发散式体外冲击波治疗长骨骨不连的相关因素  

Factors related to outcomes of radial extracorporeal shock wave for long-bone nonunion

作　　者：赵子星 杜贵忠 余金胜 兰宇斌 刘志军 贺海艳 李宏宇[2] ZHAO Zi-xing;DU Gui-zhong;YU Jin-sheng;LAN Yu-bin;LIU Zhi-jun;HE Hai-yan;LI Hong-yu(Department of Orthopaedics,The Sixth Peopled Hospital of Huizhou City,Huizhou 516200,China;Department of Orthopaedics,People's Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China)

机构地区：[1]惠州市第六人民医院,广东惠州516200 [2]广西壮族自治区人民医院,广西南宁530021

出　　处：《中国矫形外科杂志》2022年第10期893-897,共5页Orthopedic Journal of China

基　　金：广西医疗卫生适宜技术开发与推广应用项目(编号:S201643);广西医疗卫生重点科研项目课题(编号:桂卫重2011120);广西卫生厅中医药科技专项普通面上课题(编号:GZPT1242)。

摘　　要：[目的]探讨发散式体外冲击波(radial extracorporeal shock wave, rESW)治疗长骨骨不连的相关因素。[方法] 2014年9月—2019年6月,采用rESW治疗的长骨骨不连患者54例,包括股骨13例,胫骨22例,腓骨2例,肱骨6例,桡骨7例,尺骨4例。rESW治疗方法在无麻醉下进行,每周1次,每次30 min,连续4周。所有患者至少随访12个月,以临床和影像骨折愈合标准评定结果,并采用VAS评分评价患者状态。单项因素比较与二元多因素逻辑回归分析治疗结果的相关因素。[结果]治疗3个月后骨折愈合35例,占64.81%;6个月后骨折愈合39例,占72.22%;12个月后愈合40例,占74.07%。单项因素比较表明,愈合组肥大型骨不连的比率显著大于不愈合组(P<0.05);愈合组在骨折至r ESW治疗间隔时间、手术次数、骨折间隙和rESW治疗周期次数显著小于不愈合组(P<0.05)。逻辑回归分析表明,骨折间隔时间(OR=1.080,P=0.036)、治疗前手术次数(OR=4.900,P=0.015)、治疗前骨折间隙(OR=1.418,P=0.010)、骨不连类型(OR=31.054,P<0.001)和rESW治疗周期(OR=2.401,P<0.001)是影响rESW治疗的相关因素(P<0.05)。[结论] rESW治疗骨不连安全、有效。骨不连的类型、骨折间隔时间、治疗前手术次数和治疗前骨折端间隙是影响rESW治疗成功的相关因素。大于8个周期(次)的rESW治疗是无意义的。[Objective] To explore the factors related to the outcomes of radial extracorporeal shock wave(rESW) for long bone nonunion. [Methods] From September 2014 to June 2019, 54 patients received rESW therapy for long bone nonunion, involving 13 femurs, 22tibias, 2 fibulas, 6 humerus, 7 radius, and 4 ulnas. The r ESW was applied once a week for 30 minutes without anesthesia for 4 weeks. All patients were followed for at least 12 months to assess outcomes by using clinical and radiographic fracture healing criteria and VAS scores.Univariate comparison and binary multi-factor logistic regression were conducted to search the factors related to treatment outcome. [Results] Fracture healing achieved in 35 patients(64.81%) at 3 months after treatment, 39 cases(72.22%) at 6 months and 40 cases(74.07%)at 12 months after treatment. Regarding to univariate comparison, the union group had significantly higher ratio of hypertrophic bone nonunion than the nonunion group(P<0.05), whereas, the union group was significantly less than the nonunion group in terms of interval between fracture and rESW treatment, the number of previous surgical operations, fracture gap and the number of rESW treatment cycles(P<0.05). As results of logistic regression, interval between fracture and r ESW treatment(OR=1.080, P=0.036), the number of previous operation(OR=4.900, P=0.015), fracture gap(OR=1.418, P=0.010), the type of nonunion(OR=31.054, P<0.001) and the number of r ESW treatment cycle(OR=2.401, P<0.001) were significantly related to the outcomes of rESW therapy. [Conclusion] The rESW is safe and effective in the treatment of long bone nonunion, and its outcomes is related to the type of nonunion, interval between fracture and rESW treatment,the number of previous surgery, fracture gap. In addition, rESW therapy greater than 8 cycles might be meaningless.

关 键 词：发散式体外冲击波 骨不连 疗效 相关因素 

分 类 号：R687[医药卫生—骨科学]