腰椎后路皮质骨轨迹螺钉内固定技术应用中国专家共识制定的改良Delphi调查研究

Modified Delphi study on building Chinese experts’ consensus on cortical bone trajectory fixation for lumbar spine surgery

目的 应用改良 Delphi 调查研究法制定腰椎后路皮质骨轨迹螺钉内固定技术 (cortical bone trajectory,CBT) 应用中国专家共识。方法 应用文献检索法在 PubMed、Medline、EMBASE、Springer link、Wiley Online Library、CNKI、万方数据库、维普网等中英文数据库检索腰椎后路 CBT 技术应用的相关文献,参考我国现有在腰椎后路 CBT 技术应用的诊疗资料及标准,初步拟定包含 CBT 技术的基础研究、适应证与禁忌证、与椎弓根螺钉相比的优劣势、术前评估、手术操作、并发症、术后关注点等 7 个方面共 155 个相关问题,制定出腰椎后路 CBT 技术应用中国专家共识草案。专家共识制定专家组为中国康复医学会脊柱脊髓专业委员会腰椎研究学组委员,应用改良 Delphi 调查研究法收集专家的反馈意见,并根据意见对草案内容进行修改及调整。经过三轮专家评估,专家赞同百分比 ≥ 70% 的为达成的共识。结果 共 81 位专家组成本次共识制定的专家组,三轮专家评定问卷回收量分别为 72 (88.9%)、70 (86.4%)、69 (85.2%)。三轮专家评定后,共有 73 个问题 (47.1%) 达成共识。结论 腰椎后路 CBT 技术作为现今的研究热点内容,仍缺乏高质量、多中心、前瞻性随机研究,国内外对其技术应用的观点尚有不同,因此应用改良 Delphi 调查研究法制定的专家共识在循证医学的支持下具有一定的代表性和参考作用。

Objective To explore the application of modified Delphi research on building Chinese experts’ consensus on cortical bone trajectory (CBT) for lumbar pedicle screws.Methods Related literatures of cortical bone trajectory for lumbar surgery were searched in both Chinese and English databases,and Chinese clinical data and specifications of the technique were referred.A craft was made about clinical interviewing,surgical technique,and differences between CBT and traditional pedicle screw with summarizing of the related literatures and clinical specifications.Members of Chinese Society for the Study of the Lumbar Spine (CSSLS,including 81 experts) were selected to collect expert feedback utilizing the modified Delphi method.Total three experts’ evaluations were organized,and ≥ 70% was set as the percentage of expert approval.Results A total of 81 experts participated in the present study,and the number of questionnaires collected was 72 (88.9%),70 (86.4%) and 69 (85.2%) during the three rounds,after which consensus was reached on 47.1% among 155 questions.Conclusions Cortical bone trajectory fixation for lumbar spine surgery still lacks of high quality,multi-center,prospective and randomized studies.The application of the novel technology is controversial,so this modified Delphi study to develop consensus of experts under the support of evidence-based medicine has certain representativeness and reference.