冲击波治疗骨不连的研究

Extracorporeal shock waves in the treatment of nonunion

目的 通过体外冲击波疗法 (extracorporealshockwavetherapy ,ESWT)治疗兔胫骨骨不连 ,以探求一种新的非手术治疗骨不连的方法。方法 选择健康雄性大耳白兔 30只 ,以改进的“切除截骨骨不连模型”制作兔右胫骨骨不连 ,1 2周后经X光片证实为肥大型骨不连 2 6只 ,随机分为 2组。治疗组 1 3只兔行体外冲击波骨不连断端冲击治疗 ,对照组不行冲击波治疗 ,但均继续外固定支架固定。冲击波治疗前、后及治疗后 6、1 2周摄片。测量冲击波治疗前后骨不连间隙的变化 ,及冲击波治疗后 1 2周X光片骨性愈合情况比较 ,并行统计学分析。结果 冲击波治疗后骨不连间隙显著变窄或消失 ,平均减小宽度为 ( 0 .70± 0 .2 5)mm ,治疗前后骨不连间隙差异有非常显著性 (P <0 .0 1 ) ;冲击波治疗 1 2周治疗组与对照组骨性愈合比较差异有显著性 (P<0 .0 1 )。

Objective To investigate the effect of extracorporeal shock waves in the treatment of hypertrophic nonunion in rabbits and to develop a new nonsurgical approach.Methods Thirty healthy male rabbits were selected to develop a model of nonunion.Twelve weeks after operation,26 rabbits with hypertrophic nonunion confirmed by radiography were randomly equally divided into two groups:treatment group receiving 2 000 shock waves of 0.54 mJ/mm 2,which were applied at two sites ,lying symmetrically on the distal and proximal on nonunion,and control group.The rabbits in both groups underwent the external fixation continuously.The rabbits were radiographed immediately before and after the shock wave treatment,and repeated after 6 and 12 weeks.Computer scanning was used to measure the change in nonunion gap,and the healing was analyzed by using radiographs 12 weeks after the shock wave treatment.Results After shock wave treatment,the width of nonunion gap was narrowed by (0.70±0.25) mm averagely,with the difference before and after treatment being significant(P<0.001).After 12 weeks,there was significant diference in bony union between the treatment group and control group(P<0.01).Conclusion Hypertrophic nonunion in rabbits can be treated successfully by extracoropreal shock waves.It may become a reliable,nonsurgical way for the treatment of certain types of nonunion.