体外冲击波联合高压氧治疗骨不连的随机对照研究

A randomized controlled study of extracorporeal shock wave combined with hyperbaric oxygen in the treatment of nonunion

目的探讨体外冲击波(ESWT)联合高压氧治疗四肢长骨骨不连的临床疗效。方法选取我院60例四肢长骨骨不连患者为研究对象,按治疗方案不同分为3组,A组予ESWT治疗,B组予ESWT联合高压氧治疗,C组予手术治疗。所有患者随访至少12个月。观察各组患者治疗及随访期一般情况及并发症、治疗有效率(6、 9、 12个月)、碱性磷酸酶(A LP)含量(1、 2、 3、 4、 6周)和骨密度(6、 12、 24周)。结果所有患者均无远期并发症发生,B组皮肤并发症少于A、C组。B、 C组治疗后不同时间点有效率及ALP含量差异无统计学意义(P>0.05),但均优于A组(P<0.05)。A、B、 C组治疗各时点ALP均较治疗前升高,且随时间延长,整体呈升高趋势(P<0.05)。 B组治疗后不同时间点骨密度改善优于A组(P<0 .05)。 A、B组内治疗各时点骨密度均较治疗前升高,且随时间延长,整体亦呈升高趋势(P<0.05)。结论 ESWT联合高压氧治疗四肢长骨骨不连无创、安全、有效,且具有皮肤并发症少的特点。

Objective To investigate the efficacy of extracorporeal shock wave therapy (ESWT) combined with hyperbaric oxygen for treatment of long-bone fracture nonunion. Methods Sixty cases of long bone fracture nonunion in our hospital were used as study subjects. They were divided into three groups by random number table method. Group A was treated by ESWT,group B was treated by ESWT combined with hyperbaric oxygen and group C was treated by surgery. All patients were followed up 12 months at least. Then the healing rate (6, 9 and 12 months), bone densities (6, 12 and 24 weeks), alkaline phosphatase (ALP, 1, 2, 3, 4, and 6 weeks) and complications were observed in three groups of patients. Results All patients had no long-term complications, and the skin complications were less in group B than those in group A and C. There were no significant differences in the effective rates and ALP levels at different time points after treatment between group B and C, and which were better than those of group A (P<0 .05). The ALP levels were higher at different time points after treatment than those before treatment in three groups, and the overall trend was increased with time (P<0.05). The bone densities at different time points were higher after treatment in group B than those of group A(P<0.05). The bone mineral densities at each time point were higher in group A and group B than those before treatment, and the overall trend was increased with time (P<0 .05). Conclusion ESWT combined with hyperbaric oxygen for treatment of long-bone fracture nonunion is safe, effective and have a fewer skin complications.