Section of Thoracic Surgery, Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
Department of Surgery, College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia.
Pain Med. 2019 Oct 1;20(10):1980-1988. doi: 10.1093/pm/pny224.
Rib fractures are an important health issue worldwide, with significant, pain, morbidity, and disability for which only symptomatic treatment exists.
Based on our previous experimental model, the objective of the current study was to assess for the first time whether pulsed ultrasound (PUS) application could have beneficial effects on humans.
Prospective, double-blinded, randomized, controlled trial of 51 patients. Four were excluded, and 47 were randomized into the control group (N = 23) or PUS group (N = 24). The control group received a PUS procedure without emission, and the PUS group received 1 Mhz, 0.5 W/cm2 for 1 min/cm2. Pain level, bone callus healing rate, physical and work activity, pain medication intake, and adverse events were blindly evaluated at baseline and one, three, and six months.
There were no significant differences at baseline between groups. PUS treatment significantly decreased pain by month 1 (P = 0.004), month 3 (P = 0.005), and month 6 (P = 0.025), significantly accelerated callus healing by month 1 (P = 0.013) and month 3 (P < 0.001), accelerated return to physical activity by month 3 (P = 0.036) and work activity (P = 0.001) by month 1, and considerably reduced pain medication intake by month 1 (P = 0.057) and month 3 (P = 0.017). No related adverse events were found in the PUS group.
This study is the first evidence that PUS treatment is capable of improving rib fracture outcome, significantly accelerating bone callus healing, and decreasing pain, time off due to both physical activity and convalescence period, and pain medication intake. It is a safe, efficient, and low-cost therapy that may become a new treatment for patients with stable rib fractures.
肋骨骨折是一个全球性的重要健康问题，会导致严重的疼痛、发病率和残疾，目前仅能对症治疗。
基于我们之前的实验模型，本研究的目的是首次评估脉冲超声（PUS）治疗对人类是否具有有益作用。
前瞻性、双盲、随机、对照试验纳入 51 例患者。其中 4 例被排除，47 例随机分为对照组（N=23）或 PUS 组（N=24）。对照组接受无发射的 PUS 治疗，PUS 组接受 1MHz、0.5W/cm2 强度、1min/cm2 剂量的 PUS 治疗。在基线及 1、3 和 6 个月时，对疼痛程度、骨痂愈合率、体力和工作活动、止痛药摄入以及不良事件进行盲法评估。
组间基线时无显著差异。PUS 治疗在 1 个月（P=0.004）、3 个月（P=0.005）和 6 个月（P=0.025）时显著减轻疼痛，在 1 个月（P=0.013）和 3 个月（P<0.001）时显著加速骨痂愈合，在 3 个月时加速体力活动（P=0.036）和工作活动（P=0.001）恢复，在 1 个月（P=0.057）和 3 个月（P=0.017）时显著减少止痛药摄入。在 PUS 组未发现相关不良事件。
本研究首次证明 PUS 治疗能够改善肋骨骨折的预后，显著加速骨痂愈合，减轻疼痛，减少因体力活动和康复期而导致的缺勤时间，以及止痛药摄入。这是一种安全、高效、低成本的治疗方法，可能成为稳定型肋骨骨折患者的一种新的治疗方法。
