超声技术预测体外冲击波疗法治疗骨不连的疗效

摘要

目的 探索利用超声技术预测骨不连患者行体外冲击波疗法(ESWT)治疗的疗效.方法 选取2016年3月至2017年7月在上海交通大学附属第六人民医院骨科治疗的骨不连患者作为研究对象.在ESWT治疗前超声检查测定患者的骨不连间隙、骨不连部位局部血供及骨痂硬度,初次ESWT治疗后超声检查骨不连部位骨膜下血肿形成情况.ESWT治疗后进行12个月随访,通过线性相关性分析和Logistic回归分析评估超声检测指标与患者预后的关系.结果 研究对象共57例,66处骨不连部位,年龄为12～75岁,其中男性38例,女性19例.统计学分析结果显示,超声检测的4个指标均与ESWT治疗预后显著相关,局部血供(r=0.602,OR=0.211)、骨膜下血肿形成(r=0.727,OR=0.014)为保护性因素,骨不连间隙(r=-0.712,OR=2.900)、骨痂硬度(r=-0.483,OR=16.148)为危险性因素.结论 可通过超声检测预测骨不连患者ESWT治疗的疗效,筛选合适的治疗对象.%Objective To predict the efficacy of extracorporeal shock wave therapy (ESWT) in the treatment of fracture nonunions by the use of ultrasound technique.Methods From March 2016 to July 2017,all patients diagnosed as fracture nonunions in the department of Orthopaedic Surgery in Shanghai Sixth People's Hospital were included.Nonunion gap,blood supply and callus stiffness around the nonunion site were observed through ultrasound preoperatively.Subperiosteal hematoma formation following the initial ESWT was also noted.The follow up time was 12 months after ESWT.Linear correlation analysis and logistic regression analysis were used to assess the relationship between these detection indexes and the prognosis after ESWT.Results A total of 57 patients (66 fracture nonunions) were included,38 males and 19 females,with the ages ranging from 12 to 75 years.Statistical analysis showed that the four detection indexes of ultrasound technique were related with the prognosis after ESWT:blood supply (r =0.602,OR =0.211) and subperiosteal hematoma formation (r =0.727,OR =0.014) were protective factors,while nonunion gap (r=-0.712,OR =2.900) and callus stiffness (r=-0.483,OR =16.148) were risk factors.Conclusion Ultrasound technique may be used to predict the efficacy of ESWT in the treatment of fracture nonunions and thus select appropriate patients for ESWT.