Everding J, Freistühler M, Stolberg-Stolberg J, Raschke M J, Garcia P
Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland.
Medizinisches Management, Medizincontrolling, Universitätsklinikum Münster, Münster, Deutschland.
Unfallchirurg. 2017 Nov;120(11):969-978. doi: 10.1007/s00113-016-0238-5.
Between 5 and 10 % of all fractures show disturbed healing or nonunion formation. Extracorporeal shock wave therapy (ESWT) has been described as a non-surgical treatment option. Even though the outcome has shown promising results, the procedure is not commonly used in clinical practice. The purpose of this study was to analyze the union rate of pseudarthrosis and the cost savings after ESWT.
In this study 42 nonunions were treated with shock waves (LithSpaceOrtho, JenaMedtech). The follow up examinations were performed over a period of six months. Outcome measurement included radiological fracture union and pain (VAS). The study group contained 39 pseudarthrosis in the six-week follow-up (93 %), 41 after three months (98 %) and 41 after six months (98 %).
After six weeks, 13 % of patients showed fracture union. After three months 61 % and after six months 73 % of the fractures were completely healed. The fracture healing was significantly lower in older nonunions. All patients presented significantly lower pain levels six weeks after ESWT. Shock wave treatment of all 42 pseudarthrosis made up less than one quarter of the overall operative costs.
We established the ESWT as an important treatment option for fracture nonunion in our clinic. Considering the selection of patients in this study with a high mean time from injury to ESWT and multiple prior operations, the fracture healing rate of 73 % after ESWT is comparable with operative healing rates of nonunions. Further prospective, randomized and controlled studies are needed to show the effectiveness of ESWT in the treatment of nonunions on a higher level of evidence and to identify pseudarthrosis that particularly responds to the EWST.
所有骨折中，有5%至10%会出现愈合障碍或骨不连。体外冲击波疗法（ESWT）已被描述为一种非手术治疗选择。尽管结果显示出有前景的效果，但该方法在临床实践中并不常用。本研究的目的是分析ESWT治疗后假关节的愈合率和成本节约情况。
本研究中，42例骨不连患者接受了冲击波治疗（LithSpaceOrtho，耶拿医疗技术公司）。随访检查持续了6个月。结果测量包括放射学骨折愈合情况和疼痛（视觉模拟评分法）。研究组在六周随访时有39例假关节（93%），三个月后有41例（98%），六个月后有41例（98%）。
六周后，13%的患者出现骨折愈合。三个月后为61%，六个月后为73%的骨折完全愈合。老年骨不连患者的骨折愈合率明显较低。所有患者在ESWT治疗六周后疼痛水平均显著降低。42例假关节的冲击波治疗费用占总手术费用的不到四分之一。
我们在诊所将ESWT确立为骨折不愈合的重要治疗选择。考虑到本研究中患者从受伤到接受ESWT的平均时间较长且之前接受过多次手术，ESWT治疗后73%的骨折愈合率与骨不连的手术愈合率相当。需要进一步进行前瞻性、随机对照研究，以在更高证据水平上证明ESWT治疗骨不连的有效性，并确定对EWST特别有反应的假关节。
