体外冲击波对动物骨不连愈合的影响(英文)  

Effects of extracorporeal shock waves on the healing of bone nonunion in animals

作　　者：钟俊[1] 李家元[1] 明江华[1] 彭昊[1] 刘世清[1] 王以强[2] 夏良波[3] 

机构地区：[1]武汉大学人民医院骨科,湖北省武汉市430060 [2]孝感市中心医院骨科,湖北省孝感市432100 [3]孝感市中心医院碎石中心,湖北省孝感市432100

出　　处：《中国临床康复》2006年第29期190-192,共3页Chinese Journal of Clinical Rehabilitation

摘　　要：背景:骨不连的治疗一直是骨科一个较难解决的问题,部分骨不连经多次手术治疗仍不能愈合,非手术方法效果都不太理想。体外冲击波治疗骨不连是一种近年在国外兴起的骨不连非手术治疗方法。目的:应用体外冲击波治疗骨不连,了解其对骨不连愈合的影响,并对体外冲击波治疗骨不连的机制作初步探讨。设计:随机分组设计,动物实验。单位:武汉大学人民医院骨科。材料:实验于1997-09/1999-03在武汉大学医学部动物实验中心完成。选择健康雄性日本大耳白兔40只,制作骨不连模型,以肥大型骨不连动物为实验对象,共32只,随机分治疗组和对照组,各16只。方法:治疗组采用HX902Ⅲ型多功能冲击波碎石机进行骨不连断端冲击波治疗,能量0.54mJ/mm2,频率60次/min,剂量2000次,焦点聚焦范围为1.5cm2。透视下调整碎石机第2焦点分别对准骨不连远、近端边缘相对应部位,各冲击1000次。动物行冲击波治疗后,继续外固定架固定,并自由活动。对照组动物不行任何治疗,继续外固定支架固定。主要观察指标:X射线摄片、组织学检查和电子透射显微镜检查观察骨不连的愈合情况。结果:纳入动物32只,均进入结果分析。①X射线摄片:在体外冲击波治疗过程中,通过透视发现骨不连处骨折线逐渐模糊,两硬化骨端密度减低,骨髓腔趋于通畅,冲击波治疗前后摄片所见骨不连间隙有显著性变窄。冲击波治疗6周,治疗组6只(6/14)动物骨性连接,12周有12只(12/12)动物骨性连接。对照组治疗12周摄片有1只动物骨性连接。经四格表确切概率法检验,治疗组骨不连愈合情况好于对照组,差异显著(P<0.001)。②光镜检查:治疗组治疗2周时成骨细胞和间充质细胞聚集增生活跃;治疗6周时骨小梁形成丰富;治疗12周时骨不连愈合好。而对照组一直表现为慢性炎症反应,骨小梁形成少。③电镜检查:治疗2周时治疗组成骨�BACKGROUND：. The therapy of nonunion has been a difficult issue in orthopedics all the time. Part of nonunion can＇t heal even after many times of operations. The effects of non-surgical treatments are not satisfactory. Extracorporeal shock waves （ESV） is a new method that popular abroad in recent years. OBJECTIVE： To investigate the effect of ESW on nonunion, and preliminarily probe into its mechanism. DESIGN： Randomized group-division design, animal experiment. SETTING： Department of Orthopedics, Renmin Hospital of Wuhan University. MATERIALS： The experiment was conducted in the Medical Experimental Center of Animal, Wuhan University from September 1997 to March 1999. Forty healthy male rabbits were selected to establish model of nonunion. Thirty-two rabbits with hypertrophic nonunion were taken as materials and randomly divided into treatment group and control group with 16 rabbits in each group. METHODS： A multifunctional ESW apparatus Of type HX902Ⅲ was adopted to treat the broken ends of nonunion in the treatment group with the energy, frequency, dose and focus range of 0.54 mJ/mm^2, 60 times/minute, 2 000 times and 1.5 cm^2 respectively. The second focus of shock wave was adjusted, aiming at corresponding parts in distal and proximal sites of nonunion, and acted 1 000 times. After that, rabbits were re-fixed with external apparatus and acted freely. Rabbits in the control group were fixed with external apparatus without any other treatments. MAIN OUTCOME MEASURES： Examination of the healing of nonunion with radiograph, transmission electron microscope （TEM） and in histology. RESULTS： A total of 32 enrolled animals were involved in the analysis of results.①X-ray photograph： During the treatment with ESW, the gaps of nonunion were more and more indistinct in X-rays, and the densities of two sclerotic ends were reduced, and the sclerotic marrow cavities became unobstructed. The X-rays of nonunion-gaps before ESW were significantly narrowed than those after the treatmen

关 键 词：骨折 愈合 高能量冲击波 疾病模型 动物 

分 类 号：R496[医药卫生—康复医学]