Mariotto Sofia, de Prati Alessandra Carcereri, Cavalieri Elisabetta, Amelio Ernesto, Marlinghaus Ernst, Suzuki Hisanori
Department of Morphological and Biomedical Sciences, Biochemistry Section, University of Verona, Verona, Italy.
Curr Med Chem. 2009;16(19):2366-72. doi: 10.2174/092986709788682119.
Shock waves (SW), defined as a sequence of single sonic pulses characterised by high peak pressure (100 MPa), a fast rise in pressure (< 10 ns) and a short lifecycle (10 micros), are conveyed by an appropriate generator to a specific target area at an energy density ranging from 0.03 to 0.11 mJ/mm(2). Extracorporeal SW (ESW) therapy was first used on patients in 1980 to break up kidney stones. During the last ten years, this technique has been successfully employed in orthopaedic diseases such as pseudoarthosis, tendinitis, calcarea of the shoulder, epicondylitis, plantar fasciitis and several inflammatory tendon diseases. In particular, treatment of the tendon and muscle tissues was found to induce a long-time tissue regeneration effect in addition to having a more immediate anthalgic and anti-inflammatory outcome. In keeping with this, an increase in neoangiogenesis in the tendons of dogs was observed after 4-8 weeks of ESW treatment. Furthermore, clinical observations indicate an immediate increase in blood flow around the treated area. Nevertheless, the biochemical mechanisms underlying these effects have yet to be fully elucidated. In the present review, we briefly detail the physical properties of ESW and clinical cases treated with this therapy. We then go on to describe the possible molecular mechanism that triggers the anti-inflammatory action of ESW, focusing on the possibility that ESW may modulate endogenous nitric oxide (NO) production either under normal or inflammatory conditions. Data on the rapid enhancement of endothelial NO synthase (eNOS) activity in ESW-treated cells suggest that increased NO levels and the subsequent suppression of NF-kappaB activation may account, at least in part, for the clinically beneficial action on tissue inflammation.
冲击波（SW）是指一系列单个的声脉冲，其特征为高峰压（100兆帕）、压力快速上升（<10纳秒）和短生命周期（10微秒），由合适的发生器以0.03至0.11毫焦/平方毫米的能量密度传输至特定目标区域。体外冲击波（ESW）疗法于1980年首次用于治疗肾结石患者。在过去十年中，该技术已成功应用于诸如假关节、肌腱炎、肩部钙化、肱骨外上髁炎、足底筋膜炎和几种炎症性肌腱疾病等骨科疾病。特别是，发现对肌腱和肌肉组织的治疗除了具有更直接的止痛和抗炎效果外，还能诱导长期的组织再生效应。与此一致的是，在ESW治疗4至8周后，观察到犬类肌腱中新生血管生成增加。此外，临床观察表明治疗区域周围的血流量立即增加。然而，这些效应背后的生化机制尚未完全阐明。在本综述中，我们简要详述了ESW的物理特性以及用该疗法治疗的临床病例。然后我们继续描述触发ESW抗炎作用的可能分子机制，重点关注ESW在正常或炎症条件下可能调节内源性一氧化氮（NO）生成的可能性。ESW处理细胞中内皮型一氧化氮合酶（eNOS）活性迅速增强的数据表明，NO水平升高以及随后对NF-κB激活的抑制可能至少部分解释了对组织炎症的临床有益作用。
