Low-intensity pulsed ultrasound: Fracture healing.
Low-intensity pulsed ultrasound: Fracture healing.
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DOI：
10.4103/0019-5413.50847
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发表时间：
2009-04
影响因子：
1
通讯作者：
Bhandari M
中科院分区：
文献类型：
--
作者：
Mundi R;Petis S;Kaloty R;Shetty V;Bhandari M
每年，全世界有数以百万计的人遭受骨折伤害。不及时的治疗在社会经济成本、个人成本和患者的生活质量方面是一个巨大的负担。低强度脉冲超声(LIPUS)作为一种潜在的促进新鲜骨折愈合的辅助治疗方法已受到广泛关注，但其疗效仍存在争议。本文分为两个部分，首先是文献综述，然后是系统综述。文献综述重点介绍了骨折愈合的生理学，以及LIPUS对参与骨折愈合过程的细胞和分子的影响。在第二部分中，我们系统地回顾了评估LIPUS在加速骨折愈合方面的临床有效性的随机对照试验(RCT)。我们检索系统评价的电子数据库如下：Medline(1996年至2008年11月)、EMBASE(1996年至2008年11月)和Healthstar(1966年至2008年10月)。两步筛选程序用于评估我们搜索所产生的研究的合格性。第一步是审查标题和摘要，以选择符合以下标准的研究：(I)纳入新骨折的骨骼成熟患者，(Ii)至少两个治疗臂，至少一只手臂接受LIPUS治疗，另一只手臂接受安慰剂治疗，(Iii)随机将患者分配到不同的治疗手臂，(Iv)骨折愈合时间的放射学评估，以及(V)以英语发表文章。第二步，对选定的文章进行全文综述。所有符合条件的试验都由两名评价者使用15项清晰NPT检查表(评估非药理学试验报告的检查表)对方法学报告质量进行独立评分。我们确定了总共77项研究，其中9项在初步筛选后符合我们的纳入标准。在这9项试验中，有7项纳入了最终审查。在这七项试验中研究的骨折类型包括外踝骨折、桡骨骨折和胫骨骨折。七项试验中有三项发现，与安慰剂相比，LIPUS显著缩短了愈合时间，而其他四项试验没有发现统计学上的显著差异。在评估LIPUS作为骨折愈合辅助设备的疗效的几项随机对照试验的结果中，有很大程度的不一致。虽然LIPUS已被证明在某些加速骨折愈合的试验中是有效的，但对于其在所有骨折类型和骨折护理方法中的普遍使用还没有明确的声明。未来具有更大样本量的高质量随机对照试验可能有助于阐明是否需要LIPUS治疗的具体适应症。
Annually, millions of people across the world are inflicted with bone fracture injuries. Untimely healing is a significant burden in terms of socioeconomic costs, personal costs, and patients' quality of life. Low-intensity pulsed ultrasound (LIPUS) has gained much attention as a potential adjunctive therapy for accelerating fresh fracture healing, but its efficacy remains controversial. This paper is presented in two parts a literature review followed by a systematic review. The literature review highlights the physiology of fracture healing and the influence LIPUS exerts on cells and molecules involved in this healing process. In part two, we present a systematic review of randomized controlled trials (RCTs) assessing the clinical effectiveness of LIPUS in accelerating the time to fracture healing. The electronic databases we searched for the systematic review are as follows: MEDLINE (from 1996 to November 2008), EMBASE (from 1996 to November 2008), and Healthstar (from 1966 to October 2008). A two-step screening process was used to assess the eligibility of studies yielded by our search. The first step was a review of titles and abstracts for the selection of studies that met the following criteria: (i) inclusion of skeletally mature patients with a fresh fracture, (ii) a minimum of two treatment arms with at least one arm receiving LIPUS treatment and another arm receiving placebo, (iii) random allocation of patients to the different treatment arms, (iv) radiological assessment of time to fracture healing, and (v) publication in the English language. In the second step, selected articles were reviewed in full text. Eligible trials were all scored independently by two reviewers for methodological reporting quality using the 15-item CLEAR NPT checklist (Checklist to Evaluate the Report of a Nonpharmacological Trial). We identified a total of seventy seven studies, nine of which met our inclusion criteria after the initial screening. Of these nine trials, seven were included for the final review. The types of fractures studied among these seven trials included lateral malleolar, radial, and tibial fractures. Three of the seven trials found that LIPUS significantly reduces healing time compared to placebo, whereas the other four did not find a statistically significant difference. There is a substantial level of inconsistency in the findings of several RCTs evaluating the efficacy of LIPUS as an adjunct for fracture healing. Although LIPUS has proven to be effective in certain trials for accelerating fracture healing, no definitive statement can be made regarding its universal use for all fracture types and methods of fracture care. Future high-quality RCTs with larger sample sizes may help to elucidate the specific indications that warrant or dismiss the need for LIPUS therapy.
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DOI：
10.1136/bmj.b351
发表时间：
2009-02-27
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Busse JW;Kaur J;Mollon B;Bhandari M;Tornetta P 3rd;Schünemann HJ;Guyatt GH
通讯作者：
Guyatt GH
影响因子：
5.3
作者：
Khan, Yusuf;Laurencin, Cato T.
通讯作者：
Laurencin, Cato T.
影响因子：
2.8
作者：
Parvizi, J;Wu, CC;Bolander, ME
通讯作者：
Bolander, ME
DOI：
10.2106/00004623-199707000-00002
发表时间：
1997-07-01
影响因子：
5.3
作者：
Kristiansen, TK;Ryaby, JP;Roe, LR
通讯作者：
Roe, LR
影响因子：
2.3
作者：
Rawool, NM;Goldberg, BB;Hume, E
通讯作者：
Hume, E