发散式冲击波促进胫骨骨折术后愈合效果的观察
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摘要
目的:探讨早期发散式冲击波治疗对促进胫骨骨折术后愈合的效果。方法:2014年1月1日-2017年9月30日在北京市平谷区医院行胫骨骨折固定手术的患者78例,按照手术先后顺序的单双数分为两组,研究组中不愿接受冲击波治疗的患者调整到对照组。研究组32例于术后4周开始应用冲击波治疗以促进骨折愈合,对照组46例术后进行常规治疗、功能练习,不应用冲击波治疗。比较两组患者的愈合时间、愈合率、并发症、Johner-Wruhs功能评分等。结果:研究组无一例不愈合发生,无严重并发症发生。对照组有2例不愈合、10例延迟愈合发生。研究组愈合时间小于对照组,在术后3个月、6个月骨折愈合率,术后功能方面高于对照组,差异有显著统计学意义(P<0.05)。结论:对胫骨骨折患者进行早期发散式冲击波治疗能明显缩短骨折的愈合时间,显著降低骨折延迟愈合和不愈合的发生率,是一种安全有效的促进骨折愈合的新方法。
Objective: To explore the efficacy of radial shock wave therapy(RSWT) for healing of tibial fracture after operation. Methods: Seven-eight patients undergoing the surgery for tibial fracture admitted to Beijing Pinggu Hospital form Jan. 1 st 2014 to Sep. 30th 2017 were divided into two groups according to the sequence of operation and patient' wish. Thirty-two patients in the study group received RSWT 4 weeks after operation to promote fracture healing, while the 46 patients in the control group received routine treatment and functional exercises after operation,without shockwave therapy. The healing time, healing rate, complications and Johner-Wruhs functional score were recorded. Results: There was no serious complications such as nonunion or delayed union occurred in the study group, but there were 2 cases of nonunion and 10 cases of delayed union in the control group. The healing time of the study group was shorter than that of the control group(14 weeks vs. 16 weeks). The healing rate of the study group 3 months(62.5%vs. 26.1%) and 6 months(100.0 vs. 78.3%) after treatment and function 6 months after treatment( the excellent and good outcome rate of Jonher-Wuchs scores: 93.8% vs.76.1%) were higher than those of the control group, with significant statistical differences(P < 0.05). Conclusions: RSWT can significantly shorten the healing time of tibial fractures and reduce the incidence of nonunion and delayed union. It is a safe and effective method for promoting fracture healing.
Objective: To explore the efficacy of radial shock wave therapy(RSWT) for healing of tibial fracture after operation. Methods: Seven-eight patients undergoing the surgery for tibial fracture admitted to Beijing Pinggu Hospital form Jan. 1 st 2014 to Sep. 30th 2017 were divided into two groups according to the sequence of operation and patient' wish. Thirty-two patients in the study group received RSWT 4 weeks after operation to promote fracture healing, while the 46 patients in the control group received routine treatment and functional exercises after operation,without shockwave therapy. The healing time, healing rate, complications and Johner-Wruhs functional score were recorded. Results: There was no serious complications such as nonunion or delayed union occurred in the study group, but there were 2 cases of nonunion and 10 cases of delayed union in the control group. The healing time of the study group was shorter than that of the control group(14 weeks vs. 16 weeks). The healing rate of the study group 3 months(62.5%vs. 26.1%) and 6 months(100.0 vs. 78.3%) after treatment and function 6 months after treatment( the excellent and good outcome rate of Jonher-Wuchs scores: 93.8% vs.76.1%) were higher than those of the control group, with significant statistical differences(P < 0.05). Conclusions: RSWT can significantly shorten the healing time of tibial fractures and reduce the incidence of nonunion and delayed union. It is a safe and effective method for promoting fracture healing.
引文
[1]Borrelli Jr J,Prickett WD,Ricci WM.Treatment of nonunions and osseous defects with bone graft and calcium sulfate.[J].Clinical Orthopaedics and Related Research,2003,(411):245-254.
[2]常文利,张英泽,陈伟.胫骨中下段骨折不愈合原因的研究进展[J].中国骨与关节杂志,2017,6(9):713-716.
[3]章晓云,陈跃平.骨不连的研究现状及治疗进展[J].现代中西医结合杂志,2013,22(13):1478-1480.
[4]张庆熙,高福强,孙伟,等.经皮微创钢板内固定与切开复位内固定治疗成人胫骨远端骨折的Meta分析[J].中国骨伤,2015,28(08):757-762.
[5]尹伟,马兴,刘丰虎,等.MIPPO技术对胫骨骨折愈合率及骨折愈合时间作用分析[J].创伤外科杂志,2017,19(07):542-543.
[6]Schmitz C,Csaszar NB,Milz S,et al. Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions:a systematic review on studies listed in the PEDro database[J].Br Med Bull,2015,116:115-138.
[7]Bara T,Synder M.Nine-years experience with the use of shock waves for treatment of bone union disturbances[J].Ortop Traumatol Rehabil,2007,9(3):254-258.
[8]沈保磊,刘国浚,王耀生,等.体外冲击波治疗骨不连与骨折延迟愈合的应用进展[J].中国现代药物应用,2015,9(22):273-274.
[9]刘宇,张庆宏,范恒俊,等.外固定支架在GustiloⅢ型胫腓骨开放性骨折分期治疗中的临床价值[J].医学综述,2015,21(2):348-350.
[10]Auld TS,Hwang JS,Stekas N,et al.The correlation between the OTA/AO classification system and compartment syndrome in both bone forearm fractures[J].J Orthop Trauma,2017,31(11):606-609.
[11]Peiro A,Andres F,Fernandez-Esteve F.Fernandez-esteve F(1977)acute monteggia lesions in children[J].J Bone Joint Surg Am,1977,59(1):92-97.
[12]Hak DJ,Fitzpatrick D,Bishop JA,et al.Delayed union and nonunions:Epidemiology,clinical issues,and financial aspects[J].Injury,2014,45(Suppl 2):S3-7.
[13]R,Johner,O,Wruhs.Classification of tibial shaft fractures and correlation with results after rigid internal fixation.[J].Clin Orthop Related Res,1983,(178):7-25.
[14]骨肌疾病体外冲击波疗法中国专家共识(第2版)[J].中国医学前沿杂志(电子版),2017,9(2):25-33.
[1 5]Ogden,JA,Toth-Kischkat,A,Schultheiss,R.Principles of shock wave therapy.[J].Clini Orthopaed Related Res,2001,(387):8-17.
[16]郭小波,李平,卢向东,刘强.体外冲击波对兔缺血坏死股骨头内BMP表达的影响[J].山西医科大学学报,2009,40(3):214-218.
[17]李平,郭小波,刘宇强,刘强,范晓洁.体外冲击波疗法对激素性股骨头缺血坏死中血管内皮生长因子及骨形态发生蛋白的影响[J].中华临床医师杂志(电子版),2014,(13):2474-2479.
[18]Wang CJ,Yang KD,Ko JY,et al.The effects of shockwave on bone healing and systemic concentrations of nitric oxide(NO),TGF-β1,VEGF and BMP-2 in long bone nonunions[J].Nitric Oxide,2009,20(4):298-303.
[19]McKibbin B.The biology of fracture healing in long bones[J].J Bone Joint Surg Br,1978,60-B(2):150-162.
[20]Kertzman P,Csaszar NBM,Furia JP,et al.Radial extracorporeal shock wave therapy is efficient and safe in the treatment of fracture nonunions of superficial bones:a retrospective case series[J].J Orthop Surg Res,2017,12(1):164.
[21]Vulpiani MC,Vetrano M,Conforti F,et al.Effects of extracorporeal shock wave therapy on fracture nonunions[J].Am J Orthop(Belle Mead NJ),2012,41(9):E122-E127.
[22]孙旭东,马艳春,孙萍.冲击波治疗骨折延迟愈合36例临床观察[J].中国实用医药,2015,10(20):109-110.
[2]常文利,张英泽,陈伟.胫骨中下段骨折不愈合原因的研究进展[J].中国骨与关节杂志,2017,6(9):713-716.
[3]章晓云,陈跃平.骨不连的研究现状及治疗进展[J].现代中西医结合杂志,2013,22(13):1478-1480.
[4]张庆熙,高福强,孙伟,等.经皮微创钢板内固定与切开复位内固定治疗成人胫骨远端骨折的Meta分析[J].中国骨伤,2015,28(08):757-762.
[5]尹伟,马兴,刘丰虎,等.MIPPO技术对胫骨骨折愈合率及骨折愈合时间作用分析[J].创伤外科杂志,2017,19(07):542-543.
[6]Schmitz C,Csaszar NB,Milz S,et al. Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions:a systematic review on studies listed in the PEDro database[J].Br Med Bull,2015,116:115-138.
[7]Bara T,Synder M.Nine-years experience with the use of shock waves for treatment of bone union disturbances[J].Ortop Traumatol Rehabil,2007,9(3):254-258.
[8]沈保磊,刘国浚,王耀生,等.体外冲击波治疗骨不连与骨折延迟愈合的应用进展[J].中国现代药物应用,2015,9(22):273-274.
[9]刘宇,张庆宏,范恒俊,等.外固定支架在GustiloⅢ型胫腓骨开放性骨折分期治疗中的临床价值[J].医学综述,2015,21(2):348-350.
[10]Auld TS,Hwang JS,Stekas N,et al.The correlation between the OTA/AO classification system and compartment syndrome in both bone forearm fractures[J].J Orthop Trauma,2017,31(11):606-609.
[11]Peiro A,Andres F,Fernandez-Esteve F.Fernandez-esteve F(1977)acute monteggia lesions in children[J].J Bone Joint Surg Am,1977,59(1):92-97.
[12]Hak DJ,Fitzpatrick D,Bishop JA,et al.Delayed union and nonunions:Epidemiology,clinical issues,and financial aspects[J].Injury,2014,45(Suppl 2):S3-7.
[13]R,Johner,O,Wruhs.Classification of tibial shaft fractures and correlation with results after rigid internal fixation.[J].Clin Orthop Related Res,1983,(178):7-25.
[14]骨肌疾病体外冲击波疗法中国专家共识(第2版)[J].中国医学前沿杂志(电子版),2017,9(2):25-33.
[1 5]Ogden,JA,Toth-Kischkat,A,Schultheiss,R.Principles of shock wave therapy.[J].Clini Orthopaed Related Res,2001,(387):8-17.
[16]郭小波,李平,卢向东,刘强.体外冲击波对兔缺血坏死股骨头内BMP表达的影响[J].山西医科大学学报,2009,40(3):214-218.
[17]李平,郭小波,刘宇强,刘强,范晓洁.体外冲击波疗法对激素性股骨头缺血坏死中血管内皮生长因子及骨形态发生蛋白的影响[J].中华临床医师杂志(电子版),2014,(13):2474-2479.
[18]Wang CJ,Yang KD,Ko JY,et al.The effects of shockwave on bone healing and systemic concentrations of nitric oxide(NO),TGF-β1,VEGF and BMP-2 in long bone nonunions[J].Nitric Oxide,2009,20(4):298-303.
[19]McKibbin B.The biology of fracture healing in long bones[J].J Bone Joint Surg Br,1978,60-B(2):150-162.
[20]Kertzman P,Csaszar NBM,Furia JP,et al.Radial extracorporeal shock wave therapy is efficient and safe in the treatment of fracture nonunions of superficial bones:a retrospective case series[J].J Orthop Surg Res,2017,12(1):164.
[21]Vulpiani MC,Vetrano M,Conforti F,et al.Effects of extracorporeal shock wave therapy on fracture nonunions[J].Am J Orthop(Belle Mead NJ),2012,41(9):E122-E127.
[22]孙旭东,马艳春,孙萍.冲击波治疗骨折延迟愈合36例临床观察[J].中国实用医药,2015,10(20):109-110.