TAILIEUCHUNG - Applications in Musculoskeletal Disorders - part 9

Họ kết luận rằng năng lượng cao ESWT là một điều trị không xâm lấn tuyệt vời cho pseudarthrosis và nên được sử dụng như một phương pháp điều trị chính. Beutler et al. (1999) báo cáo 11 trong số 27 bệnh nhân được chữa lành (41%) 3 tháng sau khi SWT với hai lần 2000 xung tại | Discussion 69 mation was observed without bony consolidation. They concluded that high-energy ESWT was an excellent noninvasive treatment for pseudarthrosis and should be used as a primary treatment method. Beutler et al. 1999 reported 11 out of 27 patients healed 41 3 months after SWT with two times 2000 impulses at 18 kv. Schaden 2000 demonstrates a success rate of in 49 nonunions and of 75 in 15 infected nonunions. He suggestes that shock waves had a stimulating effect on osteoformation. In 2001 Schaden et al. had treated 115 patients with nonunions or delayed fracture healing. In 87 of the patients a single SWT resulted in bony consolidation. Wang and co-workers 2001 applied 6000 impulses at 28 kV for posttraumatic nonunions of the femur and tibia 3000 impulses at 28 kV for nonunions of the humerus 2000 impulses at 24 kV for nonunions of the radius and ulna and 1000 impulses at 20 kV for nonunions of the metatarsal bones. Altogether 72 patients underwent SWT. The rate of bony unions was described as 40 at 3 months ait 6 months and 80 at 12 months. The least effectiveness was seen in atrophic nonunions. The current observational cohort study focused on the treatment of nonunions of femur or tibia being defined as a fracture or osteotomy in which no radiological signs of cortical bridging occurred for at least 9 months after the last operative intervention. Stringent exclusion criteria were applied SWT was standardized and adjunct treatment remained unchanged. The decision whether bony healing had occurred was made by an independent observer. Radiological success was seen in 72 of the patients and a clear connection with a positive tracer uptake in the mineralization phase of bone scintigraphy. Therefore patients with a scintigraphically inactive pseudarthrosis are excluded. Six out of eight patients with an inactive pseudarthrosis and subsequent treatment failure after ESWT smoked each more than 20 cigarettes per day. In the knowledge of a possible .

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