Barker A T, Lunt M J
Clin Phys Physiol Meas. 1983 Feb;4(1):1-27. doi: 10.1088/0143-0815/4/1/002.
The main impression received by us whilst writing this review is the scarcity of technical data in the clinical studies and the total absence of controlled trials. The spatial patterns of the stimulus have not been measured, and no experiments have proved that there is an effect from the magnetic field itself. Control experiments using dummy stimulators must be done, since the orthopaedic management of the stimulated patients is different from conventional management and this may have significant and beneficial clinical effects. There is no clinical study at present which shows a direct therapeutic benefit due solely to the application of the magnetic field component of the overall treatment regime. The in vivo animal experiments suggest that there may be effects due to the magnetic fields used but results are very scarce compared with the accumulated data from direct current stimulation. In vitro studies are far removed from the clinical situation, but could nonetheless prove useful if the opportunity of controlling the stimulus can be taken. In the majority of experiments, approximately spatially uniform magnetic fields have been applied, but temporal changes in the magnetic field and both spatial and temporal variation in electric field lead to non-uniform stimulation. Little attempt has been made to assess or control the induced fields by defining the system geometry. Hence it is still unknown whether effects are due to the magnetic field, the induced extracellular electric field or to fields induced at cellular level by regions of different conductivity. In conclusion, we believe that, unlike steady current work, the pulsed magnetic field treatment of fractures has not been sufficiently well investigated and, although some of the animal experiments suggest significant effects, the benefit of using magnetic fields in the clinical management of non-union and delayed union has still to be proven. Double blind trials are essential and, if these do prove that there is a definite effect of the fields, the mechanisms must then be studied using a combination of theoretical, in vivo and in vitro techniques.
在撰写本综述时，我们得到的主要印象是临床研究中技术数据匮乏，且完全没有对照试验。刺激的空间模式未被测量，也没有实验证明磁场本身会产生影响。必须进行使用假刺激器的对照实验，因为接受刺激治疗的患者的骨科处理方式与传统处理方式不同，这可能会产生显著且有益的临床效果。目前尚无临床研究表明仅应用整体治疗方案中的磁场成分就能带来直接的治疗益处。体内动物实验表明，所使用的磁场可能会产生影响，但与直流电刺激积累的数据相比，结果非常稀少。体外研究与临床情况相差甚远，但如果能利用机会控制刺激，仍可能证明是有用的。在大多数实验中，施加的磁场在空间上大致均匀，但磁场的时间变化以及电场的空间和时间变化会导致刺激不均匀。通过定义系统几何形状来评估或控制感应场的尝试很少。因此，目前尚不清楚效果是由于磁场、感应的细胞外电场还是不同电导率区域在细胞水平感应的场所致。总之，我们认为，与稳恒电流研究不同，脉冲磁场治疗骨折的研究尚不充分，尽管一些动物实验表明有显著效果，但在临床治疗骨不连和延迟愈合中使用磁场的益处仍有待证明。双盲试验至关重要，如果这些试验确实证明磁场有明确效果，那么必须结合理论、体内和体外技术来研究其机制。
