Impact of low-intensity extracorporeal shockwave therapy on vascular parameters and sexual function in patients with arteriogenic erectile dysfunction

Previous published studies have shown an improvement of penile hemodynamic parameters after low-intensity extracorporeal shockwave therapy(Li-ESWT).However,the clinical significance of these findings remains unclear,and definitive selection criteria for Li-ESWT based on preexisting comorbidities have yet to be established.This was an observational study of 113 patients with ED,evaluated between January 2019 and December 2021 in Andrology Unit at the Department of Urology and Renal Transplantation,University of Foggia(Foggia,Italy).Penile dynamic Doppler was performed to evaluate vascular parameters and 5-item version of the International Index of Erectile Dysfunction(IIEF-5)questionnaire was administered to assess the severity of ED.This was repeated 1 month after treatment.Patients with a peak systolic velocity(PSV)<30 cm s−1 were considered eligible for Li-ESWT.Our protocol consisted of 8 weekly sessions with 1500 strokes distributed in 5 different locations along the penis.After treatment,a significant mean(±standard deviation[s.d.])PSV increase of 5.0(±3.4)cm s−1 was recorded and 52/113(46.0%)patients reached a PSV>30 cm s−1 at posttherapeutic penile dynamic Doppler.A clinically significant IIEF-5 score improvement was observed in 7 patients,21 patients,and 2 patients with mild-to-moderate,moderate,and severe pretreatment ED,respectively.No different outcomes were assessed based on smoking habits,previous pelvic surgery,or use of oral phosphodiesterase-5 inhibitor(PDE5i).On the other side,only 1(6.7%)in 15 patients with diabetes mellitus showed an IIEF-5 score improvement after Li-ESWT.Shockwave treatment determined a significant increase in PSV and correlated IIEF-5 improvement in ED patients.This advantage seemed particularly evident for moderate ED and was not affected by smoking habits,previous pelvic surgery,and use of PDE5i.Conversely,diabetic patients did not benefit from the treatment.

Extracorporeal shockwave therapy for Peyronie＇s disease： an alternative treatment？

Aim： To determine retrospectively the safety and efficacy of extracorporeal shock wave therapy （ESWT） in patients with Peyronie＇s disease. Methods： Fifty-three patients with stable Peyronie＇s disease underwent ESWT （group 1）. Fifteen patients matched with the baseline characteristic of the patients in group 1, who received no treatment, were used as the control （group 2）. The patients＇ erectile function （International Index of Erectile Function [IIEF-5] score）, pain severity （visual analog scale）, plaque size and degree of penile angulation were assessed before and after the treatment in group 1 and during the follow-up in group 2. Results： The mean follow-up time was 32 months （range： 6-64 months） in group 1 and 35 months （range： 9-48 months） in group 2. All the patients were available for the follow-up. Considering erectile function and plaque size, no significant changes （P 〉 0.05） were observed in group 1 before or after the ESWT. A total of 39 patients （74%） reported a significant effect in pain relief in group 1 after ESWT. However, regarding improvement in pain, IIEF-5 score and plaque size, no significant differences were observed between the two groups. In 21 patients （40%） of group 1, the deviation angle was decreased more than 10° with a mean reduction in all patients of 11° （range： 6-20°）. No serious complications were noted considering ESWT procedure. Conclusion： ESWT is a minimally invasive and safe alternative procedure for the treatment of Peyronie＇s disease. However, the effect of ESWT on penile pain, sexual function and plaque size remains questionable.

Low-intensity extracorporeal shock wave therapy for midshaft clavicular delayed union: A case report and review of literature

BACKGROUND One of the most common complications following surgery for midshaft clavicle fracture is nonunion/delayed union.Extracorporeal shock wave therapy(ESWT)is an alternative to promote new bone formation without surgical complications.To date,no literature has reported low-intensity ESWT(LI-ESWT)in delayed union of midshaft clavicle fracture.CASE SUMMARY We reported a 66-year-old Chinese amateur cyclist with clavicle delayed union treated with 10 sessions of LI-ESWT(radial,0.057 mJ/mm^(2),3 Hz,3000 shocks).No anesthetics were applied,and no side effects occurred.At the 4 mo and 7 mo follow-ups,the patient achieved clinical and radiographical recovery,respectively.CONCLUSION In conclusion,our findings indicated that LI-ESWT could be a good option for treating midshaft clavicular delayed union.

Treatment of Peripheral Neuropathy: Combination Therapy Using LED Light, Extracorporeal Shockwave Therapy, Platelet Rich Plasma, and an Oral Dietary Supplement

Objectives: Peripheral neuropathy (PN) is a significant contributor to disability in the elderly. It is also one of the most prevalent complications of type 2 diabetes, prediabetes and metabolic syndrome. PN is commonly associated with pain, numbness, tingling, burning, and cramping in the feet and legs. Current treatment options are limited to controlling pain, seizures and use of antidepressant medications. These treatments have undesirable side effects and don’t stop PN progression. Here we utilized a combination of individual-specific modalities to improve local circulation and relieve PN symptoms. Methods: We conducted an open-label, multicenter pilot trial with 34 subjects (19 males and 15 females ranging from 40 - 85 years of age). All of the participants were diagnosed with peripheral neuropathy and had bilateral symptoms in their feet, and many reported the same symptoms (pain, numbness, tingling, burning, and cramping) in their lower legs. The duration of symptoms ranged from four months to over six years. On Day 0, subjects were given a 90-day supply of the oral supplement with dosing instructions and a LED light therapy device. They also received three platelet-rich plasma (PRP) injections in their lower extremities. Subjects also received an extracorporeal shockwave therapy (ESWT) treatment for each foot and subsequently twice per week for the first six weeks, then once weekly for the duration of the study. Subjects filled out the Brief Pain Index (BPI) at weekly intervals. On Day 90, subjects completed the Patient Global Impression of Change (PGIC) survey. Results: There were significant responses to pain, as evidenced by BPI scores at weeks 8, 9, 10 and 11 (p = 0.02, 0.01, 0.02, and 0.003, respectively). Analysis of the final day PGIC survey showed a favorable outcome for 73% of participants (p = 0.003), with the majority reporting Very Much Improved. Conclusions: By utilizing a multi-modality treatment protocol that includes PRP, LED light therapy, ESWT and an oral dietary supplement, we observed significant reductions in BPI scores. Quality of life and their overall impression of change (PGIC) were significantly improved, and there were no significant side effects.

Clinical effect of extracorporeal shockwave therapy for knee osteoarthritis: A meta analysis

Objective:To provide evidence-based evidence for the clinical use of shockwave therapy in KOA.Methods: Two researchers independently searched the randomized controlled study of shockwave therapy for KOA in the databases of CNKI、VIP、WanFang Data、 Sinomed and PubMed. Jadad rating scale was used for literature quality evaluation, and the extracted data was meta-analyzed by RevMan5.3 software.Results: A total of 15 randomized controlled trials involving 1248 patients were included. The results of meta-analysis showed: The clinical effective rate of shock wave therapy for knee osteoarthritis was reliable[RR=1.12, 95%CI(1.03, 1.20), p=0.005], and the efficacy was reliable in reducing the visual analogue scale [MD=-1.73, 95%CI(-2.31, -1.14), p<0.00001] , Lequesne osteoarthritis severity index[MD=-1.60, 95%CI(-2.55, -0.64), p<0.00001] and WOMAC[MD=-6.03, 95%CI(-9.49,-2.57) p=0.0006] of KOA patients, without serious adverse reactions.Conclusion:At present, the evidence shows that shock wave can effectively improve the pain and other related symptoms in KOA patients, and the curative effect is reliable.

Clinical Use of Extracorporeal Shockwave Therapy(ESWT)for the Treatment of Carpus Valgus Deformities in Young Foals:A Retrospective Study of 64 Cases(2006-2009)

The purpose of this study was to report the use and assess the effects of extracorporeal shockwave therapy (ESWT) for the treatment of carpal joint valgus deformities (CJVDs) in young foals. Only foals with CJVDs greater than 5° were included in the study. Foals were assigned to 3 treatment groups based on their degree of CJVD measured during the initial evaluation: valgus deformity (VD) of 5° to 8.9° (Group 1), VD of 9° to 11.9° (Group 2) and VD greater than or equal to 12° (Group 3). ESWT was applied on the convex side of the angular deformity immediately following the initial radiographic evaluation. Foals were subsequently evaluated clinically and radiologically followed by treatment every 10 days until resolution of the VD, with resolution defined as a deviation less than 5 degrees. Each treatment group received specific exercise, hoof trimming and hoof/shoe extension recommendations. Sixty-four (64) foals were included in the study;ages ranged from 8 to 60 days old at inclusion in the study with a mean age of 26.7 days. Of the 28 foals included in Group 1, 10 had bilateral CJVD. There were 21 in Group 2, and 15 in Group 3. Treatment success was defined as a VD angle less than 5°, and was reached in all foals in Groups 1 and 2. Five (5) foals in Group 3 completed the study with a VD angle of 5° to 6.7° at the last radiographic assessment. No major complications were observed during the study. In conclusion, ESWT in conjunction with controlled exercise, hoof trimming and hoof/shoe extensions corrected severe CJVDs in young foals. The use of ESWT eliminates possible negative side effects of general anesthesia and surgical techniques to treat VDs. Future studies should include a control population, more severe cases, other types of angular limb deformities, and older foals.

Extracorporeal shockwave therapy for Peyronie's disease:an alternative treatment?

Aim:To determine retrospectively the safety and efficacy of extracorporeal shock wave therapy(ESWT)in patients with Peyronie's disease.Methods:Fifty-three patients with stable Peyronie's disease underwent ESWT(group 1). Fifteen patients matched with the baseline characteristic of the patients in group 1,who received no treatment,were used as the control(group 2).The patients'erectile function(International Index of Erectile Function [IIEF-5] score), pain severity(visual analog scale),plaque size and degree of penile angulation were assessed before and after the treatment in group 1 and during the follow-up in group 2.Results:The mean follow-up time was 32 months(range: 6-64 months)in group 1 and 35 months(range:9-48 months)in group 2.All the patients were available for the follow-up.Considering erectile function and plaque size,no significant changes(P>0.05)were observed in group 1 before or after the ESWT.A total of 39 patients(74%)reported a significant effect in pain relief in group 1 after ESWT.However.regarding improvement in pain,IIEF-5 score and plaque size,no significant differences were observed between the two groups.In 21 patients(40%)of group 1,the deviation angle was decreased more than 10° with a mean reduction in all patients of 11°(range:6-20°).No serious complications were noted considering ESWT procedure.Conclusion:ESWT is a minimally mvasive and safe alternative procedure for the treatment of Peyronie's disease.However,the effect of ESWT on penile pain,sexual function and plaque size remains questionable.

Treatment of Vasculogenic Erectile Dysfunction with Piezowave2 Device. Application of Low Intensity Shockwaves Using Novel Linear Shockwave Tissue Coverage (LSTC-ED®) Technique. A Prospective, Multicentric, Placebo-Controlled Study

Low intensity shockwave (LiSW) treatment is known to improve revascularization. The method has been evaluated and is used to treat vasculogenic erectile dysfunction (ED). The present study aimed to demonstrate the efficacy of a linear focused piezoelectric shockwave device (Richard Wolf/ELvationPiezowave2) to treat patients with vasculogenic ED using a novel linear shockwave tissue coverage LSTC-ED® technique. A total of 75 patients were treated using the Piezowave2 device and the LSTC-ED® technique. Patients’ erectile function was evaluated using the modified IIEF-5 (International Index of Erectile Function) scale at the beginning of treatment and at 1 month post treatment;patients were additionally questioned using our own Treatment Satisfaction Questionnaire (TSQ). The study also included a group of 50 patients treated by placebo;the outcomes of both groups were compared. The average IIEF-5 score of patients in the treatment group increased from 14.4 at baseline to 18.6 at 1 month post treatment. According to the IIEF-5 scale, treatment was successful in 81.33% of patients (61/75). According to the Treatment Satisfaction Questionnaire (answers 1 to 3 of the TSQ), treatment was successful in 77.3% of patients (58/75). In the placebo group of 50 patients only 5 patients showed an improvement based on IIEF score, and 8 reported an improvement based on their answers to the TSQ. No significant adverse effects were observed during treatment or in the follow-up period. The Piezowave2 device and the LSTC-ED® technique proved to be suitable and effective to treat erectile dysfunction.

Efficacy and safety of low-intensity shockwave therapy plus tadalafil 5 mg once daily in men with type 2 diabetes mellitus and erectile dysfunction:a matched-pair comparison study

Low-intensity extracorporeal shockwave therapy(LiESWT)represents a promising treatment for patients with erectile dysfunction(ED).We investigated the efficacy of LiESWT combined with tadalafil 5 mg once daily in men with type 2 diabetes mellitus(T2DM)and ED and compared LiESWT protocols administering different number of shockwaves.We performed a retrospective matched-pair comparison using data from a prospectively maintained database.Seventy-eight patients who received tadalafil 5 mg once dai7ly for 12 weeks+LiESWT performed with an electrohydraulic source for 3 weeks(Group A)were matched 1:1 to patients who received tadalafil 5 mg once daily alone for 12 weeks(Group B).A subgroup analysis was performed according to the number of shockwaves delivered during each session(1500,1800,and 2400 in subgroup A1,A2,and A3,respectively).The mean International Index of Erectile Function-5(IIEF-5)score variations with respect to baseline recorded at 4,12,and 24 weeks after the end of the treatment were investigated as treatment outcomes.The mean IIEF-5 scores significantly improved in all groups and subgroups at 4-week follow-up without intergroup differences.At 12-and 24-week follow-up,the mean IIEF-5 improvement was significantly higher among patients in the A3 subgroup(+5.0±2.1[P<0.001]and+4.7±2.3[P<0.001],respectively).The combined approach with tadalafil 5 mg once daily and LiESWT with a protocol involving 2400 shockwaves provides significant advantages in terms of IIEF-5 improvement and durability compared to tadalafil 5 mg once daily alone in patients with T2DM and ED.

Low-intensity extracorporeal shock wave therapy promotes recovery of sciatic nerve injury and the role of mechanical sensitive YAP/TAZ signaling pathway for nerve regeneration

Background:Histological and functional recovery after peripheral nerve injury(PNI)is of significant clinical value as delayed surgical repair and longer distances to innervate terminal organs may account for poor outcomes.Low-intensity extracorporeal shock wave therapy(LiESWT)has already been proven to be beneficial for injured tissue recovery on various pathological conditions.The objective of this study was to explore the potential effect and mechanism of LiESWT on PNI recovery.Methods:In this project,we explored LiESWT’s role using an animal model of sciatic nerve injury(SNI).Shockwave was delivered to the region of the SNI site with a special probe at 3 Hz,500 shocks each time,and 3 times a week for 3 weeks.Rat Schwann cells(SCs)and rat perineurial fibroblasts(PNFs)cells,the two main compositional cell types in peripheral nerve tissue,were cultured in vitro,and LiESWT was applied through the cultured dish to the adherent cells.Tissues and cell cultures were harvested at corresponding time points for a reverse transcription-polymerase chain reaction,Western blotting,and immunofluorescence staining.Multiple groups were compared by using one-way analysis of variance followed by the Tukey-Kramer test for post hoc comparisons.Results:LiESWT treatment promoted the functional recovery of lower extremities with SNI.More nerve fibers and myelin sheath were found after LiESWT treatment associated with local upregulation of mechanical sensitive yes-associated protein(YAP)/transcriptional co-activator with a PDZ-binding domain(TAZ)signaling pathway.In vitro results showed that SCs were more sensitive to LiESWT than PNFs.LiESWT promoted SCs activation with more expression of p75(a SCs dedifferentiation marker)and Ki67(a SCs proliferation marker).The SCs activation process was dependent on the intact YAP/TAZ signaling pathway as knockdown of TAZ by TAZ small interfering RNA significantly attenuated this process.Conclusion:The LiESWT mechanical signal perception and YAP/TAZ upregulation in SCs might be one of the underlying mechanisms for SCs activation and injured nerve axon regeneration.

Combined extracorporeal shockwave therapy and exercise for the treatment of tendinopathy:A narrative review

Tendinopathy is a chronic degenerative musculoskeletal disorder that is common in both athletes and the general population.Exercise and extracorporeal shockwave therapy(ESWT)is among the most common treatments used to mediate tendon healing and regeneration.The review presents the current understanding of mechanisms of action of ESWT and exercise in isolation and briefly synthesises evidence of their effectiveness for various tendinopathies.The central purpose of the review is to synthesize research findings investigating the combination of ESWT and exercise for five common tendinopathies(plantar heel pain,rotator cuff,lateral elbow,Achilles,and patellar tendinopathy)and provide recommendations on clinical applicability.Collectively,the available evidence indicates that ESWT combined with exercise in the form of eccentric training,tissue-specific stretching,or heavy slow resistance training are effective for specific tendinopathies and can therefore be recommended in treatment.Whilst there are at present a limited number of studies investigating combined EWST and exercise approaches,there is evidence to suggest that the combination improves outcomes in the treatment of plantar heel pain,Achilles,lateral elbow,and rotator cuff tendinopathy.However,despite overall positive outcomes in patellar tendinopathy,the combined treatment has not been shown at present to offer additional benefit over eccentric exercise alone.

Efficacy and safety of extracorporeal shock wave therapy combined with sodium hyaluronate in treatment of knee osteoarthritis:a systematic review and Meta-analysis

OBJECTIVE:To assess the efficacy and safety of extracorporeal shockwave therapy(ESWT)combined with sodium hyaluronate(HA)for the treatment of knee osteoarthritis(KOA).METHODS:PubM ed,Embase,the Cochrane Library,Web of Science,China National Knowledge Infrastructure,Wanfang database,China Science and Technology Journal Database,and SinoMed were searched from inception to July 2020.The quality of the randomized controlled trials was evaluated independently by two reviewers according to the criteria in the Cochrane Collaboration for Systematic Reviews.The identified articles were then screened individually using EndnoteX9 for eligibility in this Meta-analysis.The heterogeneity among the articles was evaluated using I2.RESULTS:A total of 17 studies,comprising 2000 individuals,were included in this Meta-analysis.The results showed that a significant improvement was observed in knee pain and function based on the clinical efficacy of ESWT combined with HA.Statistical analysis of clinical efficacy showed that[relative risk(RR)=1.21,95%confidence interval(CI)(1.12,1.30),P<0.01].Statistical analysis of visual analog scale showed that[standardized mean difference(SMD)=-2.84,95%CI(-4.01,-1.66),P<0.01].Western Ontario and McMaster University osteoarthritis index statistical analysis showed that[SMD=-1.57,95%CI(-2.52,-0.61),P<0.01].Lysholm score statistical analysis showed that[SMD=1.71,95%CI(0.98,2.44),P<0.01].In addition,only minor side effects,such as redness and swelling of the skin,were observed.CONCLUSIONS:Medium to low quality evidence showed that ESWT combined with HA offers an inexpensive,welltolerated,safe,and effective method to improve pain and functionality in patients with KOA.However,tightly controlled,randomized,large multicenter trials are warranted to validate the current findings.

Efficacy of penile low-intensity shockwave treatment for erectile dysfunction:correlation with the severity of cavernous artery disease

We analyzed the efficacy of penile low-intensity extracorporeal shockwave treatment for erectile dysfunction(ED)combined with cavernous artery disease(CAD).ED was evaluated by the International Index of Erectile Function,subdividing patients into mild and moderate/severe forms.CAD was assessed using penile color Doppler ultrasonography.Patients(n=111)with a positive outcome after treatment,based upon the minimal clinically important difference of the International Index of ED,were followed up for 3 months and 6 months.We found a significant mean increase in the index of erectile function,with an overall improvement in hemodynamic parameters of the cavernous artery.In particular,93.9%of the patients with mild ED without CAD responded to treatment and 72.7%resumed normal erectile function.Only 31.2%of the patients with moderate/severe ED and CAD responded to treatment,and none resumed normal erectile function.All patients with mild ED and no CAD maintained the effects of therapy after 3 months,while no patients with moderate/severe ED and CAD maintained the benefits of treatment after 3 months.Thus,patients with mild ED and no CAD have better and longer lasting responses to such treatment,with a higher probability of resuming normal erectile function than patients with moderate/severe ED and CAD.

Effects of individual shock wave therapy vs celecoxib on hip pain caused by femoral head necrosis

BACKGROUND Celecoxib has been used to treat hip discomfort and functional difficulties associated with osteonecrosis of the femoral head(ONFH),although significant adverse reactions often follow long-term use.Extracorporeal shock wave therapy(ESWT)can delay the progression of ONFH,alleviate the pain and functional limitations it causes,and avoid the adverse effects of celecoxib.AIM To investigate the effects of individual ESWT,a treatment alternative to the use of celecoxib,in alleviating pain and dysfunction caused by ONFH.METHODS This was a randomized,controlled,double-blinded,non-inferiority trial.We examined 80 patients for eligibility in this study;8 patients were excluded based on inclusion and exclusion criteria.A total of 72 subjects with ONFH were randomly assigned to group A(n=36;celecoxib+alendronate+sham-placebo shock wave)or group B(n=36;individual focused shock wave[ESWT based on magnetic resonance imaging three-dimensional(MRI-3D)reconstruction]+alendronate).The outcomes were assessed at baseline,at the end of treatment,and at an 8-wk follow-up.The primary outcome measure was treatment efficiency after 2 wk of intervention using the Harris hip score(HHS)(improvement of 10 points or more from the baseline was deemed sufficient).Secondary outcome measures were post-treatment HHS,visual analog scale(VAS),and Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)scores.RESULTS After treatment,the pain treatment efficiency of group B was greater than that of group A(69%vs 51%;95%CI:4.56%to 40.56%),with non-inferiority thresholds of-4.56%and-10%,respectively.Furthermore,the HHS,WOMAC,and VAS scores in group B dramatically improved during the follow-up period as compared to those in group A(P<0.001).After therapy,the VAS and WOMAC in group A were significantly improved from the 2nd to 8th wk(P<0.001),although HHS was only significantly altered at the 2 wk point(P<0.001).On the 1st d and 2nd wk after treatment,HHS and VAS scores were different between groups,with the difference in HHS lasting until week 4.Neither group had severe complications such as skin ulcer infection or lower limb motorsensory disturbance.CONCLUSION Individual shock wave therapy(ESWT)based on MRI-3D reconstruction was not inferior to celecoxib in managing hip pain and restrictions associated with ONFH.

A review of regenerative therapies as penile rehabilitation in men following primary prostate cancer treatment:Evidence for erectile restoration and cavernous nerve regeneration

Objective:The following article explores our evolving understandings of the role of regenerative technology as an effective penile rehabilitation tool in men with erectile dysfunction(ED)in the setting of prostate cancer(PCa)treatment and PCa survivorship.Methods:This narrative clinical review paper summarizes what is currently known about various modalities of regenerative therapy in restoring spontaneous erectile function(EF)in men following PCa treatment with an emphasis on penile rehabilitation strategies.Results:Conventional medical therapy often does not reverse underlying endothelial dysfunction or promote neuro-vasculogenesis to preserve penile health in men with ED.Over the past decade,there has been considerable interest in the role of regenerative therapy to restore endothelial dysfunction and ED without future dependency on medical therapy.Regenerative therapy can be classified into cellular-based(immunomodulators,stem cells,and platelet-rich plasma),biomaterials(nerve graft transfer),and device-related technology(low-intensity shockwave).Although published literature shows early promise in the role of regenerative technology for ED,there is a paucity of high-quality clinical trials in the setting of penile rehabilitation and PCa survivorship to support their use as standard care and be adopted in clinical guidelines.

高能量激光联合体外冲击波治疗对足底筋膜炎患者视觉模拟评分和足部功能指数的影响

目的探讨高能量激光联合体外冲击波治疗对足底筋膜炎(PF)患者的视觉模拟评分法(VAS)、足部功能指数(FFI)的影响。方法选取2021年1月至2022年3月于江苏大学附属医院疼痛科就诊的59例PF患者作为研究对象,根据治疗方法分为A组(n=29)与B组(n=30)。A组行体外冲击波治疗,B组行高能量激光联合体外冲击波治疗。比较两组治疗前后VAS及FFI评分。结果治疗后1个月,两组VAS评分均低于治疗前,且B组低于A组,差异有统计学意义(P<0.05)。两组FFI评分组间、时间、交互比较差异有统计学意义(P<0.05);治疗3周、治疗后1个月,两组FFI评分均低于前一时间点,且B组低于A组,差异有统计学意义(P<0.05)。结论高能量激光联合体外冲击波治疗足底筋膜炎,可更好地缓解疼痛和改善患者的足部功能,值得临床推广应用。

肥胖对体外冲击波治疗膝骨关节炎疗效的影响

目的探讨肥胖对体外冲击波治疗(extracorporeal shockwave therapy,ESWT)膝骨关节炎(knee osteoarthri-tis,KOA)疗效的影响。方法选取2021年1月至2022年12月于武警浙江省总队医院进行ESWT的123例KOA患者,其中男性38例,女性85例;年龄(59.36±5.69)岁;病程(14.92±6.9)个月。患者根据体质量指数(body mass in-dex,BMI)分为正常组(BMI<25 kg/m^(2))和肥胖组(BMI≥25 kg/m^(2))。所有患者接受ESWT,每周1次,连续治疗8周。比较两组治疗前,治疗第2周后及第8周后患者的视觉模拟评分法(Visual Analogue Scale,VAS)、膝骨性关节炎功能指数(Lequesne评分)及西大略和麦克马斯特大学骨关节炎指数(McMaster University Osteoarthritis Index,WOMAC)评分,以评价患者疼痛和功能改善情况。结果两组患者治疗前VAS评分差异无统计学意义,治疗第2周后肥胖组VAS疼痛评分疼痛缓解优于正常组[(2.40±0.79)分比(3.28±1.17)分,P<0.01];肥胖组Lequesne评分改善优于正常组[(4.40±2.54)分比(5.81±2.58)分,P<0.01];肥胖组WOMAC评分中的疼痛评分、功能评分改善优于正常组[(6.76±2.58)比(7.98±2.24),P<0.01;(21.14±8.59)比(25.91±8.09),P<0.01]。治疗第8周后,VAS疼痛评分显示与正常组相比,肥胖组疼痛改善明显[(1.63±0.85)分比(2.27±1.44)分,P<0.01];Lequesne评分显示治疗第8周后与正常组相比,肥胖组患者治疗后功能改善明显[(3.09±1.68)分比(4.47±2.76)分,P<0.01];WOM-AC评分中疼痛评分、僵硬评分、功能评分治疗第8周后正常组为(5.00±2.74)、(2.54±1.15)、(22.25±8.17)分,与肥胖组(3.27±1.78)、(2.17±0.75)、(18.45±5.84)分相比,肥胖组患者治疗第8周后疼痛及功能改善明显(P<0.05),在治疗第2周后、第8周后,WOMAC评分中疼痛评分结果与VAS评分结果一致,疼痛明显减轻,WOMAC评分中的功能评分与Lequesne功能评分相一致,功能明显改善。结论ESWT可以早期缓解患者的疼痛及功能,早期治疗效果肥胖患者优于正常体重患者;在ESWT治疗过程中,对于肥胖的患者,ESWT对于膝骨关节炎的治疗效果优于正常体重患者;肥胖可以影响KOA发生发展,但是不影响ESWT对KOA的治疗,相较正常体重患者,肥胖患者更有利于ESWT对KOA的治疗。

体外冲击波治疗股骨头坏死的临床实践指南(2024年版)

股骨头坏死(osteonecrosis of the femoral head,ONFH)是骨科常见难治性、致残性疾病,是引起髋关节疼痛及功能障碍的常见原因之一,给患者个人、家庭和社会造成了沉重的负担。体外冲击波疗法(extracorporeal shock wave ther-apy,ESWT)具有非侵入、安全、有效的特点,已被广泛应用于包括股骨头坏死在内的骨肌疾病临床治疗领域。然而,现阶段ONFH的ESWT方案在适应证选择、治疗参数、评价方法等层面缺乏统一共识,限制了疗法的推广及应用。因此,如何规范、科学、有效地为早、中期ONFH患者提供ESWT干预是临床医生关注的问题。本指南由中国人民解放军总医院第三医学中心、中日友好医院牵头,组织中国研究型医院学会冲击波医学专业委员会,以及国内ONFH、ESWT领域专家,参考国内外最新文献、结合国内临床经验及实际情况,采用改良2011年版牛津大学循证医学中心(Oxford Center for Evidence-Based Medicine,OCEBM)证据级别及推荐等级标准,遵循2014年版《世界卫生组织指南制订手册》及中华医学会发布的《中国制订/修订临床诊疗指南的指导原则(2022版)》。同时参考了指南研究与评价工具Ⅱ(Appraisal of Guide-lines for Research and EvaluationⅡ,AGREEⅡ)、卫生保健实践指南的报告条目(Reporting Items for Practice Guidelines in Healthcare,RIGHT)以及中国临床实践指南评价体系(Appraisal of Guidelines for Research and Evaluation in China,A-GREE-China)等方法,遴选出医生最为关注的9个临床问题,并最终形成9条循证医学推荐意见。本指南旨在为ONFH ESWT治疗技术的推广应用提供建设性意见及依据,提高ESWT的科学性和规范性。

体外冲击波疗法与手术治疗骨折延迟愈合和骨不连的有效性与安全性比较:一项基于临床随机对照试验研究的Meta分析

目的采用Meta分析方法评价体外冲击波疗法(ESWT)与手术治疗骨折延迟愈合和骨不连的有效性和安全性。方法计算机检索中国知网、万方数据库、Pubmed、Cochrane Library等中、英文数据库关于ESWT对比手术治疗骨折延迟愈合和骨不连的临床随机对照试验(RCTs),试验组采用ESWT,对照组采用手术治疗。检索时间从建库至2023年10月。结局指标包括愈合率、愈合时间、不良反应发生率、治疗费用。结果共纳入16篇RCTs,Meta分析结果显示,对比对照组,试验组的愈合率更高(OR=1.720,95%CI:1.240~2.380,P=0.001),愈合时间(d)缩短约27 d(MD=-27.110,95%CI:-49.700~-4.510,P=0.020),治疗费用(万元)减少约3.2万元(MD=-3.200,95%CI:-3.850~-2.560,P<0.001),不良反应发生率比较差异无统计学意义(RR=0.520,95%CI:0.100~2.860,P=0.450)。结论对比手术治疗骨折延迟愈合和骨不连,ESWT愈合率更高,愈合时间更短,无严重不良反应,成本-效益优势显著,具有较好的临床应用及推广价值。

Acupuncture may anticipate the antalgic effects of focused shockwave therapy to rotator cuff tendinopathy:A retrospective clinical study

Objective:The purpose of the study is to evaluate whether the clinical effects of focused extracorporeal shockwave therapy(f-ESWT)and acupuncture anticipate the clinical response in patients with rotator cuff tendinopathy in the short term.Design:An observational retrospective clinical study.Setting/Location:Physical Medicine and Rehabilitation Unit,Sant’Andrea University Hospital in Rome,Italy.Subjects/Interventions:We analyzed retrospectively thirty patients(22 females and 8 males)with rotator cuff tendinopathy.Fifteen patients underwent f-ESWT and acupuncture combined therapy(Group A)and fifteen patients underwent only f-ESWT therapy(Group B).Outcome measures:The outcome measures were the Visual Analogic Scale(VAS),Assessment Shoulder and Elbow Scale(ASES)and Roles and Maudsley Score(RMS).The follow-ups were T0(pre-treatment),T1(3 weeks after the start of the treatment),and T2(at 8 weeks).In order to compare groups,the ANOVA and Friedman tests were adopted.Group A patients had a more rapid and statistically significant improvement trend in VAS(P<0.001),ASES scale(P<0.001),and a higher level of satisfaction to treatment assessed by RMS(P<0.001)than group B in the short term.Conclusions:The study showed that combined treatment decreases the recovery time of the shoulder involved in terms of pain and motor function in the short term.However,these results shall be confirmed by controlled randomized studies.