Zhang Li, Weng Changshui, Zhao Zhanbo, Fu Xiaobing
Department of Rehabilitation Medicine, Nan Lou of Chinese PLA General Hospital, Beijing, China.
School of Software and Microelectronics, Peking University, Beijing, China.
Wound Repair Regen. 2017 Aug;25(4):697-706. doi: 10.1111/wrr.12566. Epub 2017 Oct 18.
A growing number of clinical studies demonstrate that extracorporeal shock wave therapy (ESWT) is a feasible noninvasive method for improving chronic wound healing. This systematic review and meta-analysis aimed to assess the effectiveness of ESWT compared with that of the standard care treatment for the healing of chronic wounds, irrespective of etiology, in clinical practice. Randomized controlled trials that investigated the effect of ESWT on chronic wounds with different etiologies from 2000 to 2017 were included in this review. The methodological quality of each selected article was rated using the Jadad scale. A fixed or random effects model was used to calculate the pooled effect sizes according to the heterogeneity of the studies. The cumulative effect of ESWT on each outcome was illustrated using forest plots. Seven randomized controlled trials involving 301 subjects were included in this review. Meta-analyses revealed that the use of ESWT as an adjunct to wound treatment could significantly accelerate the impaired healing process of chronic wounds. Compared with the control treatment, ESWT markedly increased the wound healing rate by 1.86-fold (OR = 2.86, 95% CI: 1.63-5.03, p = 0.0003) and the percentage of the wound healing area by 30.46% (SMD = 30.46; 95% CI: 23.80-37.12; p < 0.00001). In addition, the wound healing time was reduced by 19 days (SMD = -19.11, 95% CI: -23.74-(-14.47), p < 0.00001) in chronic wound patients. No serious complications or adverse effects were observed secondary to the application of ESWT. The above data suggested that ESWT as an adjunct to wound treatment, could more significantly improve the healing process of chronic wounds than the standard care treatment alone. More high-quality, well-controlled randomized trials are needed to evaluate the efficacy of ESWT in clinical practice.
越来越多的临床研究表明，体外冲击波疗法（ESWT）是一种改善慢性伤口愈合的可行的非侵入性方法。本系统评价和荟萃分析旨在评估在临床实践中，与标准护理治疗相比，ESWT对各种病因的慢性伤口愈合的有效性。本评价纳入了2000年至2017年期间研究ESWT对不同病因慢性伤口影响的随机对照试验。使用Jadad量表对每篇入选文章的方法学质量进行评分。根据研究的异质性，使用固定效应或随机效应模型计算合并效应量。使用森林图展示ESWT对每个结局的累积效应。本评价纳入了7项涉及301名受试者的随机对照试验。荟萃分析显示，将ESWT作为伤口治疗的辅助手段可显著加速慢性伤口受损的愈合过程。与对照治疗相比，ESWT使伤口愈合率显著提高1.86倍（OR = 2.86，95%CI：1.63 - 5.03，p = 0.0003），伤口愈合面积百分比提高30.46%（SMD = 30.46；95%CI：23.80 - 37.12；p < 0.00001）。此外，慢性伤口患者的伤口愈合时间缩短了19天（SMD = -19.11，95%CI：-23.74 -（-14.47），p < 0.00001）。未观察到因应用ESWT继发的严重并发症或不良反应。上述数据表明，与单独的标准护理治疗相比，ESWT作为伤口治疗的辅助手段能更显著地改善慢性伤口的愈合过程。需要更多高质量、严格对照的随机试验来评估ESWT在临床实践中的疗效。
