[Expert consensus on reconstruction treatment for irreparable posterosuperior massive rotator cuff tears].

内容摘要

Irreparable posterosuperior massive rotator cuff tears represent a common and challenging condition in shoulder surgery. Reconstruction procedures can effectively restore the anatomical structure and function of the shoulder joint and, as an important joint-preserving treatment option for irreparable posterosuperior massive rotator cuff tears, have garnered increasing attention and application among shoulder surgeons. However, a lack of consensus currently exists regarding its definition, diagnostic criteria, and treatment strategies, leading to inconveniences in clinical decision-making and academic communication. To standardize the indications, surgical option selection, and postoperative rehabilitation strategies for the reconstruction of irreparable posterosuperior massive rotator cuff tears, the Shoulder Joint Study Group of the Fifth Committee of the Chinese Society of Sports Medicine of Chinese Medical Association organized experts in the relevant field to develop a consensus using a modified Delphi method, which involved two rounds of questionnaire surveys and one online expert meeting. After reviewing domestic and foreign literature, the consensus drafting group compiled the initial draft and questionnaire items. Suitable topics were selected via the first round of expert voting, and the recognition level of responses to each consensus question was determined in the second round. Online expert discussions were subsequently held to refine wording and reconcile divergent views, yielding the final consensus. A consensus is confirmed with an approval rate of no less than 85%. It is classified into three tiers: high consensus (95.0%-100%), general consensus (90.0%-94.9%), and basic consensus (85.0%-89.9%). This consensus ultimately formulated 10 recommendations focusing on core issues, including the definition and diagnosis of irreparable posterosuperior massive rotator cuff tears, the indications and timing of reconstruction surgery, the selection and application principles of commonly used reconstruction techniques, perioperative management and phased rehabilitation protocols, and the prevention and treatment of postoperative complications. This consensus aims to provide a clinical decision-making reference for orthopedic surgeons, sports medicine physicians, and rehabilitation specialists, thereby promoting the standardization and individualization of reconstruction treatment for irreparable massive rotator cuff tears and improving patient functional outcomes. 后上不可修复巨大肩袖撕裂是肩关节外科领域的治疗难点。重建术式作为重要的保肩治疗手段，其临床应用日益广泛，但目前尚缺乏统一的定义、诊断标准及重建治疗规范。为提供系统性临床指导，推动诊疗策略的规范化与个体化，由中华医学会运动医疗分会第五届委员会肩关节学组发起，组织国内相关领域专家，严格遵循改良Delphi法，通过2轮问卷调查及1轮线上专家论证会议，系统梳理并整合循证医学证据与专家临床经验制定本共识。共识起草小组在参阅国内外相关文献后，拟定共识初稿及问卷条目，经第1轮专家投票筛选合适题目，第2轮专家投票明确各共识问题的认可程度；随后组织线上专家讨论，进一步优化条款表述、统一分歧意见，最终形成本共识。共识认定标准为赞成率≥85%，并根据赞成率高低分为3级：高度共识（95.0%～100%）、普遍共识（90.0%～94.9%）、基本共识（85.0%～89.9%）。本共识围绕后上不可修复巨大肩袖撕裂的定义与诊断、重建手术的适应证与时机、常用重建技术的选择与应用要点、围术期管理与阶段性康复方案，以及术后并发症的防治等核心问题，共形成推荐意见10条。本共识基于当前最佳证据和专家意见，为骨科、运动医学科及康复科医师在重建治疗后上不可修复巨大肩袖撕裂的临床决策中提供重要参考。遵循共识建议，有望规范重建技术的应用，优化围术期管理，从而改善患者肩关节功能与生活质量。.