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

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 rESW 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 rE- SW 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 rE- SW 治疗是无意义的。

Abstract:

[Objective] To explore the factors related to the outcomes of radial extracorporeal shock wave (rESW) for long bone non- union. [Methods] From September 2014 to June 2019, 54 patients received rESW therapy for long bone nonunion, involving 13 femurs, 22 tibias, 2 fibulas, 6 humerus, 7 radius, and 4 ulnas. The rESW 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 non- union than the nonunion group (P＜0.05) , whereas, the union group was significantly less than the nonunion group in terms of interval be- tween 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 rESW treatment (OR=1.080, P=0.036) , the number of previous opera- tion (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 rESW treat- ment 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.