中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (9): 1625-1628.doi: 10.3969/j.issn.1673-8225.2010.09.024

• 器官移植临床实践 • 上一篇    下一篇

体外冲击波治疗骨折延迟愈合及骨不连：动物实验及临床病例随访

邢  星，冯  培   

  1. 齐齐哈尔市公安医院骨外科，黑龙江省齐齐哈尔市    161006
  • 出版日期:2010-02-26 发布日期:2010-02-26
  • 作者简介:邢 星，男，1968年生，辽宁省新民县人，汉族，1999年哈尔滨医科大学毕业，副主任医师，主要从事显微微创方面的研究。 mayanli5555@126.com

Extracorporeal shock wave therapy for nonunion or delayed osseous union: Animal experiment and clinical follow-up

Xing Xing, Feng Pei   

  1. Department of Orthopaedics Surgery, Public Security Hospital of Qiqihaer City, Qiqihaer  161006, Heilongjiang Province, China
  • Online:2010-02-26 Published:2010-02-26
  • About author:Xing Xing, Associate chief physician, Department of Orthopaedics Surgery, Public Security Hospital of Qiqihaer City, Qiqihaer 161006, Heilongjiang Province, China mayanli5555@126.com

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摘要：

背景：体外冲击波技术是利用液电能量转换及传递原理，造成不同密度组织之间产生能量梯度差及扭拉力，从而达到治疗目的，它用于治疗泌尿系、消化系结石已成为十分成熟的技术。而将其用于骨组织，治疗骨不连、骨折延迟愈合的报道很少。
目的：通过动物实验及临床验证试验，观察体外冲击波治疗骨不连及骨折延迟愈合的疗效果。
方法：采用冲击波通过体外聚焦作用于骨组织，了解体外冲击波对骨膜组织代谢的影响，通过动物实验，观察骨膜组织体外培养H3-TdR掺入放射性自显影结果。临床验证部分通过体外冲击波治疗骨不连16例及骨折延迟愈合16例，观察其冲击治疗后的随访结果。
结果与结论：动物实验结果表明，冲击1，2周实验侧骨膜组织H3-TdR标记率明显高于对照侧(P < 0.05~0.01)，说明实验侧骨膜成骨有丝分裂明显增强，骨膜成骨作用增强。临床验证结果表明，治疗后16周，16例延迟愈合均愈合；16例骨不连患者中13例愈合，另3例也有明显骨痂形成。所有病例冲击治疗后均无不良事件发生。提示冲击波治疗各种类型的骨不连及骨折延迟愈合效果可靠。

关键词: 体外冲击波, 骨折, 延迟愈合, 骨不连, 动物实验, 临床验证

Abstract:

BACKGROUND: Extracorporeal shock wave (ESW) therapy is using principles of liquid-electric conversion and transfer to produce energy gradient difference and torsional tension in tissues with varied density. It is a matured technique in treating urinary and digestive system calculosis. However, the applications of ESW in treating nonunion or delayed osseous union are few.     
OBJECTIVE: To explore the therapeutic effects of ESW in treating nonunion or delayed osseous union by animal experiment and clinical verification.
METHODS: The effect of ESW on periosteal metabolism was explored by focusing extracorporeal wave on bone tissues, and the autoradiography of H3-TdR labeling rate was observed by animal experiment. ESW was used to treat nonunion patients (n=16) or delayed osseous union patients (n=16), and the follow-up results were evaluated.  
RESULTS AND CONCLUSION: By autoradiography, the H3-TdR labeling rate was greater in the experimental sides than that of the control sides at 1 and 2 weeks after operation (P < 0.05-0.01), which confirmed that the mitotic activity of periosteal osteoblasts was increased, namely, endosteal osteogenesis was enhanced. Clinical verification results demonstrated that, at 16 weeks after operation, 16 patients with delayed union were all cured, 13 were cured among the 16 cases of nonunion, and the remained 3 cases had notably callus formation. No adverse events occurred in all cases. The results suggested that it is reliable to treat nonunion or delayed osseous union using ESW therapy.

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