体外冲击波治疗骨不连的方法选择与影响因素

Method selection and impacting factors of extracorporeal shock wave therapy for fracture nonunion

[目的]研究不同体外冲击波疗法(extracorporeal shock wave therapy, ESWT)治疗深部、较深部及浅部骨不连的疗效,并探讨其影响因素。[方法] 2011年11月—2022年9月采用ESWT治疗各类骨不连87例。深部骨不连选择聚焦式ESWT(focused ESWT, fESWT),浅部选择发散式ESWT (radial ESWT, rESWT),较深部选择聚焦式联合发散式ESWT (f-rESWT)。观察骨折愈合情况,同时分析影响愈合率的相关因素。[结果] 87例患者在治疗期间均无不良事件发生。至末次随访时,深部骨不连愈合24例,愈合率75.0%;较深部愈合36例,愈合率78.3%;浅部愈合7例,愈合率77.8%。按治疗方法,三组间年龄、性别、骨不连分型、临床愈合时间和影像不同时间点愈合率的差异均无统计学意义(P>0.05)。按末次随访时患者是否达到影像愈合分组,愈合组的年龄显著小于不愈合组[(34.3±10.5)岁vs (40.5±10.1)岁, P=0.042],而愈合组治疗次数显著多于不愈合组[(22.6±9.8)次vs (8.3±3.6)次, P=0.011],两组在性别、骨不连类型及诊断距首次治疗间隔时间均无明显差异(P>0.05)。多因素逻辑回归分析表明,年龄是骨不连愈合的负面影响因素(OR=0.920, P=0.040),而ESWT治疗次数是骨不连愈合的正面影响因素(OR=1.125, P=0.004)。[结论]根据骨不连发生部位的深浅选择不同ESWT个性化治疗方法可获得满意疗效。治疗次数和年龄是ESWT治疗骨不连的重要影响因素。

[Objective]To investigate the efficacy of different extracorporeal shock wave therapies(ESWTs)in the treatment of deep,relatively deep and superficial fracture nonunion,and explore relative impacting factors.[Methods]From November 2011 to September 2022,a total 87 patients received ESWTs,including focused ESWT(fESWT)used for deep fracture nonunion,fESWT combined with radial ESWT(rESWT),(f-rWSWT)for relatively deeper nonunion,and rESWT for superficial nonunion.The fracture nonunion healing was ob⁃served and the related factors affecting the healing rate were analyzed.[Results]No adverse events occurred in 87 patients during treat⁃ment.At the last follow-up,the deep bone nonunion healed in 24 cases(75.0%),while relatively deeper nonunion healed in 36 cases(78.3%),and superficial nonunion healed in 7 cases(77.8%).There were no statistically significant differences in age,sex,bone nonunion type,clinical healing time and healing rate at different time points on images among the three groups based on treatment methods(P>0.05).According to whether the patients had achieved nonunion healed on images at the last follow-up,the healed group were significantly young⁃er in age than the non-healed group[(34.3±10.5)years vs(40.5±10.1)years,P=0.042],the healed group got significantly more times of treatment than the non-healed group[(22.6±9.8)times vs(8.3±3.6)time,P=0.011],despite insignificant differences between the two groups in gender,type of bone nonunion and interval between diagnosis and first treatment(P>0.05).As results of multivariate logistic regression,the age was a negative factor for nonunion healing(OR=0.920,P=0.040),while the treatment times of ESWT was a positive factor for non⁃union healing(OR=1.125,P=0.004).[Conclusion]The individualized ESWT based on depth of fracture nonunion site,does obtain satisfac⁃tory curative effect.Treatment times and age are important factors impacting ESWT treatment of fracture nonunion.