Rutten Sjoerd, Nolte Peter A, Guit Gerard L, Bouman Donald E, Albers Gerardus H R
Department of Orthopedics and Traumatology, Tergooiziekenhuizen, The Netherlands.
J Trauma. 2007 Apr;62(4):902-8. doi: 10.1097/01.ta.0000238663.33796.fb.
Low-intensity pulsed ultrasound is effective in fresh fracture healing, resulting in a 40% reduction in healing time. The aim of this study is to determine the effect of ultrasound treatment on established tibia nonunions.
The study group consists of all Dutch patients of posttraumatic consecutive nonunion of the tibia, who started their ultrasound treatment between January 2000 and February 2003. In total, 71 cases have been included, which involve 56 men and 15 women. Mean age was 40 years. Low-intensity pulsed ultrasound was the only new treatment. Strict criteria of enrollment minimized any spontaneous healing chance. According to literature, the spontaneous healing rate was between 5% and 30%. The study outcome, healed or failed, was the primary efficacy parameter. Thirty percent was chosen to represent the maximum expected spontaneous healing and was the basis for statistical evaluation. Stratification was performed for the variables at the ultrasound treatment start.
The overall healing rate is 52 of 71 cases (73%). Ultrasound treatment shows a statistical significant higher healing rate compared with that of the spontaneous healing chance (p < 0.0001). Stratification shows no statistical significance for any of the variables analyzed. The long-term follow-up shows high compliance rate and no refractures.
Tibia nonunions have a high occurrence rate and cause significant impairment to daily functioning. This study shows that low-intensity pulsed ultrasound is effective in the treatment of established tibia nonunions and can be seen as a good, safe, and cheaper alternative to surgery.
低强度脉冲超声对新鲜骨折愈合有效，可使愈合时间缩短40%。本研究的目的是确定超声治疗对已形成的胫骨骨不连的影响。
研究组包括2000年1月至2003年2月期间开始接受超声治疗的所有荷兰创伤后连续性胫骨骨不连患者。总共纳入71例，其中男性56例，女性15例。平均年龄为40岁。低强度脉冲超声是唯一的新治疗方法。严格的纳入标准将任何自发愈合的机会降至最低。根据文献，自发愈合率在5%至30%之间。愈合或未愈合的研究结果是主要疗效参数。选择30%来代表预期的最大自发愈合率，并作为统计评估的基础。在开始超声治疗时对变量进行分层。
71例中有52例（73%）总体愈合。与自发愈合机会相比，超声治疗显示出统计学上显著更高的愈合率（p < 0.0001）。分层显示所分析的任何变量均无统计学意义。长期随访显示依从率高且无再骨折。
胫骨骨不连发生率高，对日常功能造成严重损害。本研究表明，低强度脉冲超声对已形成的胫骨骨不连治疗有效，可被视为一种良好、安全且更便宜的手术替代方法。
