40
fractures at various locations. Vogel et al reported a 60.4% union rate in 48 patients with
pseudarthroses treated with 3,000 shockwave impulses [
108
]. Wang et al treated 72
patients with non
-
unions of long bone fracture with shockwave therapy, and reported a
success rate of 82.4% bony union at 6
-
month follow
-
up [
104
]. Rompe et al reported a
50% success rate in the treatment of delayed bone union with shockwaves in clinical
study [
109
], whereas Schleberger and Senge [
110
] showed successful fracture healing in
three of four pseudoarthroses treated with 2000 impulses of shockwaves. Recently, Elster
EA et al reported an 80.2% success in 172 non
-
union of the tibia [
14
]. The results of
ESWT in non
-
union of long bone appear to be comparable to surgical intervention.
However, the advantages of ESWT include no surgery with no surgical pain and surgical
risks.
AVNFH (Avascular necrosis of the femoral head)
For symptomatic hips affected by AVNFH, conservative treatments are generally not
successful, and surgery is indicated with the type of surgery varying according to the stage
of the disease [
111
]. Core decompression with or without bone grafting is considered the
gold standard of femoral head preserving procedures. However, the results of core
decompression varied widely and most reports are unsatisfactory [
112
] ESWT was
recently utilized in the treatment of early AVNFH. Several articles reported the positive
effect of shockwave therapy for AVNFH [
21
,
22
,
113
,
114
,
115
,
116
]. Wang et al
compared 23 patients with 29 hips treated with ESWT and 25 patients with 28 hips treated
by core decompression with non
-
vascularized fibular bone grafting, total hip arthroplasty
(THA) was performed in 3% and 21% (
P
= 0.039) in 1 year, 10% and 32% (
P
= 0.044) in
2 years and 24% and 64% (
P
= 0.002) in 8 to 9
-
year follow
-
up for the ESWT group and
the surgical group respectively. Significant improvements in pain and function were noted
at each time intervals favoring the ESWT. There was a trend of decrease in the size of the
lesion in the ESWT group [
22
,
117
]. In animal experiment in rabbits, ESWT was shown
to increase BMP
-
2 protein and mRNA, and up
-
regulation of VEGF expression in necrotic
subchondral bone of the femoral head. The up
-
regulation of VEGF may play a role
inducing the ingrowth of neovascularization and improvement in blood supply to the
femoral head [
118
,
119
]. These findings are in concert with our findings with
histopathological examination and immunohistochemical analysis, ESWT was shown to
promote angiogenesis and bone remodeling and regenerative effect in AVNFH [
117
]. It
appears that ESWT is effective in the retardation or prevention of collapse of the femoral
head in early AVNFH. The application of ESWT was also found effective in the treatment
of corticosteriod induced AVNFH in patients with systemic lupus erythematosus [
114
].
Wang et al compared 15 patients with 26 hips in patients with systemic lupus
erythematosus with the control of 24 patients with 29 hips, THA was performed in 12%
and 14% respectively, and there were no difference in pain and function. It is concluded
that the response of patients with SLE to ESWT for AVNFH is comparable to AVNFH in
non
-
SLE patients [
114
].
Other disorders
Several studies reported a positive effect of shockwave therapy in Peyronie's disease and
complex regional pain syndrome (RSD or reflex sympathetic dystrophy) [
120
],
osteoarthritis of the knee [
121
], spine fusion [
122
], malignant cells [
123
,
124
], and gene
therapy [
125
]. Furthermore, the application of ESWT has been expanded to
Summary of Contents for VIPP
Page 1: ...CellSonic VIPP Owner s Manual ...
Page 2: ...2 ...
Page 14: ...14 ...
Page 29: ...29 PATIE NT TREATMENT PROTOCOL WORKSHEET 1 ...
Page 49: ...49 ...
Page 50: ...50 ...
