Mühldorfer-Fodor Marion, Wagner Matthias, Kottmann Tanja, van Schoonhoven Jörg, Prommersberger Karl-Josef
Klinik für Handchirurgie, Rhön Klinikum Campus Bad Neustadt.
Klinik für Diagnostische Radiologie, Rhön Klinikum Campus Bad Neustadt.
Handchir Mikrochir Plast Chir. 2020 Sep;52(5):404-412. doi: 10.1055/a-1250-8078. Epub 2020 Sep 29.
Focused, high energy shock wave therapy (ESWT) stimulates bone healing by neo-angiogenesis and activating osteocytes. This study investigates if applying an ESWT intraoperatively improves and accelerates the healing of a scaphoid nonunion after reconstruction using a non-vascularized bone graft.
In this prospective, ongoing study, patients with a scaphoid reconstruction using a non-vascularized bone graft and stabilization for non-union, are randomized for having additionally an intraoperative ESWT (intervention group) or not (control group). In 6 weeks-intervals, patients have a clinical and radiological follow-up, including a CT scan at 12, 18, and if needed 24 weeks postoperatively. The intervention group and the control group are compared with regard to the proportion of the bridged contact area between scaphoid and the bone graft at 12, 18, and 24 weeks postoperatively and the rate of the healed scaphoids at the final follow-up. At time of this data analysis, 35 patients of the intervention group and 33 patients of the control group had passed all of their scheduled follow-ups.
Twenty-four weeks postoperatively, the scaphoids of 27 patients (77 %) in the intervention group and those of 20 patients (61 %) in the control group were healed. At 12, 18, and 24 weeks, the contact area between scaphoid and the bone graft proximally was bridged by 80 %, 84 %, and 86 % respectively in the intervention group, and 74 %, 81 %, and 84 % in the control group. Distal to the bone graft, the gap was bridged by 91 %, 94 %, and 95 % for the intervention group and 77 %, 90 %, and 94 % for the control group. At 12 weeks postoperatively, the proportional healing distal to the bone graft was significantly higher after ESWT.
A single, intraoperative ESWT improves the healing rate of scaphoid reconstruction with a non-vascularized bone graft and accelerates the gap bridging during the first 12 weeks after surgery.
聚焦高能冲击波疗法（ESWT）通过新生血管形成和激活骨细胞来促进骨愈合。本研究旨在探讨术中应用ESWT是否能改善并加速使用非带血管骨移植重建后的舟骨不愈合的愈合。
在这项前瞻性、正在进行的研究中，使用非带血管骨移植重建舟骨并对不愈合进行固定的患者，被随机分为术中额外接受ESWT治疗的干预组和未接受ESWT治疗的对照组。患者每6周进行一次临床和影像学随访，包括术后12周、18周以及必要时24周的CT扫描。比较干预组和对照组在术后12周、18周和24周时舟骨与骨移植之间桥接接触面积的比例，以及最终随访时舟骨愈合的比例。在进行此次数据分析时，干预组的35例患者和对照组的33例患者均完成了所有预定的随访。
术后24周时，干预组27例患者（77%）的舟骨愈合，对照组20例患者（61%）的舟骨愈合。在12周、18周和24周时，干预组舟骨与近端骨移植之间的接触面积分别为80%、84%和86%被桥接，对照组分别为74%、81%和84%。在骨移植远端，干预组间隙被桥接的比例为91%、94%和95%，对照组为77%、90%和94%。术后12周时，ESWT治疗后骨移植远端的愈合比例显著更高。
单次术中ESWT可提高使用非带血管骨移植重建舟骨的愈合率，并加速术后前12周的间隙桥接。
