体外冲击波治疗骨不连的方法选择与影响因素

Method selection and impacting factors of extracorporeal shock wave therapy for fracture nonunion

摘要:

[目的] 研究不同体外冲击波疗法 （extracorporeal shock wave therapy, ESWT） 治疗深部、较深部及浅部骨不连的疗效，并探讨其影响因素。[方法]2011 年 11 月—2022 年 9 月采用 ESWT 治疗各类骨不连 87 例。深部骨不连选择聚焦式 ESWT （focused ESWT, fESWT），浅部选择发散式 ESWT（radial ESWT, rESWT），较深部选择聚焦式联合发散式 ESWT（f-rESWT）。观察骨折愈合情况，同时分析影响愈合率的相关因素。[结果]87 例患者在治疗期间均无不良事件发生。至末次随访时，深部骨不连愈合 24 例，愈合率 75.0%；较深部愈合 36 例，愈合率 78.3%；浅部愈合 7 例，愈合率 77.8%。按治疗方法，三组间年龄、性别、骨不连分型、临床愈合时间和影像不同时间点愈合率的差异均无统计学意义 （P＞0.05）。按末次随访时患者是否达到影像愈合分组，愈合组的年龄显著小于不愈合组 [(34.3±10.5) 岁 vs (40.5±10.1) 岁, P=0.042]，而愈合组治疗次数显著多于不愈合组 [(22.6±9.8) 次 vs (8.3±3.6) 次, P=0.011]，两组在性别、骨不连类型及诊断距首次治疗间隔时间均无明显差异 （P＞0.05）。多因素逻辑回归分析表明，年龄是骨不连愈合的负面影响因素 （OR=0.920, P=0.040），而 ESWT 治疗次数是骨不连愈合的正面影响因素（OR=1.125, P=0.004）。[结论]根据骨不连发生部位的深浅选择不同 ESWT 个性化治疗方法可获得满意疗效。治疗次数和年龄是 ESWT 治疗骨不连的重要影响因素。

Abstract:

[Objective] To investigate the efficacy of different extracorporeal shock wave therapies (ESWTs) in the treatment of deep, relatively deep and superficial fracture nonunion, and explore relative impacting factors. [Methods] From November 2011 to September 2022, a total 87 patients received ESWTs, including focused ESWT (fESWT) used for deep fracture nonunion, fESWT combined with radial ESWT (rESWT), (f- rWSWT) for relatively deeper nonunion, and rESWT for superficial nonunion. The fracture nonunion healing was ob- served and the related factors affecting the healing rate were analyzed. [Results] No adverse events occurred in 87 patients during treat- ment. At the last follow- up, the deep bone nonunion healed in 24 cases (75.0%), while relatively deeper nonunion healed in 36 cases (78.3%), and superficial nonunion healed in 7 cases (77.8%). There were no statistically significant differences in age, sex, bone nonunion type, clinical healing time and healing rate at different time points on images among the three groups based on treatment methods (P＞ 0.05). According to whether the patients had achieved nonunion healed on images at the last follow-up, the healed group were significantly young- er in age than the non-healed group [(34.3±10.5) years vs (40.5±10.1) years, P=0.042], the healed group got significantly more times of treatment than the non-healed group [(22.6±9.8) times vs (8.3±3.6) time, P=0.011], despite insignificant differences between the two groups in gender, type of bone nonunion and interval between diagnosis and first treatment (P＞0.05). As results of multivariate logistic regression, the age was a negative factor for nonunion healing (OR=0.920, P=0.040), while the treatment times of ESWT was a positive factor for non- union healing (OR=1.125, P=0.004). [Conclusion] The individualized ESWT based on depth of fracture nonunion site, does obtain satisfac- tory curative effect. Treatment times and age are important factors impacting ESWT treatment of fracture nonunion.