Rachuene Pududu Archie, Dey Roopam, Kauta Ntambue Jimmy, Sivarasu Sudesh, du Plessis Jean-Pierre, Roche Stephen, Vrettos Basil
Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa - Department of Orthopaedics, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa.
Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa - Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, South Africa - Biomedical Engineering Research Centre (BMERC), University of Cape Town, South Africa - Health through Physical Activity Lifestyle and Sports (HPALS), University of Cape Town, South Africa.
SICOT J. 2024;10:23. doi: 10.1051/sicotj/2024021. Epub 2024 May 30.
Pre-operative planning for reverse shoulder arthroplasty (RSA) poses challenges, particularly when dealing with glenoid bone loss. This modified Delphi study aimed to assess expert consensus on RSA planning processes and rationale, specifically targeting low-resourced institutions. Our objective was to offer pre-operative decision-making algorithms tailored for surgeons practising in resource-constrained hospitals with limited access to computed tomography (CT) scans.
A working group generated statements on pre-operative imaging and glenoid of glenoid morphology and intra-operative decision-making. The study was conducted in three stages, with virtual consensus meetings in between. Stages 2 and 3 consisted only of closed questions/statements. The statements with over 70% were considered consensus achieved and those with less than 10% were considered disagreement consensus achieved.
Twelve shoulder surgeons participated, with 67% having over five years of experience in shoulder arthroplasty. In the absence of glenoid bone loss, the sole use of plain radiographs for pre-operative planning reached consensus and is recommended by these groups, while 100% advise using CT scans when bone loss is present. Most surgeons (70%) recommend using patient-specific instrumentation (PSI) in cases of structural bone loss. Most of the statements on intra-operative decision-making related to component placement and enhancing stability failed to reach consensus.
While consensus was achieved on most aspects of pre-operative imaging and planning, technical aspects of surgery lacked consensus. Planning for patients with structural glenoid bone loss necessitates CT scans and planning tools.
反向肩关节置换术（RSA）的术前规划具有挑战性，尤其是在处理肩胛盂骨缺损时。这项改良的德尔菲研究旨在评估关于RSA规划流程和基本原理的专家共识，特别针对资源匮乏的机构。我们的目标是为在资源有限且难以获得计算机断层扫描（CT）的医院工作的外科医生提供量身定制的术前决策算法。
一个工作组就术前成像、肩胛盂形态以及术中决策制定了相关陈述。该研究分三个阶段进行，中间设有虚拟共识会议。第二和第三阶段仅包含封闭式问题/陈述。超过70%达成一致的陈述被视为达成共识，低于10%达成一致的陈述被视为未达成共识。
12名肩关节外科医生参与了研究，其中67%在肩关节置换方面有超过五年的经验。在不存在肩胛盂骨缺损的情况下，仅使用普通X线片进行术前规划达成了共识，这些团队推荐采用这种方法，而当存在骨缺损时，100%的人建议使用CT扫描。大多数外科医生（70%）建议在存在结构性骨缺损的情况下使用定制器械（PSI）。大多数关于术中决策制定的陈述，涉及假体组件放置和增强稳定性方面，未达成共识。
虽然在术前成像和规划的大多数方面达成了共识，但手术技术方面缺乏共识。对于存在结构性肩胛盂骨缺损的患者进行规划时，需要CT扫描和规划工具。
