Blood Flow in the Scaphoid Is Improved by Focused Extracorporeal Shock Wave Therapy
Blood Flow in the Scaphoid Is Improved by Focused Extracorporeal Shock Wave Therapy
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DOI：
10.1097/corr.0000000000000993
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发表时间：
2020-01-01
影响因子：
4.2
通讯作者：
Kisch, Tobias
中科院分区：
文献类型：
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作者：
Schleusser, Sophie;Song, Jungin;Kisch, Tobias
体外冲击波治疗（ESWT）已显示出对骨不连或骨愈合延迟、假关节和骨缺血性坏死患者的益处。到目前为止，这些效应可以通过ESWT后生长因子的释放、细胞的激活和微骨折来解释。微循环是骨愈合的一个重要因素，在舟状骨骨折中可能会受到损害，因为其血液供应来自远端。由于这种灌注模式，舟状骨骨折后容易发生骨不连。体外冲击波治疗增强软组织微循环参数的能力是确定其是否改善舟状骨微循环的兴趣所在。问题/目的（1）单次ESWT治疗舟骨后毛细血管血流量是否增加？(2)在舟骨进行单次ESWT后，骨中的氧饱和度和毛细血管后静脉充盈压是否增加？方法对20例无腕关节疼痛、无重要代谢紊乱的健康志愿者进行ESWT（0.3mJ/mm 2，8Hz，1000次脉冲）治疗。平均年龄为43 ± 14岁，12名男性和8名女性（占总数的40%）。2017年1月至2017年5月招募志愿者。在应用ESWT之前未给予麻醉剂。一种创新的探头设计用于测量骨压缩软组织和结合激光多普勒血流仪和分光光度法被用来无创测量舟状骨微循环参数。在应用ESWT之前和之后1、2、3、5、10、15、20、25和30分钟评估血流量、氧合和静脉充盈压。室温、湿度、环境光和测量顺序保持一致。进行配对t检验以比较实验数据与基线（p < 0.05视为显著）。结果基线时，骨毛细血管血流量为108 +/- 46任意单位（AU）（86 - 130）。ESWT治疗后，为129 +/- 44 AU 1分钟时（106 - 150; p = 0.011，百分比变化19%），138 +/- 46 AU（116 - 160; p = 0.002，百分比变化28%）2分钟时，146 +/- 54 AU（121至171; p = 0.002，百分比变化35%），5分钟时为150 +/- 52 AU（126至174; p < 0.001，百分比变化39%）。在治疗后30分钟测量期结束前，其保持升高，与基线相比为141 +/- 42 AU（121 - 161; p = 0.002）。骨血氧饱和度和毛细血管后静脉充盈压无变化，数据可用。结论在30分钟的测量时间内，单次ESWT增加了舟骨毛细血管血流量。然而，骨氧合和毛细血管后静脉充盈压没有变化。由于需要增加氧合来改善骨愈合，因此尚不清楚毛细血管血流的单独增加是否具有临床益处。由于测量时间仅限于30分钟，因此骨氧合和毛细血管后充盈压可能仅在测量时间结束后才显示变化。
Background Extracorporeal shock wave therapy (ESWT) has shown benefits in patients with nonunion or delayed bone healing, pseudarthrosis, and avascular necrosis of bone. Until now, these effects were explained by the release of growth factors, activation of cells, and microfractures occurring after ESWT. Microcirculation is an important factor in bone healing and may be compromised in fractured scaphoids because its blood supply comes from the distal end. Due to this perfusion pattern, the scaphoid bone is prone to nonunion after fracture. The ability of ESWT to enhance microcirculation parameters in soft tissue was of interest to determine if it improves microcirculation in the scaphoid. Questions/purposes (1) Does capillary blood flow increase after a single session of ESWT in the scaphoid? (2) Do oxygen saturation in the bone and postcapillary venous filling pressure increase after a single session of ESWT in the scaphoid? Methods ESWT (0.3 mJ/mm(2), 8Hz, 1000 impulses) was applied to the intact scaphoid of 20 volunteers who were without wrist pain and without any important metabolic disorders. Mean age was 43 +/- 14 years, 12 men and eight women (40% of total). Volunteers were recruited from January 2017 to May 2017. No anesthetic was given before application of ESWT. An innovative probe designed for measurements in bone by compressing soft tissue and combining laser-Doppler flowmetry and spectrophotometry was used to noninvasively measure parameters of microcirculation in the scaphoid. Blood flow, oxygenation, and venous filling pressure were assessed before and at 1, 2, 3, 5, 10, 15, 20, 25, and 30 minutes after ESWT application. Room temperature, humidity, ambient light and measuring sequences were kept consistent. A paired t-test was performed to compare experimental data with baseline (p < 0.05 taken as significant). Results At baseline, capillary blood flow of the bone was 108 +/- 46 arbitrary units (AUs) (86 to 130). After treatment with ESWT, it was 129 +/- 44 AUs (106 to 150; p = 0.011, percentage change of 19 %) at 1 minute, 138 +/- 46 AUs (116 to 160; p = 0.002, percentage change of 28%) at 2 minutes, 146 +/- 54 AUs (121 to 171; p = 0.002, percentage change of 35%) at 3 minutes and 150 +/- 52 AUs (126 to 174; p < 0.001, percentage change of 39%) at 5 minutes. It remained elevated until the end of the measuring period at 30 minutes after treatment at 141 +/- 42 AUs (121 to 161; p = 0.002) versus baseline). Oxygen saturation and postcapillary venous filling pressure in bone showed no change, with the numbers available. Conclusions A single session of ESWT increased capillary blood flow in the scaphoid during measuring time of 30 minutes. Bone oxygenation and postcapillary venous filling pressure, however, did not change. Because increased oxygenation is needed for improved bone healing, it remains unclear if a sole increase in capillary blood flow can have clinical benefits. As the measuring period was limited to only 30 minutes, bone oxygenation and postcapillary filling pressure may subsequently show change only after the measuring-period ended.