Department of Clinical Methodology and Surgical Techniques, Orthopedics Section, Faculty of Medicine and Surgery of University of Bari, General Hospital, Bari, Italy.
Ultrasound Med Biol. 2010 Aug;36(8):1306-13. doi: 10.1016/j.ultrasmedbio.2010.05.004.
The peculiar anatomical characteristics and precarious vascularization of the carpal scaphoid are responsible for a difficult healing of fractures and a fairly frequent subsequent evolution to pseudoarthrosis. Recently, extracorporeal shockwaves therapy (ESWT) has yielded encouraging results in the treatment of pseudoarthrosis of various bone segments. We report a retrospective study comparing the results of application of three sessions of shockwaves therapy (SW) with energy flux density (EFD) impulses of 0.09 (SD = 0.02) mJ/mm(2) ESWT emitted by an electromagnetic generator in 58 patients (group I) affected by pseudoarthrosis of the carpal scaphoid, with the results of surgical treatment consisting of stabilization and bone graft according to the Matti-Russe technique, performed in 60 subjects (controls, group II). There were no statistically significant differences in the mean duration of the pseudoarthrosis (p = 0.46), sex distribution (p = 0.41) and mean age at recruitment (p = 0.95) between the two patient groups. Posttreatment clinical-functional assessment, based on the Mayo Wrist Score, showed a significantly improved score, rising from 28-74.6 in group I already after 2 mo (p < 0.001), with 86.3% of the results judged as satisfactory or excellent; in group II the mean score rose from 27.5-74.2 after 2 mo, with 83.4% of the results judged as satisfactory or excellent (p < 0.001). At the same two-months follow-up (FU), radiographic consolidation was shown in 75.9% of patients in group I and 76.7% in group II. These improvements persisted at the subsequent controls at six and 12 mo in both groups. The Mayo Wrist Score and X-rays did not show statistically significant differences at the various FU visits in the two groups (p > 0.05). On the basis of our data, we can conclude that the results of ESWT are comparable with those of surgical stabilization and bone graft in the treatment of scaphoid pseudoarthrosis. In view of their minimal invasiveness, shockwaves should therefore be considered the treatment of choice of this disorder.
腕舟骨假关节的特殊解剖学特征和脆弱的血管化导致骨折愈合困难，且随后相当频繁地发展为假关节。最近，体外冲击波治疗（ESWT）在治疗各种骨段的假关节方面取得了令人鼓舞的结果。我们报告了一项回顾性研究，比较了应用三振冲击波治疗（SW）与电磁发生器发射的能量通量密度（EFD）冲击（组 I，58 例患者）与外科治疗（组 II，60 例患者）的结果，冲击能量为 0.09（SD = 0.02）mJ/mm(2)。两组患者的假关节平均持续时间（p = 0.46）、性别分布（p = 0.41）和招募时的平均年龄（p = 0.95）均无统计学差异。基于 Mayo 腕关节评分的治疗后临床功能评估显示，治疗组的评分显著提高，从 28-74.6 分提高到 2 个月时（p < 0.001），86.3%的结果评为满意或优秀；在组 II 中，平均评分从 27.5-74.2 分提高到 2 个月时，83.4%的结果评为满意或优秀（p < 0.001）。在相同的 2 个月随访时，组 I 中有 75.9%的患者和组 II 中有 76.7%的患者显示放射学愈合。在两组中，这些改善在随后的 6 个月和 12 个月随访时仍然存在。在两组的各个随访中，Mayo 腕关节评分和 X 射线均无统计学差异（p > 0.05）。基于我们的数据，我们可以得出结论，ESWT 的结果与手术稳定和骨移植治疗舟骨假关节的结果相当。鉴于其微创性，冲击波应被视为治疗这种疾病的首选方法。
