背景:对已建立的舟骨骨不连进行切开复位和内固定后的主要目标是实现结合。据报道,低强度脉冲超声(LIPUS)可提高临床和动物模型中多发性骨折和不愈合的愈合率并减少愈合时间。LIPUS治疗舟骨骨不连的证据,然而,是稀疏的。这项研究的目的是评估活动性LIPUS(相对于假LIPUS)是否会加速舟骨骨不连手术后的愈合时间。
方法:招募需要手术治疗的舟骨骨不连成人进行多中心治疗,prospective,双盲随机对照试验。手术后,患者在术后首次就诊时自行使用激活或假LIPUS单位。主要结果是术后6至8周开始的连续计算机断层扫描(CT)扫描结合时间。次要结局包括患者报告的结局指标,运动范围,和握力。
结果:共有142名受试者完成了研究(活性LIPUS组69名,假手术组73名)。平均年龄27岁,该队列88%为男性。愈合时间没有差异(p=0.854;危险比,0.965;95%置信区间,0.663至1.405)。同样,在任何次要结局方面,活跃LIPUS组和假手术组之间没有差异,除了基线时(p=0.008)和最终随访时(p=0.043)的腕关节屈曲。
结论:接受手术固定术治疗已确定的舟骨骨不连的患者,LIPUS治疗对缩短愈合时间没有影响。
方法:治疗级别I.有关证据级别的完整描述,请参阅作者说明。
UNASSIGNED: This article was updated on September 4, 2024 because of a previous error, which was discovered after the preliminary version of the article was posted online. In the Note listing the members of the Wrist and Elbow Research Group of Canada, the text that had read \"Thomas T. Goetz, MD, FRCSC\" now reads \"Thomas J. Goetz, MD, FRCSC\".
BACKGROUND: The primary goal after open reduction and internal fixation of an established scaphoid nonunion is to achieve union. Low-intensity pulsed ultrasound (LIPUS) has been reported to increase the rate of union and to decrease the time to union for multiple fractures and nonunions in clinical and animal models. The evidence for LIPUS in the treatment of scaphoid nonunion, however, is sparse. The aim of this study was to assess whether active LIPUS (relative to sham LIPUS) accelerates the time to union following surgery for scaphoid nonunion.
METHODS: Adults with a scaphoid nonunion indicated for surgery were recruited for a multicenter, prospective, double-blinded randomized controlled trial. After surgery, patients self-administered activated or sham LIPUS units beginning at their first postoperative visit. The primary outcome was the time to union on serial computed tomography (CT) scans starting 6 to 8 weeks postoperatively. Secondary outcomes included patient-reported outcome measures, range of motion, and grip strength.
RESULTS: A total of 142 subjects completed the study (69 in the active LIPUS group and 73 in the sham group). The average age was 27 years, and the cohort was 88% male. There was no difference in time to union (p = 0.854; hazard ratio, 0.965; 95% confidence interval, 0.663 to 1.405). Likewise, there were no differences between the active LIPUS and sham groups with respect to any of the secondary outcomes, except for wrist flexion at baseline (p = 0.008) and at final follow-up (p = 0.043).
CONCLUSIONS: Treatment with LIPUS had no effect on reducing time to union in patients who underwent surgical fixation of established scaphoid nonunions.
METHODS: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.