Lou Shenghan, Lv Houchen, Li Zhirui, Zhang Licheng, Tang Peifu
Department of Orthopedics, Chinese PLA General Hospital, Beijing Department of Spine Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P.R. China.
Medicine (Baltimore). 2017 Sep;96(39):e8181. doi: 10.1097/MD.0000000000008181.
Low-intensity pulsed ultrasonography (LIPUS) is a form of mechanical stimulation that is delivered via a special device to the fracture site for the acceleration of fracture healing. We conducted a meta-analysis to assess the effect of LIPUS for fresh fractures in adults.
MEDLINE, EMBASE and the Cochrane Library searched between Jan 1980 and Nov 2016. Studies should be quasi-randomized and randomized controlled trials (RCTs) comparing treatment with LIPUS to placebo or no treatment in adults with fresh fractures, reporting outcomes such as function; time to union; delayed union or non-union. Summary standard mean difference (SMD) and the risk ratio (RR) with their 95% confidence interval (CI) calculated with a random effects model. I statistic was used to assess the heterogeneity. Risk of bias was assessed by the Cochrane risk-of-bias tool. The GRADE system was used to evaluate the evidence quality.
A total of 12 trials with 1099 patients were included. The pooled results showed that LIPUS significantly reduced the time to fracture union (SMD: 0.65, 95% CI: 1.13 to 0.17), improved the quality of life (SMD: 0.20, 95% CI: 0.03-0.37) without affecting the time to full weight bearing (SMD: 0.76, 95% CI: 1.92 to 0.4), the time to return to work (SMD: 0.06, 95% CI: 0.14 to 0.27), or the incidence rate of delayed union and nonunion (RR: 1.02, 95% CI: 0.60-1.74).
Moderate-to-high quality evidence shows that LIPUS treatment reduces the time to fracture union and improves the quality of life without affecting functional recovery and incident rate of delayed union and nonunion, suggesting that LIPUS treatment may be a good treatment modality for adults with fresh fractures. However, there are some methodological limitations in the eligible trials, further studies are needed to determine the clinical circumstances under which LIPUS is truly valid and to examine the optimal approach for the use of this adjunctive therapy.
低强度脉冲超声（LIPUS）是一种机械刺激形式，通过特殊设备作用于骨折部位以促进骨折愈合。我们进行了一项荟萃分析，以评估LIPUS对成人新鲜骨折的疗效。
检索1980年1月至2016年11月期间的MEDLINE、EMBASE和Cochrane图书馆。研究应为半随机和随机对照试验（RCT），比较LIPUS治疗与安慰剂或不治疗对成人新鲜骨折的效果，报告功能、愈合时间、延迟愈合或不愈合等结果。采用随机效应模型计算汇总标准均数差（SMD）和风险比（RR）及其95%置信区间（CI）。用I统计量评估异质性。采用Cochrane偏倚风险工具评估偏倚风险。使用GRADE系统评估证据质量。
共纳入12项试验，1099例患者。汇总结果显示，LIPUS显著缩短了骨折愈合时间（SMD：0.65，95%CI：1.13至0.17），改善了生活质量（SMD：0.20，95%CI：0.03 - 0.37），而不影响完全负重时间（SMD：0.76，95%CI：1.92至0.4）、恢复工作时间（SMD：0.06，95%CI：0.14至0.27）或延迟愈合和不愈合的发生率（RR：1.02，95%CI：0.60 - 1.74）。
中高质量证据表明，LIPUS治疗可缩短骨折愈合时间并改善生活质量，而不影响功能恢复以及延迟愈合和不愈合的发生率，提示LIPUS治疗可能是成人新鲜骨折的一种良好治疗方式。然而，纳入的试验存在一些方法学局限性，需要进一步研究以确定LIPUS真正有效的临床情况，并探讨这种辅助治疗的最佳使用方法。
