体外冲击波防治骨质疏松的研究进展
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摘要
骨质疏松发病的显著特征是骨量减少,其最严重的并发症是骨质疏松骨折。体外冲击波具有很好的成骨作用,越来越多的研究关注其对骨质疏松骨折的防治作用。通过在Pubmed、中国知网、万方医学检索冲击波与骨质疏松相关文献,并进行总结分析,对体外冲击波防治骨质疏松的治疗时机、能量选择、治疗效果进行综述,得出以下结论 :在治疗时机方面,体外冲击波可用于骨质疏松治疗的各个时期;在能量选择方面,中、高能量体外冲击波均可用于骨质疏松的防治;在治疗效果方面,体外冲击波能不同程度地改善骨质疏松患者骨量减少程度,尤其是与抗骨质疏松药物联用时,效果更好。但体外冲击波治疗骨质疏松的最佳能量及次数仍需进一步研究。
The prominent feature of osteoporosis is the reduction of bone mass. The most serious complication is osteoporotic fracture. Extracorporeal shock wave has good osteogenesis. Therefore, more and more studies pay attention to extracorporeal shock wave for prevention and treatment of osteoporotic fracture. Through searching literatures of "shock wave" and "osteoporosis" in Pubmed, CNKI and Wanfang medical database, the timing, energy selection and therapeutic effects of extracorporeal shock wave on prevention and treatment of osteoporosis were reviewed. The following conclusions were drawn: in terms of treatment timing,extracorporeal shock waves can be used in various periods; in terms of energy selection, medium and high energy extracorporeal shock waves can be used; in terms of therapeutic effects, extracorporeal shock waves can improve the degree of bone loss in patients with osteoporosis to varying degrees, especially when combined with anti-osteoporosis drugs. However, the optimal energy and frequency of treatment still need for further study.
The prominent feature of osteoporosis is the reduction of bone mass. The most serious complication is osteoporotic fracture. Extracorporeal shock wave has good osteogenesis. Therefore, more and more studies pay attention to extracorporeal shock wave for prevention and treatment of osteoporotic fracture. Through searching literatures of "shock wave" and "osteoporosis" in Pubmed, CNKI and Wanfang medical database, the timing, energy selection and therapeutic effects of extracorporeal shock wave on prevention and treatment of osteoporosis were reviewed. The following conclusions were drawn: in terms of treatment timing,extracorporeal shock waves can be used in various periods; in terms of energy selection, medium and high energy extracorporeal shock waves can be used; in terms of therapeutic effects, extracorporeal shock waves can improve the degree of bone loss in patients with osteoporosis to varying degrees, especially when combined with anti-osteoporosis drugs. However, the optimal energy and frequency of treatment still need for further study.
引文
[1]中华医学会骨质疏松和骨矿盐疾病分会.原发性骨质疏松症诊疗指南(2017)[J].中华骨质疏松和骨矿盐疾病杂志,2017,5(10):413-443.
[2]Pajarinen J,Lindahl J,Michelsson O,et al.Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail.A randomised study comparing post-operative rehabilitation[J].J Bone Joint Surg Br,2005,87(1):76-81.
[3]Rogmark C,Johnell O.Primary arthroplasty is better than internal fixation of displaced femoral neck fractures:a metaanalysis of 14 randomized studies with 2,289 patients[J].Acta Orthop,2006,77(3):359-367.
[4]中华医学会骨科学分会骨质疏松学组.骨质疏松性骨折诊疗指南[J].中华骨科杂志,2017,37(1):1-10.
[5]BBlack DM,Rosen CJ.Clinical Practice.Postmenopausal Osteoporosis[J].N Engl J Med,2016,374(3):254-262.
[6]Nakamura Y,Suzuki T,Kato H.Denosumab significantly improves bone mineral density with or without bisphosphonate pre-treatment in osteoporosis with rheumatoid arthritis:Denosumab improves bone mineral density in osteoporosis with rheum atoid arthritis[J].Arch Osteoporos,2017,12(1):80.
[7]Xue F,Goli V,Petraro P,et al.Marginal structural model to evaluate the association between cumulative osteoporosis medication and infection using claims data[J].Osteoporos Int,2017,28(10):2893-2901.
[8]Wozniak LA,Johnson JA,McAlister FA,et al.Understanding fragility fracture patients'decision-making process regarding bisph osphonate treatment[J].Osteoporos Int,2017,28(1):219-229.
[9]Gerdesmeyer L,Schaden W,Besch L,et al.Osteogenetic effect of extracorporeal shock waves in human[J].Int J Surg,2015,24(Pt B):115-119.
[10]Zhai L,Ma XL,Jiang C,et al.Human autologous mesenchymal stem cells with extracorporeal shock wave therapy for nonunion of long bones[J].Indian J Orthop,2016,50(5):543-550.
[11]van der Jagt OP,Piscaer TM,Schaden W,et al.Unfocused extracor poreal shock waves induce anabolic effects in rat bone[J].J Bone Joint Surg Am,2011,93(1):38-48.
[12]Zhang Q,Liu L,Sun W,et al.Extracorporeal shockwave therapy in osteonecrosis of femoral head:A systematic review of now available clinical evidences[J].Medicine(Baltimore),2017,96(4):e5897.
[13]Kertzman P,Császár 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.
[14]Liu S,Zhai L,Shi Z,et al.Radial Extracorporeal Pressure Pulse Therapy for the Primary Long Bicipital Tenosynovitis a Prospective Randomized Controlled Study[J].Ultrasound Med Biol,2012,38(5):727-735.
[15]Gerdesmeyer L,Mittermayr R,Fuerst M,et al.Current evidence of extracorporeal shock wave therapy in chronic Achilles tendinopathy[J].Int J Surg,2015,24(Pt B):154-159.
[16]Wu YC,Tsai WC,Tu YK,et al.Comparative Effectiveness of Nonoperative Treatments for Chronic Calcific Tendinitis of the Shoulder:A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials[J].Arch Phys Med Rehabil,2017,98(8):1678-1692.
[17]Yalva?B,Mesci N,Geler KülcüD,et al.Comparison of ultrasound and extracorporeal shock wave therapy in lateral epicondylosis[J].Acta Orthop Traumatol Turc,2018,52(5):357-362.
[18]Salvioli S,Guidi M,Marcotulli G.The effectiveness of conservative,non-pharmacological treatment,of plantar heel pain:Asystematic review with meta-analysis[J].Foot(Edinb),2017,33:57-67.
[19]Snyder R,Galiano R,Mayer P,et al.Diabetic foot ulcer treatment with focused shockwave therapy:two multicentre,prospective,controlled,double-blinded,randomised phaseⅢclin ical trials[J].J Wound Care,2018,27(12):822-836.
[20]Xiang J,Wang W,Jiang W,et al.Effects of extracorporeal shock wave therapy on spasticity in post-stroke patients:Asystematic review and meta-analysis of randomized controlled trials[J].J Rehabil Med,2018,50(10):852-859.
[21]张堃,刘建,孟国林,等.体外冲击波对骨质疏松兔股骨髁部松质骨影响的实验研究[J].中国骨质疏松杂志,2008,14(6):381-384.
[22]张堃,韩娟,刘建,等.不同能流密度体外冲击波对骨质疏松兔股骨髁部松质骨影响的实验研究[J].中国骨质疏松杂志,2009,15(12):871-876.
[23]刘彧,艾全,刘水涛,等.体外冲击波对大鼠骨质疏松性骨折愈合作用的实验研究[J].中国综合临床,2016,32(2):97-100.
[24]武政,冯阳阳,阴彦斌.微聚焦高能冲击波治疗骨质疏松性骨折的疗效评价[J].创伤外科杂志,2017,19(2):135-138.
[25]Tam KF,Cheung WH,Lee KM,et al.Shockwave exerts osteogenic effect on osteoporotic bone in an ovariectomized goat model[J].Ultrasound Med Biol,2009,35(7):1109-1118.
[26]van der Jagt OP,van der Linden JC,Schaden W,et al.Unfocused extracorporeal shock wave therapy as potential treat ment for osteoporosis[J].J Orthop Res,2009,27(11):1528-1533.
[27]Huang HM,Li XL,Tu SQ,et al.Effects of Roughly Focused Extracorporeal Shock Waves Therapy on the Expressions of Bone Morphogenetic Protein-2 and Osteoprotegerin in Osteoporotic Fracture in Rats[J].Chin Med J(Engl),2016,129(21):2567-2575.
[28]Shi L,Gao F,Sun W,et al.Short-term effects of extracorporeal shock wave therapy on bone mineral density in postmenopausal osteo porotic patients[J].Osteoporos Int,2017,28(10):2945-2953.
[29]W?lfl C,Schuster L,H?ner B,et al.Influence of extracorporeal shock wave therapy(ESWT)on bone turnover markers in organisms with normal and low bone mineral density during fracture healing:a randomized clinical trial[J].GMS Interdiscip Plast Reconstr Surg DGPW,2017,6:Doc17.
[30]Mackert GA,Schulte M,Hirche C,et al.Low-energy extracorporeal shockwave therapy(ESWT)improves metaphyseal fracture healing in an osteoporotic rat model[J].PLoS One,2017,12(12):e0189356.
[31]van der Jagt OP,Waarsing JH,Kops N,et al.Unfocused extracorporeal shock waves induce anabolic effects in osteoporotic rats[J].J Orthop Res,2013,31(5):768-775.
[32]中国研究型医院学会冲击波医学专业委员会,国际冲击波医学学会中国部.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.
[2]Pajarinen J,Lindahl J,Michelsson O,et al.Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail.A randomised study comparing post-operative rehabilitation[J].J Bone Joint Surg Br,2005,87(1):76-81.
[3]Rogmark C,Johnell O.Primary arthroplasty is better than internal fixation of displaced femoral neck fractures:a metaanalysis of 14 randomized studies with 2,289 patients[J].Acta Orthop,2006,77(3):359-367.
[4]中华医学会骨科学分会骨质疏松学组.骨质疏松性骨折诊疗指南[J].中华骨科杂志,2017,37(1):1-10.
[5]BBlack DM,Rosen CJ.Clinical Practice.Postmenopausal Osteoporosis[J].N Engl J Med,2016,374(3):254-262.
[6]Nakamura Y,Suzuki T,Kato H.Denosumab significantly improves bone mineral density with or without bisphosphonate pre-treatment in osteoporosis with rheumatoid arthritis:Denosumab improves bone mineral density in osteoporosis with rheum atoid arthritis[J].Arch Osteoporos,2017,12(1):80.
[7]Xue F,Goli V,Petraro P,et al.Marginal structural model to evaluate the association between cumulative osteoporosis medication and infection using claims data[J].Osteoporos Int,2017,28(10):2893-2901.
[8]Wozniak LA,Johnson JA,McAlister FA,et al.Understanding fragility fracture patients'decision-making process regarding bisph osphonate treatment[J].Osteoporos Int,2017,28(1):219-229.
[9]Gerdesmeyer L,Schaden W,Besch L,et al.Osteogenetic effect of extracorporeal shock waves in human[J].Int J Surg,2015,24(Pt B):115-119.
[10]Zhai L,Ma XL,Jiang C,et al.Human autologous mesenchymal stem cells with extracorporeal shock wave therapy for nonunion of long bones[J].Indian J Orthop,2016,50(5):543-550.
[11]van der Jagt OP,Piscaer TM,Schaden W,et al.Unfocused extracor poreal shock waves induce anabolic effects in rat bone[J].J Bone Joint Surg Am,2011,93(1):38-48.
[12]Zhang Q,Liu L,Sun W,et al.Extracorporeal shockwave therapy in osteonecrosis of femoral head:A systematic review of now available clinical evidences[J].Medicine(Baltimore),2017,96(4):e5897.
[13]Kertzman P,Császár 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.
[14]Liu S,Zhai L,Shi Z,et al.Radial Extracorporeal Pressure Pulse Therapy for the Primary Long Bicipital Tenosynovitis a Prospective Randomized Controlled Study[J].Ultrasound Med Biol,2012,38(5):727-735.
[15]Gerdesmeyer L,Mittermayr R,Fuerst M,et al.Current evidence of extracorporeal shock wave therapy in chronic Achilles tendinopathy[J].Int J Surg,2015,24(Pt B):154-159.
[16]Wu YC,Tsai WC,Tu YK,et al.Comparative Effectiveness of Nonoperative Treatments for Chronic Calcific Tendinitis of the Shoulder:A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials[J].Arch Phys Med Rehabil,2017,98(8):1678-1692.
[17]Yalva?B,Mesci N,Geler KülcüD,et al.Comparison of ultrasound and extracorporeal shock wave therapy in lateral epicondylosis[J].Acta Orthop Traumatol Turc,2018,52(5):357-362.
[18]Salvioli S,Guidi M,Marcotulli G.The effectiveness of conservative,non-pharmacological treatment,of plantar heel pain:Asystematic review with meta-analysis[J].Foot(Edinb),2017,33:57-67.
[19]Snyder R,Galiano R,Mayer P,et al.Diabetic foot ulcer treatment with focused shockwave therapy:two multicentre,prospective,controlled,double-blinded,randomised phaseⅢclin ical trials[J].J Wound Care,2018,27(12):822-836.
[20]Xiang J,Wang W,Jiang W,et al.Effects of extracorporeal shock wave therapy on spasticity in post-stroke patients:Asystematic review and meta-analysis of randomized controlled trials[J].J Rehabil Med,2018,50(10):852-859.
[21]张堃,刘建,孟国林,等.体外冲击波对骨质疏松兔股骨髁部松质骨影响的实验研究[J].中国骨质疏松杂志,2008,14(6):381-384.
[22]张堃,韩娟,刘建,等.不同能流密度体外冲击波对骨质疏松兔股骨髁部松质骨影响的实验研究[J].中国骨质疏松杂志,2009,15(12):871-876.
[23]刘彧,艾全,刘水涛,等.体外冲击波对大鼠骨质疏松性骨折愈合作用的实验研究[J].中国综合临床,2016,32(2):97-100.
[24]武政,冯阳阳,阴彦斌.微聚焦高能冲击波治疗骨质疏松性骨折的疗效评价[J].创伤外科杂志,2017,19(2):135-138.
[25]Tam KF,Cheung WH,Lee KM,et al.Shockwave exerts osteogenic effect on osteoporotic bone in an ovariectomized goat model[J].Ultrasound Med Biol,2009,35(7):1109-1118.
[26]van der Jagt OP,van der Linden JC,Schaden W,et al.Unfocused extracorporeal shock wave therapy as potential treat ment for osteoporosis[J].J Orthop Res,2009,27(11):1528-1533.
[27]Huang HM,Li XL,Tu SQ,et al.Effects of Roughly Focused Extracorporeal Shock Waves Therapy on the Expressions of Bone Morphogenetic Protein-2 and Osteoprotegerin in Osteoporotic Fracture in Rats[J].Chin Med J(Engl),2016,129(21):2567-2575.
[28]Shi L,Gao F,Sun W,et al.Short-term effects of extracorporeal shock wave therapy on bone mineral density in postmenopausal osteo porotic patients[J].Osteoporos Int,2017,28(10):2945-2953.
[29]W?lfl C,Schuster L,H?ner B,et al.Influence of extracorporeal shock wave therapy(ESWT)on bone turnover markers in organisms with normal and low bone mineral density during fracture healing:a randomized clinical trial[J].GMS Interdiscip Plast Reconstr Surg DGPW,2017,6:Doc17.
[30]Mackert GA,Schulte M,Hirche C,et al.Low-energy extracorporeal shockwave therapy(ESWT)improves metaphyseal fracture healing in an osteoporotic rat model[J].PLoS One,2017,12(12):e0189356.
[31]van der Jagt OP,Waarsing JH,Kops N,et al.Unfocused extracorporeal shock waves induce anabolic effects in osteoporotic rats[J].J Orthop Res,2013,31(5):768-775.
[32]中国研究型医院学会冲击波医学专业委员会,国际冲击波医学学会中国部.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.