Effects of extracorporeal shock waves and ultrasound on the treatment of long bones nonunion - literature review

Uvod: Zlomi dolgih kosti se normalno zacelijo v treh mesecih. Zlom, ki v tem času ne kaže kostnega celjenja, lahko opredelimo kot odloženo celjenje zloma. O nezaceljenem zlomu govorimo takrat, ko ugotovimo, da kljub dolgotrajnemu zdravljenju (osem mesecev in več od poškodbe) ni prišlo do kostnega zraščanja. Nezaceljene zlome delimo na vitalne hipertrofične ter slabo vitalne atrofične nezaceljene zlome. Nezaceljene zlome lahko zdravimo z udarnimi globinskimi valovi, tj. akustičnimi tlačnimi valovi, ki trajajo le mikrosekundo in dosegajo tlak od 100 do več kot 1000 atmosfer. Ravno tako pa lahko nezaceljene zlome zdravimo z ultrazvokom, tj. vrsto zvoka, ki se širi s frekvenco več kot 20.000 Hz. Namen: Namen diplomskega dela je bil na podlagi pregleda strokovne literature primerjati učinkovitost terapije z ultrazvokom v primerjavi s terapijo z udarnimi globinskimi valovi pri zdravljenju nezaceljenih zlomov dolgih kosti. Metode dela: Pri izdelavi diplomskega dela je bila uporabljena deskriptivna ali opisna metoda. Literaturo smo iskali v podatkovni zbirki PubMed. Rezultati: Vključitvenim kriterijem je ustrezalo deset člankovpet člankov, kjer so kot obliko terapije uporabili fokusne udarne globinske valove, ter pet člankov, kjer so uporabili ultrazvok. Avtorji so obravnavali nezaceljene zlome dolgih kosti v različnih časovnih obdobjih, z dano obliko terapije (ultrazvok ali udarni globinski valovi). Merili so čas, ki je bil potreben, da so se nezaceljeni zlomi zacelili ter končno uspešnost terapije. Največ nezaceljenih zlomov, vključenih v pregled, je bilo v področju goleni. Razprava in zaključek: Če primerjamo rezultate raziskav, pri katerih so uporabili udarne globinske valove v primerjavi z ultrazvokom, opazimo večji odstotek uspešnosti terapije z udarnimi globinskimi valoviiz tega bi lahko sklepali, da so udarni globinski valovi nekoliko uspešnejša terapija za zdravljenje nezaceljenih zlomov. Da bi lahko z gotovostjo potrdili našo domnevo, bi bilo treba narediti večje število kakovostnih raziskav, kjer bi primerjali učinke udarnih globinskih valov in ultrazvoka v isti raziskavi.Introduction: Long bone fractures usually heal within three months. A fracture that does not show bone healing at this time can be defined as delayed healing. Bone nonunion occurs when, despite prolonged treatment (eight months or more since injury), bone healing has not occurred. Nonunion is divided into vital hypertrophic and poorly vital atrophic nonunion. Nonunion can be treated with extracorporeal shock waves, i.e. acoustic pressure waves that last only a microsecond and reach a pressure of 100 to more than 1000 atmospheres. Nonunion can also be treated with ultrasound, which is a type of sound that propagates at a frequency of more than 20,000 Hz. Purpose: The purpose of this diploma thesis was to compare the effectiveness of ultrasound therapy versus extracorporeal shock wave therapy in the treatment of long bone nonunion, based on a review of scientific literature. Methods: A descriptive method was used in this thesis. The literature was searched in the PubMed database. Results: Ten articles met the inclusion criteria, of which five articles where extracorporeal shock waves were used as therapy, and five articles where ultrasound was used. The authors considered nonunion of the long bones at different time periods, with a given form of therapy (ultrasound or shockwaves). They measured the time it took for the nonunion to heal and the final success of the therapy. Most nonunions included in the examination were in the tibia region. Discussion and conclusion: Comparing the results of studies using shockwave versus ultrasound, we see a greater percentage of success with shockwave therapy, which would suggest that shockwaves are a slightly more successful therapy for nonunions. In order to be able to confirm our assumption with certainty, a larger number of quality studies should be done comparing the effects of shock waves and ultrasound in the same research