Extracorporeal Shock-Wave Therapy Compared with Surgery for Hypertrophic Long-Bone Nonunions
Extracorporeal Shock-Wave Therapy Compared with Surgery for Hypertrophic Long-Bone Nonunions
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DOI：
10.2106/jbjs.h.00841
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发表时间：
2009-11-01
影响因子：
5.3
通讯作者：
Santilli, Valter
中科院分区：
文献类型：
--
作者：
Cacchio, Angelo;Giordano, Lucio;Santilli, Valter
背景：几项研究的作者推荐体外冲击波治疗作为长骨不连手术治疗的替代方法。本研究旨在比较两种不同装置产生的体外冲击波治疗与手术治疗长骨不连的效果。方法：126例长骨不连患者随机分为体外冲击波治疗组（1组和2组）和手术治疗组（3组）。冲击波组接受4000次冲击波脉冲治疗，能量通量密度分别为0.40 mJ/mm(2)（第1组）和0.70 mJ/mm(2)（第2组）。三组患者人口学特征相似，病程：；骨不连和随访时间。放射学结果（主要结局）和临床结果（次要结局）分别在治疗前、治疗后3个月、6个月、12个月和24个月测定。结果：三组患者的影像学表现无明显差异。6个月时，第1组70%的不连愈合，第2组71%的不连愈合，第3组73%的不连愈合。治疗后3个月和6个月，两种冲击波组的临床疗效均显著优于手术组（p < 0.001）。然而，在治疗后12个月和24个月，三组之间没有差异，除了DASH评分，1组和3组在12个月时差异显著（p = 0.038）， 2组和3组在12个月时差异显著（p = 0.021）。结论：体外冲击波治疗刺激长骨肥厚性骨不连愈合与手术治疗同样有效，且短期临床效果更好。
Background: The authors of several studies have recommended extracorporeal shock-wave therapy as an alternative to surgical treatment for long-bone nonunions. This study was performed to compare the results of extracorporeal shock-wave therapy produced by two different devices with those of surgical treatment in the management of long-bone nonunions.Methods: One hundred and twenty-six patients with a long-bone nonunion were randomly assigned to receive either extracorporeal shock-wave therapy (Groups 1 and 2) or surgical treatment (Group 3). The patients in the shock-wave groups, received four treatments with 4000 impulses of shock waves with an energy flux density of 0.40 mJ/mm(2) (Group 1) or 0.70 mJ/mm(2) (Group 2). The patients in the three groups had similar demographic characteristics, duration:; of nonunion, and durations of follow-up. Radiographic results (the primary outcome) and clinical results (the secondary outcomes) were determined before and three, six, twelve, and twenty-four months after treatment.Results: The radiographic findings did not differ among the three groups of patients. At six months, 70% of the nonunions in Group 1, 71% of the nonunions in Group 2, and 73% of the nonunions in Group 3 had healed. Three and six months after treatment, the clinical outcomes in the two shock-wave groups were significantly better than those in the surgical group (p < 0.001). However, at both twelve and twenty-four months after treatment, there were no differences among the three groups, with the exception of the DASH score, which differed significantly between Groups 1 and 3 (p = 0.038) and between Groups 2 and 3 (p = 0.021) at twelve months.Conclusions: Extracorporeal shock-wave therapy is as effective as surgery in stimulating union of long-bone hypertrophic nonunions and yields better short-term clinical outcomes.