体外冲击波治疗对动物骨不连愈合的影响及机理探讨

目的:应用体外冲击波治疗骨不连,了解其对骨不连愈合的影响,并对体外冲击波治疗骨不连的机理作初步探讨.方法:选用日本大耳白兔制作骨不连模型,以肥大型骨不连动物为实验对象,分治疗组和对照组;将体外冲击波的第二焦点对准骨不连两断端行冲击波治疗;定期拍片、光镜和电镜检查.结果:体外冲击波治疗12周X光片显示,治疗组骨不连愈合较对照组好,统计学检验有显著性差异;光镜及电镜检查显示:治疗组成骨细胞和间充质细胞聚集增生活跃,骨小梁形成丰富,骨不连愈合好.而对照组一直表现为慢性炎症反应,骨小梁形成少.可见破骨细胞活动.结论:体外冲击波治疗肥大型骨不连效果满意,其有望成为一种非手术治疗骨不连的良好方法.

An Experimental Study on Extracorporeal Shock Waves for the Treatment of Nonunions And Its Mechanism

Objective:The aim of the experiment study on rabbits was to investigate the effect of extracorporeal shock waves for the treatment of nonunions, and to probe the mechanism of it prelimiarily.Methods:40 healthy rabbits were selected to make the models of nonunions, 32 rabbits of hypertrophic nonunions confirmed by radiograph were grouped at random into two groups, a treatment and a control group. The shock wave focus was aimed and applied on the two sites, lying symmetrically on the distal and proximal of nonunions of the treatment group.Standardized radiographs, histological and Transmission Electron Microscope(TEM) examinations were performed periodically.Results: 12 weeks after shock wave treatment, the rabbits of the treatment group, reached radiographically observable bony union, but the rabbits in the control, still had persistent nonunions all the time. Statistical analysis demonstrated the significanct difference in outcome between the two groups. Histological and TEM examination showed, in the treatment group, large quantities of osteoblasts and mesenchymal cells assembled and proliferated in the nonunion sites and subperiosteal, rich trabecular formed.However,in the group control, there was much chronic inflammation and few trabecular. osteogenetic activates few under TEM in group control, but activating osteoclasts.Conclusion:The results indicate that hypertrophic nonunions in rabbits can be treated successfully with extracorcpreal shock waves. The authors think that it may become a reliable, non-invasive way for the treatment of certain types of nonunions.