Bioventus International, Taurusavenue 31, 2131 LS, Hoofddorp, Netherlands.
Department of Trauma Surgery, University Hospital Regensburg, Germany.
Injury. 2021 Jun;52 Suppl 2:S91-S96. doi: 10.1016/j.injury.2021.05.002. Epub 2021 May 12.
The use of low intensity pulsed ultrasound (LIPUS) to accelerate the fracture repair process in humans was first reported by Xavier & Duarte in 1983 [1]. This success led to clinical trials and the 1994 approval of LIPUS in the United States for the accelerated healing of certain fresh fractures. LIPUS was approved in the US for the treatment of established non-unions in 2000, and is also approved around the world. In this article, we present relevant literature on the effect of LIPUS on bone healing in patients with acute fractures and non-unions and provide a molecular explanation for the effects of LIPUS on bone healing. Data on LIPUS accelerated fracture repair is controversial with many controlled studies showing a positive effect. However, the largest trial in acute tibial fractures stabilized with an intramedullary nail failed to show significant differences in accelerated healing and in functional outcomes. Uncontrolled data from prospective case series suggest a positive effect of LIPUS in non united fractures with healing rates of around 85%. Evaluation of results from studies, both positive and negative, has enabled an understanding that the patient population with potentially the greatest benefit from receiving LIPUS are those at-risk for fracture healing, e.g. diabetic & elderly patients. The elucidation of a pathway to activate the Rac-1 pathway by LIPUS might explain this beneficial effect. Overall, there is a strong need for further clinical trials, particularly for acute fractures at risk of progressing to non-union and in established non-unions including a comparison to the current standard of care.
低强度脉冲超声波（LIPUS）在促进人类骨折修复过程中的应用最早是由 Xavier 和 Duarte 于 1983 年报道的[1]。这一成功促使了临床试验，并于 1994 年在美国批准 LIPUS 用于加速某些新鲜骨折的愈合。2000 年，LIPUS 在美国被批准用于治疗已确立的骨不连，并且在全球范围内也得到了批准。在本文中，我们介绍了关于 LIPUS 对急性骨折和骨不连患者骨愈合影响的相关文献，并对 LIPUS 对骨愈合影响的分子机制进行了解释。关于 LIPUS 促进骨折修复的研究结果存在争议，许多对照研究显示出积极的效果。然而，一项关于髓内钉固定的急性胫骨骨折的最大试验未能显示加速愈合和功能结果的显著差异。前瞻性病例系列的非对照数据表明，LIPUS 对骨不连具有积极的影响，愈合率约为 85%。对阳性和阴性研究结果的评估使我们了解到，最有可能从接受 LIPUS 中受益的患者人群是那些有骨折愈合风险的患者，例如糖尿病和老年患者。LIPUS 通过激活 Rac-1 通路的途径的阐明可能解释了这种有益的效果。总的来说，我们非常需要进一步的临床试验，特别是对于有进展为骨不连风险的急性骨折，以及对于已确立的骨不连，包括与当前标准治疗方法的比较。
