体外高能震波治疗骨不连和骨延迟愈合的初步结果

High-energy extracorporeal shock waves in treatment of nonunion and delayed union:preliminary results

目的观察Ossatron高能体外震波仪治疗骨不连和骨延迟愈合的效果。方法2004年10月～2005年10月采用体外震波治疗18例四肢骨折术后骨不连和4例骨延迟愈合患者,C型臂X线机透视定位,根据不同骨折部位选择合适的震波能量、频率和冲击次数。内固定不稳定者震波治疗后以石膏或支具固定6～8周。术后6、12周及以后每个月随访复查X线片,直至骨折愈合。结果所有患者获3～12个月(平均6．7个月)随访。10例患者震波后出现局部瘀斑或肿胀,术后1～3 d缓解；无其它并发症发生。22例患者中,13例(59．1%)获骨性愈合,骨折愈合时间平均为4．3个月(6周～6个月)。18例内固定稳定的患者中12例骨折获愈合,其愈合率为66．7%。9例患者(40．9%)骨折未愈合。结论震波治疗对骨折断端稳定的骨不连和延迟愈合具有一定疗效,其突出特点是安全、无创。

Objective To observe the effects of the Ossatron high-energy shock waves on bone nonunion and delayed union. Methods Between October 2004 and October 2005, 18 patients with nonunion and four patients with delayed union were treated with high-energy extracorporeal shock wave therapy （Ossatron, HMT Co., Swiss） . Facture lines were located with C-arm X-ray before treatment. Parameters of shock waves were decided according to fracture sites. Patients with unstable fixation received plaster or bracing for 6 to 8 weeks after treatment. After therapy, follow-up radiography was performed at 6 and 12 weeks and monthly afterwards until the fracture united. Results The mean follow-up was 6. 7 months （range, 3 to 12 months） . There were no complications except local petechial hemorrhage and local swelling in 10 patients. Thirteen patients （59. 1% ） got bony union, including 12 patients （66. 7% ） with stable internal fixation, and the average healing time was 4. 3 months （range, 6 weeks to 6 months）. Nine fractures （40.9%） still suffered nonunion. Conclusion High-energy shock waves are a good alternative therapy for nonunion and delayed union, with obvious advantages of being non-lnvasive and safe.