Department of Hand, Plastic and Reconstructive Surgery, Burn Center, Department of Hand and Plastic Surgery of Heidelberg University, BG Trauma Center, Ludwigshafen, Germany.
Gespür Consulting, Fürstenrieder Str 279a, 81377, Munich, Germany.
Arch Orthop Trauma Surg. 2023 Nov;143(11):6965-6972. doi: 10.1007/s00402-023-05023-5. Epub 2023 Aug 14.
The purpose of this agreement was to establish consensus statements on the use of low-intensity pulsed ultrasound (LIPUS) in hand surgery.
Based on Delphi consensus methodology, a preliminary list of questions on the use of LIPUS in hand surgery was developed by an interdisciplinary team of hand and plastic surgeons as well as psychologists and experts from communications science. Based on these, questionnaires were invented and a total of three Delphi rounds have been conducted. Delphi panelists consisted of 11 German hand surgeons with a mean experience in hand surgery of 15 years (7-23 years). Questions and statements were revised during this process, resulting in a consensus at the end of round three.
After three Delphi rounds, the following recommendations could be derived. LIPUS can be applied for impaired fracture healing of the digits, metacarpals, carpal bones as well as a prophylactic procedure in order to avoid further revision surgery. LIPUS therapy can be useful in addition to revision surgery for delayed union and non-unions. In the case of certain risk factors (replantation, revascularization, osteoporosis, smoking), it can be applied directly postoperatively in order to prevent impaired fracture healing. It should be applied for 90-120 days.
There is a consensus among German hand surgeons, when and how LIPUS can be applied for improving fracture healing of the hand. Randomized controlled trials with direct comparison of fracture treatment with and without LIPUS are needed to support these statements with objective data.
本协议旨在就低强度脉冲超声（LIPUS）在手外科中的应用达成共识。
基于德尔菲共识方法，由手外科和整形外科医生、心理学家以及传播学专家组成的跨学科团队制定了一份关于 LIPUS 在手部外科应用的初步问题清单。在此基础上发明了调查问卷，并进行了总共三轮德尔菲研究。德尔菲小组成员由 11 名德国手外科医生组成，他们在手外科方面的平均经验为 15 年（7-23 年）。在这个过程中，对问题和陈述进行了修订，最终在第三轮达成了共识。
经过三轮德尔菲研究，得出以下建议：LIPUS 可应用于手指、掌骨、腕骨骨折愈合不良，也可作为预防性措施，以避免进一步的修正手术。LIPUS 治疗可作为延迟愈合和不愈合的修正手术的辅助手段。对于某些危险因素（再植、血运重建、骨质疏松、吸烟），可以直接在术后应用，以防止骨折愈合不良。它应该应用 90-120 天。
德国手外科医生在何时以及如何应用 LIPUS 来改善手部骨折愈合方面达成了共识。需要进行随机对照试验，直接比较有和没有 LIPUS 的骨折治疗，以客观数据支持这些结论。
