Effect Of Extracorporeal Shock Wave On The Repairation Of Muscle And Bone Tissue In Stress Fracture And Clinical Evaluation

Objective：Using extracorporeal shock wave (ESWT) to treat exploringly theanimal models of stress fracture,and observe the effects of ESW on the repairation ofmuscle and bone tissue in stress fracture,meanwhile, evaluate the efficacy and safetyof this treatment. At last,using ESW to treat the cases of stress fracture because ofhigh intensity training process in the forces,and observe the Clinical efficacy,whichprovide preliminary clinical evidence for developing and promoting the use ofextracorporeal shock wave to treat stress fractures.Methods：（一）The experimental study of Extracorporeal shock wave on the repairation ofmuscle and bone tissue in stress fracture.1、Using rabbit training experimental instrument to establish Stress fracturemodel.2、Use the ESWT to intervene the stress fracture model,and observe the securityof ESWT.3、Observing the changes of PLA2, MDA of the damaged muscle tissue andX-ray, ECT.(二) The clinical efficacy of extracorporeal shock wave to treat stress fracturesForty-five male soldier patients who were diagnosed stress fracture in hospitalwere randomly divided into two groups:①ESW group,treated by Extracorporealshock wave as group A, were32persons.②Cast immobilization group, treated byplaster immobilization,were13persons.The fracture healing conditions of two groupswere evaluated according to systemic conditions, the X-ray and CT imaging, fatigueseverity score, MPQ pain scores and sBAP value at the1th,2th and4th weeks aftertreatment, respectively.Main results:(一) Results of animal experiments: 1、After the intervention of ESW on the stress fracture model, the X-rayshowed the amount and speed of callus of ESW group were better than non-ESWgroup.The ECT results showed the degree and extent of concentration of radionuclideof ESW group were lower than the non-ESW group after4weeks and8weeks.2、The pathological results of muscle and cortical bone are as follows:①Compared with non-ESW group, the degree of the muscle fiber rupture of ESWgroup was light.②The cortical bone of ESW group were basically neat,and theirperiosteum had poliferative response.However, the cortical bone of non-ESW groupwere not neat, periosteal proliferation were severe and a large number of granulationtissue were formed.(二)Results of clinical studies:1、Changes of fatigue scores and pain score are as follows: Compared withcontrol group, the DOMS rating and MPQ scores of ESW group were significantlydecreased after one month of treatment (P<0.05).And the same time, the DOMSrating and MPQ scores of ESW group were significantly decreased,compared withprior treatment after one month.2、The results of X-ray and CT scan are as follows: After twice therapy ofextracorporeal shock wave,24patients appeared obvious callus after two weeks,anddensity of fractures gap increased quickly. After4weeks, the fracture line disappeared,callus becomes dense and the medullary cavity gained completely recanalization.Atlast,the rate of bone healing was75%.Conclusions：1、Extracorporeal shock wave could promote the osteogenic process of themodel animal of stress fracture.2、Compared with conservative treatment, extracorporeal shock wave therapyon stress fracture can effectively relieve pain, reduce muscle fatigue.3、Extracorporeal shock wave which was used to treat stress fracture canpromote the growth of poroma and shorten the healing time.Meanwhile, there were nosignificant neurological, vascular injury and other systemic complications.This method is simple，safe，effective,which demonstrate that ESWT is an effective methodfor the treatment of stress fractures.