摘要
目的比较放散状与聚焦状冲击波治疗骨折延迟愈合或不愈合的疗效。方法对2011年4月至8月收治的47例骨折延迟愈合或不愈合患者资料进行凹顾性分析，男38例，女9例；年龄21-56岁，平均35．0岁。所有患者均为肥大型稳定性骨折延迟愈合或不愈合。骨折延迟愈合或不愈合部位：股骨24例，肱骨6例，胫骨17例。初次内固定方法：钢板固定37例，外同定支架同定8例，带锁髓内钉内固定2例。23例患者接受放散状冲击波治疗（放散组），24例患者接受聚焦状冲击波治疗（聚焦组），根据不同骨折部位选择合适的冲击能量、频率和剂量进行治疗。患者每个月复金x线片，了解骨痂生长情况。比较两组患者的治愈率和有效率。结果所有患者术后均获9个月随访。放散组23例患者中，22例有较明显的骨痂生长，其中21例完全愈合，1例部分愈合，1例无效，治愈率为91．3％，有效率为95．7％。骨折愈合时间为8-24周，平均12周。聚焦组24例患者中，17例完全愈合，7例无效，治愈率和有效率均为70．8％。骨折愈合时间为8-40周，平均18周。两组患者治愈率比较差异无统计学意义（P=0．137），有效率比较差异有统计学意义（P=0．048）。两组分别有4、9例患者出现肢体血管损伤。结论体外冲击波是治疗骨折延迟愈合或不愈合较理想的方法；放散状冲击波治疗骨折延迟愈合或不愈合的有效率优于聚焦状冲击波。
Objective To compare radial and focusing extracorporeal shock waves in terms of their effects on the treatment of delayed union and nonunion of fractures. Methods Forty-seven patients with delayed union or nonunion of hypertrophic stable type received extracorporeal shock wave therapy from April to August 2011. They were 38 men and 9 women, aged from 21 to 56 years （average, 35.0 years）. The lesions involved the femur in 24 cases, the humerus in 6 cases and the tibia in 17 cases. The primary fixations in- cluded plating in 37 cases, external fixator in 8 cases, and locking intramedullary nailing in 2 cases. Twen- ty-three patients received radial shock wave therapy and 24 focusing shock wave therapy. Therapies were conducted with suitable shock wave energy, frequency and dosage according to the specific fracture location. X-ray follow-ups were performed at monthly intervals to evaluate the callus growth. The 2 groups were com- pared in terms of the cure rate and effective rate. Results The mean follow-up was 9 months. Of the 23 patients receiving radial extracorporeal shock wave therapy, 21 got complete bone union, one partial union, and one no obvious callus growth. The cure rate and effective rate wel~ 91.3% and 95.7% respectively. The ration time ranged from 8 to 24 weeks, averaging 12 weeks. Of the 24 patients receiving focusing treatment, 17 got complete bone union and 7 no obvious callus growth. The cure rate and effective rate were both 70. 8%. The union time ranged from 8 to 40 weeks, averaging 18 weeks. There was a significant difference in the eftective rate between the 2 groups （ P = 0. 048） but no regarding the cure rate （ P = 0. 137）. Radial shock wave treatment caused vascular injury in 4 cases and focusing shock wave in 9 cases. Conclusions Extracorporeal shock waves are effective treatment of delayed union and nonunion of fractures. The radial extracorporeal shock waves may be more effective than the focusing extracorporeal shock waves.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2012年第11期968-972,共5页
Chinese Journal of Orthopaedic Trauma
关键词
高能量冲击波
骨折
不愈合
延迟愈合
四肢
High-energy shock waves
Fractures, nonunited： Delayed union
Extremities
