体外冲击波治疗骨折不愈合和骨折延迟愈合的作用

Treatment of nonunion and delayed union of bone fracture with extracorporeal shock wave

目的:探讨体外冲击波在治疗骨折不愈合和延迟愈合的机制以及临床研究中存在的问题。资料来源:应用计算机检索Medline 1990-01/2004-12与体外冲击波相关的文章,检索词“extracorporeal shoc kwave,fracture healing,nonunion,delayed osseous union”,并限定语言种类为English。同时计算机检索万方数据资源系统与中国期刊全文数据库1994-01/2004-12期间的文章,限定文章语言种类为中文,检索词“体外冲击波,骨折愈合,骨不连,骨折延迟愈合”。资料选择:对资料进行初审,选取包括实验组和对照组的文献,筛除明显非随机实验的研究,对剩余的文献开始查找全文,进一步判断为随机对照实验。纳入标准为:①随机对照实验,采用单盲,双盲或非盲法。②实验包含平行对照组。排除标准:重复性实验。资料提炼:共收集到45篇关于体外冲击波治疗骨折不愈合和延迟愈合的随机对照文章,39个实验符合纳入标准。排除的6篇均为重复的同一研究。39个实验包括体外冲击波治疗骨折不愈合和延迟愈合的动物实验研究、临床研究、可能的机制以及临床研究存在的问题,分别对各实验给予评价。资料综合:许多临床研究发现体外冲击波对治疗人类长骨骨折后的骨折不愈合,疗效是肯定的,有效率可达到41%～85%,并且具有非侵入性、并发症少、相对安全等优点。体外冲击波治疗骨不连的机制是综合因素的作用,其激活了骨不连的生物学状态,出现了一种类似新鲜骨折的愈合过程,加之体外冲击波本身对组织细胞的刺激作用,细胞因子和生长因子的诱导成骨等多种因素协同作用,从而使骨不连得以愈合。但体外冲击波能量大小、治疗次数、总剂量、是否需要麻醉及镇静药目前还存在很大分歧。结论:体外冲击波疗法是治疗骨折不愈合和延迟愈合的一种安全有效、非侵袭性、并发症少的方法,但是仍然缺乏可靠的随机前瞻性研究充分证明该治疗效果确切。

OBJECTIVE： To probe into the mechanism of extracorporeal shock wave in treatment of nonunion and delayed union of bone fracture and the existed unsolved problems in the clinical study. DATA SOURCES： Papers about extracorporeal shock wave from January 1990 to December 2004 were computer-searched in Medline, with the key words of “extracorporeal shock wave, fracture healing, nonunion, delayed osseous union” ,and the language was limited to English. Meanwhile, the same papers as above were also computer-searched in Wanfang database and China Journal full-text database, limiting the language to Chinese, with the key words of “extracorporeal shock wave, fracture healing, nonunion, delayed osseous union”in Chinese. STUDY SELECTION： The related papers were selected by the primary trial, and the selection was performed and the literatures in the experimental group and control group. Excluded papers were obviously non-randomly control experiment, and the left papers were searched in the full-text and further judging as randomly controlled trial. Inclusion criteria：①Randomly controlled trial with single-blind, double-blind or non-blind methods.②Studies include concurrent control group. Exclusion criteria： Repeated studies DATA EXTRACTION： Totally 45 randomly controlled papers on nonunion and delayed union of bone fracture with extracorporeal shock wave were found, and 39 experiments were quoted. Six articles were excluded due to repeated studies. Thirty-nine trials involved animal experimentations, clinical trials, mechanism and unsolved problems of extracorporeal shock wave therapy of nonunion or delayed osseous union. Each trial was assessed. DATA SYNTHESIS： It was found in many clinical studies that extracorporeal shock wave has effect on the nonunion of bone fracture in treatment of bone fracture of human long bone. Curative rate was 41% -85% with the advantages of noninvasiveness , less complications and relative safety. Mechanism of extracorporeal shock wave in treatment of osseous nonunion was caused by integrative factors, which active the biological state of osseous nonunion. Coordination effect of many factors promotes the healing of osseous nonunion, such as fresh bone fracture-like healing process appeared , extracorporeal shock wave itself has stimulating effect on tissue cell, and cytokine and growth factor could induce into osteoblast. At present, it had great difference of the power of energy, treatment times, total doses of extracorporeal shock wave as well as whether to need anesthesia and sedative. CONCLUSION： Extraeorporeal shock wave therapy is a safe, effective and noninvasive method with less complications in the treatment of nonunion or delayed osseous union of bone fracture. But it is still to lack reliablely random prospective studies to prove the exact curative effect.