CAJ | 학술논문

目的：应用改良Delphi法制定神经根型颈椎病治疗专家共识。方法应用文献检索法检索国内外关于神经根型颈椎病治疗的相关文献，并参考我国现有的神经根型颈椎病诊疗资料及规范，初步拟定包含八个方面（非手术治疗有效比、颈部制动、理疗、药物治疗、手术适应证、手术禁忌证、颈前路手术减压、颈前路手术内固定植入）23个问题的神经根型颈椎病治疗草案。在全国多个地区选取有专业代表性的专家组成专家组，应用改良Delphi法收集专家反馈意见，并对草案中的内容进行筛选及修改。共组织三次专家评估，专家赞同百分比设为≥70%。结果共30位专家组成专家组，三次专家评估的问卷回收数量分别为30份（100%）、24份（80.0%）、16份（53.3%）；三次专家评估完成后，专家赞同百分率≥70%的问题共计18个，占所有问题的64.3%（18/28）。专家在七个方面达成共识，包括非手术治疗有效比（1个）、颈部制动（1个）、理疗（1个）、药物治疗（5个）、手术适应证（3个）、手术禁忌证（4个）、手术方式（3个）。结论在目前神经根型颈椎病部分治疗方案仍缺乏循证医学支持的情况下，应用改良Delphi法制定的专家共识代表性强、意见趋同性好，在研究过程中部分未达成共识的治疗方案为今后研究指明了方向。
목적：응용개량Delphi법제정신경근형경추병치료전가공식。방법응용문헌검색법검색국내외관우신경근형경추병치료적상관문헌，병삼고아국현유적신경근형경추병진료자료급규범，초보의정포함팔개방면（비수술치료유효비、경부제동、리료、약물치료、수술괄응증、수술금기증、경전로수술감압、경전로수술내고정식입）23개문제적신경근형경추병치료초안。재전국다개지구선취유전업대표성적전가조성전가조，응용개량Delphi법수집전가반궤의견，병대초안중적내용진행사선급수개。공조직삼차전가평고，전가찬동백분비설위≥70%。결과공30위전가조성전가조，삼차전가평고적문권회수수량분별위30빈（100%）、24빈（80.0%）、16빈（53.3%）；삼차전가평고완성후，전가찬동백분솔≥70%적문제공계18개，점소유문제적64.3%（18/28）。전가재칠개방면체성공식，포괄비수술치료유효비（1개）、경부제동（1개）、리료（1개）、약물치료（5개）、수술괄응증（3개）、수술금기증（4개）、수술방식（3개）。결론재목전신경근형경추병부분치료방안잉결핍순증의학지지적정황하，응용개량Delphi법제정적전가공식대표성강、의견추동성호，재연구과정중부분미체성공식적치료방안위금후연구지명료방향。
Objective Cervical radiculopathy treatment experts' consensus to establish radiculopathy type by using the modified Delphi method. Methods Use document retrieval method to review information and articles about the treatment guidelines and articles of cervical radiculopathy including domestic and international areas, established a protocol about clini?cal consensus of the treatments for cervical radiculopathy. This protocol included 23 questions (the effective proportion of non?operating therapy, neck immobilization, physiotherapy, pharmacologic treatment, surgical indications, contraindications, anteri?or surgical decompression, anterior surgical implants). We performed a modified Delphi survey in which current professional opinions from experienced experts, representing from almost all of the Chinese provinces, were gathered. And then we modi?fied the protocol according to those professional opinions. Three rounds were performed and finally we established consensus. Consensus was achieved with ≥70% agreement. Results The panel included 30 experienced experts. The recycling question?naire's quantity of three rounds were 30(100%), 24(80%) and 16(53.3%) respectively. After three expert assessments, there were 18 questions which achieved with≥70%agreement and these questions accounted for 64.3%(18/28) of all the questions. Consen?sus of the treatments for cervical radiculopathy was reached on 7 aspects, including:the effective proportion of non?operating thera?py (1 question), neck immobilization (1 question), physiotherapy (1 question), pharmacologic treatment (5 questions), surgical indi?cations (3 questions), contraindications (4 questions), surgery (3 questions). Conclusion This modified Delphi study had reached a consensus concerning several treatment issues on cervical radiculopathy which had strong representativeness of experts and good convergence of opinions. In the absence of high?level evidence, at present, these experts' opinion findings will guide health care providers to define appropriate treatment in their regions. Areas with no consensus provide excellent insight for future research.