中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (17): 3135-3138.doi: 10.3969/j.issn.1673-8225.2010.17.024

• 骨与关节损伤基础实验 basic experiments of bone and joint injury • 上一篇    下一篇

液电式体外冲击波治疗创伤性距骨缺血性坏死

翟  磊1，孙  楠2，张柏青3，王景贵1，邢更彦4   

  1. 武装警察部队医学院附属医院，   1骨科， 2肾病科，天津市 300162；3武装警察北京总队五支队卫生队，北京市     100192；4武装警察部队总医院关节四肢外科，北京市  100039
  • 出版日期:2010-04-23 发布日期:2010-04-23
  • 通讯作者: 邢更彦，教授，硕士生导师，武装警察部队总医院关节四肢外科，北京市100039 jstzzl2000@yahoo.com.cn
  • 作者简介:翟 磊★，男，1982年生，江苏省泰州市人，汉族，2008年河北医科大学毕业，硕士，医师，主要从事骨与关节疾病的临床与基础研究。
  • 基金资助:

    国家自然科学基金资助项目(30371430)“ESWT作用后成骨细胞力化学信号转导及相关基因表达”。

Effect of liquid-electric extracorporeal shock wave on treating traumatic avascular necrosis of talus

Zhai Lei1, Sun Nan2, Zhang Bai-qing3, Wang Jing-gui1, Xing Geng-yan4   

  1. 1 Department of Orthopaedics, 2 Department of Nephrology, Affiliated Hospital of Medical College of Chinese Armed Police Force, Tianjin  300162, China; 3 Health Team of the Fifth Detachment of Chinese Armed Police Force in Beijing, Beijing 100029, China; 4 Department of Joint Limb Surgery, General Hospital of Chinese Armed Police Force, Beijing 100039, China
  • Online:2010-04-23 Published:2010-04-23
  • Contact: Xing Geng-yan, Professor, Master’s supervisor, Department of Joint Limb Surgery, General Hospital of Chinese Armed Police Force, Beijing 100039, China jstzzl2000@yahoo.com.cn
  • About author:Zhai Lei★, Master, Physician, Department of Orthopaedics, Affiliated Hospital of Medical College of Chinese Armed Police Force, Tianjin 300162, China
  • Supported by:

    the National Natural Science Foundation of China, No. 30371430*

PDF

746

被引次数

33

摘要：

背景：创伤性距骨坏死至今为止尚无理想的治疗方法，体外冲击波是目前一种微创、简单、疗效显著的骨肌系统疾病治疗新方法，其是否能够治疗距骨坏死尚无相关研究。
目的：应用液电式体外冲击波治疗创伤性距骨缺血性坏死并分析其治疗效果，探索创伤性距骨坏死新的治疗方法。
方法：纳入2004-09/2009-06武装警察部队医学院附属医院收治的创伤性距骨缺血性坏死患者34例，均为单侧发病，按随机数字表达分为体外冲击波疗法组和对照组，每组17例。采用体表痛点定位结合X射线定位，工作电压8~10 kV，能流密度0.12~0.16 mJ/mm2，冲击频率40~50次/min，冲击次数800~1 000次。1次/周，共治疗3~5次。治疗前后采用目测类比评分评估疼痛情况；参照美国足踝关节外科协会踝关节功能评分进行功能评价；治疗后18个月时复查踝关节MRI，比较治疗前后坏死面积的变化。
结果与结论：两组病例治疗后18个月，体外冲击波疗法组的疼痛、踝关节功能、踝关节MRI坏死面积的改善情况均优于对照组(P < 0.01)。对照组有1例因创伤性关节炎剧烈疼痛致踝关节活动受限，于治疗后第15周行踝关节融合术。提示液电式体外冲击波治疗创伤性距骨缺血性坏死是一种值得提倡的非侵入性、方法简单、疗效显著、并发症少的微创治疗方法。

关键词: 体外冲击波, 液电式, 距骨, 创伤性, 缺血性坏死

Abstract:

BACKGROUND: No method is ideal for treating traumatic avascular necrosis of talus up to now. Extracorporeal shock wave therapy (ESWT) is a micro-traumatic, simple, and effective method to treat musculoskeletal diseases; however, the therapeutic effect on necrosis of talus needs to be further studied. 
OBJECTIVE: To evaluate the therapeutic effect of liquid-electric extracorporeal shock wave on traumatic avascular necrosis of talus, and to explore new treatments of traumatic avascular necrosis of talus.
METHODS: A total of 34 patients with traumatic avascular necrosis of talus were selected from the Affiliated Hospital of Medical College of Chinese Armed Police Force from September 2004 to June 2009. The patients were randomly divided into ESWT and control groups, with 17 patients per group. All patients were treated with pain point positioning combined with surface X-ray localization, the working voltage of 8-10 kV, energy flow density of 0.12-0.16 mJ/mm2, impact frequency of 40-50 times/min, and impact of 800-1 000 times, once a week, for 3-5 cycles. Pain was evaluated with VAS before and after treatment, function of ankle was evaluated with AOFAS standards, and MRI of ankle was re-checked at 18 months after treatment to compare necrotic area before and after treatment.
RESULTS AND CONCLUSION: VAS pain, function of ankle, and necrotic area of ankle in the ESWT group were significantly improved compared to those in the control group at 18 months after treatment (P < 0.01). Activity of one case in the control group was limited by severe pain due to traumatic arthritis in the first 15 weeks after ankle arthrodesis surgery. This suggested that liquid-electric extracorporeal shock wave was a non-invasive method which was simple minimally invasive treatment and had significant effect and fewer complications, for treating traumatic avascular necrosis of talus.

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