞击症是一种临床诊断，应结合临床检查。一线治疗应始终是物理治疗，皮质类固醇注射可有助于减轻症状。非手术治疗至少 6 个月失败是手术的指征。小组还同意，如果有机械撞击的证据且疼痛对非手术治疗无反应，肩峰下撞击症行肩峰下减压术是一个不错的选择。
五级，专家意见。
