聚焦体外冲击波疗法治疗指间关节融合骨折的疼痛性骨延迟愈合或骨不连
Focused Extracorporeal Shock Wave Therapy for Painful Delayed Union or Nonunion of Fractures of Interphalangeal Coalition.
作者信息
Shimozono Yoshiharu, Mori Daisuke, Mizuno Yasuyuki, Funakoshi Noboru, Kobayashi Masahiko, Matsuda Shuichi, Yamashita Fumiharu
机构信息
Department of Orthopaedic Surgery, Kyoto Shimogamo Hospital, Kyoto, Japan.
Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
出版信息
Foot Ankle Orthop. 2024 Aug 21;9(3):24730114241268307. doi: 10.1177/24730114241268307. eCollection 2024 Jul.
BACKGROUND
Interphalangeal coalition is characterized by fusion of interphalangeal joint between the middle and distal phalanges. Interphalangeal coalition fractures often result in delayed union or nonunion. The purpose of this study was to evaluate the results of focused extracorporeal shock wave therapy (ESWT) for painful delayed union or nonunion of fractures of the interphalangeal coalition.
METHODS
The study group consisted of 9 patients (9 feet) diagnosed with painful delayed union or nonunion due to persistent pain and no tendency toward bony union for at least 3 months after the interphalangeal coalition fracture on plain radiographs between 2021 and 2023 were included. The mean age was 51.3 years (23-64). Focused ESWT was performed in all patients. The mean time from the date of injury to the start of ESWT was 16.1 weeks (12-15). ESWT was performed every 2 weeks, with each session consisting of 3000 impulses (0.15-0.25 mJ/mm). Plain radiographs were used to confirm bone union, and visual analog scale (VAS) scores were used for pain assessment.
RESULTS
Complete bony union was documented in all 9 patients. The application of focused ESWT was performed a mean of 2.7 times (2-4), and the mean duration from the initiation of treatment to the confirmation of bony union was 7.4 weeks (3.6-12.7). In all cases, the symptoms of swelling and pain were alleviated. The VAS scores exhibited significant improvement, with the mean VAS score decreasing from 3.8 (2-6) before ESWT to 0 after the achievement of union ( < .001).
CONCLUSION
In this small cohort, all patients with painful delayed union or nonunion of fractures at the interphalangeal coalitions achieved complete bony fusion after focused ESWT. Moreover, bony union was observed within 2 months of ESWT initiation. These findings suggest that focused ESWT may be a valuable treatment option for painful delayed union or nonunion of interphalangeal coalition fractures.
LEVEL OF EVIDENCE
Level IV, case series.
背景
指间关节融合的特征是中节指骨与远节指骨之间的指间关节融合。指间关节融合骨折常导致延迟愈合或不愈合。本研究的目的是评估聚焦体外冲击波疗法（ESWT）治疗指间关节融合骨折疼痛性延迟愈合或不愈合的效果。
方法
研究组包括9例患者（9足），这些患者在2021年至2023年期间因指间关节融合骨折后持续疼痛且在X线平片上至少3个月无骨愈合倾向而被诊断为疼痛性延迟愈合或不愈合。平均年龄为51.3岁（23 - 64岁）。所有患者均接受聚焦ESWT治疗。从受伤日期到开始ESWT的平均时间为16.1周（12 - 15周）。ESWT每2周进行一次，每次治疗包括3000次脉冲（0.15 - 0.25 mJ/mm）。使用X线平片确认骨愈合情况，并使用视觉模拟量表（VAS）评分进行疼痛评估。
结果
所有9例患者均记录到完全骨愈合。聚焦ESWT平均应用2.7次（2 - 4次），从开始治疗到确认骨愈合的平均持续时间为7.4周（3.6 - 12.7周）。在所有病例中，肿胀和疼痛症状均得到缓解。VAS评分有显著改善，平均VAS评分从ESWT前的3.8（2 - 6）降至骨愈合后的0（<0.001）。
结论
在这个小队列中，所有指间关节融合骨折疼痛性延迟愈合或不愈合的患者在接受聚焦ESWT治疗后均实现了完全骨融合。此外，在开始ESWT治疗后2个月内观察到骨愈合。这些发现表明，聚焦ESWT可能是治疗指间关节融合骨折疼痛性延迟愈合或不愈合的一种有价值的治疗选择。
证据水平
IV级，病例系列。
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