Low‐Level Laser Therapy for Wound Healing: Mechanism and Efficacy
Low‐Level Laser Therapy for Wound Healing: Mechanism and Efficacy
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DOI：
10.1111/j.1524-4725.2005.31086
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发表时间：
2005-03
影响因子：
2.4
通讯作者：
W. Posten;D. Wrone;J. Dover;K. Arndt;Sirunya Silapunt;Murad Alam
中科院分区：
文献类型：
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作者：
W. Posten;D. Wrone;J. Dover;K. Arndt;Sirunya Silapunt;Murad Alam
背景鉴于最近对发光二极管（LED）光调制和微创非烧蚀激光治疗的兴趣，现在是时候调查低水平激光治疗（LLLT）可能在伤口愈合中的效用。目的批判性地评价体外模型和体内动物和人体研究报告，并评估定性和定量证据的充分性LLLT在促进伤口愈合的疗效。方法查阅1965 ~ 2003年的文献资料。结果在研究LLLT对体外细胞培养的影响时，一些文章报道了使用特定的和有点任意的氦氖（HeNe）和砷化镓激光器设置的细胞增殖和胶原蛋白产生的增加，但没有可用的研究解决机制，无论是光热，光化学，或光机械，LLLT可能发挥其作用。一些研究，特别是那些使用氦氖激光的研究，报告了啮齿动物模型中手术伤口愈合的改善;然而，这些结果尚未在猪等动物中复制，猪的皮肤与人类的皮肤更相似。在人类中，在小型病例系列中发现的对浅表伤口愈合的有益作用尚未在大型研究中重现。结论为了更好地了解LLLT在皮肤伤口愈合中的效用，需要将细胞效应与生物学过程相关联的良好临床研究。未来的研究应该是良好的对照研究，合理选择激光和治疗参数。在缺乏此类研究的情况下，目前文献似乎不支持LLLT在伤口愈合中的广泛使用。尽管高能（10-100 W）激光的应用已得到充分确立，并有大量支持性文献和广泛使用，但文献中的冲突研究将美国的低水平激光治疗（LLLT）仅限于研究用途。然而，LLLT在临床上用于许多其他地区，包括加拿大，欧洲和亚洲，用于治疗各种神经，脊椎按摩，牙科和皮肤病。为了理解这种差异，回顾一下关于LLLT的研究是有用的，迄今为止，这些研究阻止了美国食品和药物管理局对许多此类技术的批准。根本问题是是否有足够的证据支持使用LLLT。
Background Given the recent interest in light-emitting diode (LED) photomodulation and minimally invasive nonablative laser therapies, it is timely to investigate reports that low-level laser therapy (LLLT) may have utility in wound healing. Objectives To critically evaluate reported in vitro models and in vivo animal and human studies and to assess the qualitative and quantitative sufficiency of evidence for the efficacy of LLLT in promoting wound healing. Method Literature review, 1965 to 2003. Results In examining the effects of LLLT on cell cultures in vitro, some articles report an increase in cell proliferation and collagen production using specific and somewhat arbitrary laser settings with the helium neon (HeNe) and gallium arsenide lasers, but none of the available studies address the mechanism, whether photothermal, photochemical, or photomechanical, whereby LLLT may be exerting its effect. Some studies, especially those using HeNe lasers, report improvements in surgical wound healing in a rodent model; however, these results have not been duplicated in animals such as pigs, which have skin that more closely resembles that of humans. In humans, beneficial effects on superficial wound healing found in small case series have not been replicated in larger studies. Conclusion To better understand the utility of LLLT in cutaneous wound healing, good clinical studies that correlate cellular effects and biologic processes are needed. Future studies should be well-controlled investigations with rational selection of lasers and treatment parameters. In the absence of such studies, the literature does not appear to support widespread use of LLLT in wound healing at this time. Although applications of high-energy (10–100 W) lasers are well established with significant supportive literature and widespread use, conflicting studies in the literature have limited low-level laser therapy (LLLT) use in the United States to investigational use only. Yet LLLT is used clinically in many other areas, including Canada, Europe, and Asia, for the treatment of various neurologic, chiropractic, dental, and dermatologic disorders. To understand this discrepancy, it is useful to review the studies on LLLT that have, to date, precluded Food and Drug Administration approval of many such technologies in the United States. The fundamental question is whether there is sufficient evidence to support the use of LLLT.