Nolte P A, van der Krans A, Patka P, Janssen I M, Ryaby J P, Albers G H
Department of Orthopaedics, Academic Medical Center, University of Amsterdam, The Netherlands.
J Trauma. 2001 Oct;51(4):693-702; discussion 702-3. doi: 10.1097/00005373-200110000-00012.
Low-intensity ultrasound has demonstrated an acceleration of bone healing and more profound callus formation in animal and human clinical experiments. In this study, the effect of pulsed, low-intensity ultrasound was determined in established nonunion cases.
The enrolled cases were reviewed for the time from their last surgical procedure and evidence of no healing or progression of healing during the 3 or more months before the start of low-intensity ultrasound therapy to determine whether the cases were established nonunions. Twenty-nine cases, located in the tibia, femur, radius/ulna, scaphoid, humerus, metatarsal, and clavicle, met the criteria for established nonunions. On average, the postfracture period before the start of ultrasound treatment was 61 weeks. Initial fracture treatment was conservative in 8 cases and operative in 21 cases. Additional treatments including bone grafting, reosteosynthesis, and other surgical procedures were performed an average of 52 weeks before the start of ultrasound treatment. Daily, 20-minute applications of low-intensity ultrasound at the site of the nonunion were performed by the patients at home.
Twenty-five of the 29 nonunion cases (86%) healed in an average treatment time of 22 weeks (median, 17 weeks). Stratification of the healed and failed outcome for age, gender, concomitant disease, bone location, fracture age, prior last surgery interval, nonunion type, smoking habits, and fixation before and during treatment showed a significant difference only in the smoking habit strata.
Noninvasive ultrasound therapy can be useful in the treatment of challenging, established nonunions.
低强度超声在动物和人类临床试验中已证明可加速骨愈合并形成更明显的骨痂。在本研究中，确定了脉冲低强度超声对已形成的骨不连病例的影响。
回顾纳入病例自上次手术以来的时间，以及在低强度超声治疗开始前3个月或更长时间内无愈合或愈合进展的证据，以确定这些病例是否为已形成的骨不连。29例位于胫骨、股骨、桡骨/尺骨、舟骨、肱骨、跖骨和锁骨的病例符合已形成骨不连的标准。超声治疗开始前骨折后的平均时间为61周。8例骨折的初始治疗为保守治疗，21例为手术治疗。在超声治疗开始前平均52周进行了包括植骨、再次骨合成和其他外科手术在内的额外治疗。患者在家中每天在骨不连部位进行20分钟的低强度超声治疗。
29例骨不连病例中有25例（86%）愈合，平均治疗时间为22周（中位数为17周）。根据年龄、性别、伴随疾病、骨位置、骨折时间、上次手术间隔时间、骨不连类型、吸烟习惯以及治疗前后的固定情况对愈合和未愈合结果进行分层分析，结果显示仅在吸烟习惯分层中有显著差异。
无创超声治疗可用于治疗具有挑战性的已形成的骨不连。
