Martini Lucia, Giavaresi Gianluca, Fini Milena, Torricelli Paola, de Pretto Mario, Schaden Wolfgang, Giardino Roberto
Experimental Surgery Department, Rizzoli Orthopedic Institute, via di Barbiano 1/10, 40136 Bologna, Italy.
Clin Orthop Relat Res. 2003 Aug(413):269-80. doi: 10.1097/01.blo.0000073344.50837.cd.
Extracorporeal shock wave therapy has been used increasingly in musculoskeletal disorders although its biologic mechanisms are not understood completely. The current study evaluated the effects of extracorporeal shock wave therapy on human osteoblastlike cells by using an electrohydraulic shock wave generator and comparing three energy levels. (Group A, 14 kV and 0.15 mJ/mm2; Group B, 21 kV and 0.31 mJ/mm2; Group C, 28 kV and 0.40 mJ/mm2; Control Group, no energy) and two total impulses (500, 1000) for each level. At the end of treatment, a reduction by approximately 76% was observed in Group C cell number versus basal value when compared with the other groups. Viability, biochemical activity, and gene expression of cultured cells were evaluated 24 and 48 hours after treatment. The viability test showed a decrease in Group C viability of approximately 54% at both culture times as compared with the other groups. Significant increases in nitric oxide, osteocalcin, and transforming growth factor-beta1 production ranging from 10% to 35% were found in Group A. All treated groups had lower C-terminal procollagen Type I values than the Control Group, but important increases were observed between 24 and 48 hours in all groups except Group C. This particular finding reveals that osteoblast differentiation in Group A is enhanced strongly during the first 24 hours after exposure leading after another 24 hours to an increase in C-terminal procollagen Type I production and consequently in bone matrix deposition. The current study showed that one of the most important aspects to be considered is not the total number of impulses used, but the energy level of the shock waves, therefore confirming that extracorporeal shock wave therapy has a dose-dependent initial destructive effect on cells when the selected energy is higher than 21 kV.
体外冲击波疗法在肌肉骨骼疾病中的应用日益广泛，但其生物学机制尚未完全明确。本研究使用液电式冲击波发生器，比较三种能量水平，评估体外冲击波疗法对人成骨样细胞的影响。（A组，14 kV和0.15 mJ/mm²；B组，21 kV和0.31 mJ/mm²；C组，28 kV和0.40 mJ/mm²；对照组，无能量），每个水平设置两个总冲击次数（500、1000）。治疗结束时，与其他组相比，C组细胞数量相对于基础值减少了约76%。在治疗后24小时和48小时评估培养细胞的活力、生化活性和基因表达。活力测试显示，与其他组相比，C组在两个培养时间点的活力均下降了约54%。A组一氧化氮、骨钙素和转化生长因子-β1的产生显著增加，增幅在10%至35%之间。所有治疗组的I型前胶原C端值均低于对照组，但除C组外，所有组在24小时至48小时之间均有显著增加。这一特殊发现表明，A组成骨细胞在暴露后的最初24小时内分化强烈，再过24小时后，I型前胶原C端产量增加，从而导致骨基质沉积增加。本研究表明，最重要的考虑因素之一不是使用的总冲击次数，而是冲击波的能量水平，因此证实当所选能量高于21 kV时，体外冲击波疗法对细胞具有剂量依赖性的初始破坏作用。
