The Experimental Study And Related Clinical Research Of Extracorporeal Shock Wave Therapy (ESWT) In Accelerating Osteogenesis

Objective: In order to reveal the mechanism of Extracorporeal Shock Wave therapy (ESWT) in accelerating osteogenesis, DNA metabolish change in periosteal osteaoblast and human mesenchymal stem cells (hMSCs) was studied with multi-approach. Meanwhile, ESWT was applied to the treatment of avascular necrosis of the femoral head (ANFH) in adults. Its curative effect and application was discussed again. The effect of ESWT of ultrasonic orientation was also compared with the ESWT of pain-point orientation for subacromial bursitis (SB) and inflammation of long-tendon of biceps muscle (ILBM) in this study. Methods: After the periosteal osteaoblast and hMSCs was stimulated by Extracorporeal Shock Wave (ESW) in vitro, their mitotic activity, cellular ultrastructue, metabolish change, proliferation and differentiation was observed and evaluated by autoradiography, transmission electron micrograph, flow cytometer, cytochemical staining for osteocalcin and collagen I expression, the Alkaline phosphatese activity. ESWT with the energy density of 0.16~0.20mJ/mm~2 was applied to the treatment to ANFH of 69 patients, and its curative effects were evaluated by the MRI, X-ray, and the Harris hip score, before ESWT, and after ESWT for 3, 6, 12 months. Another group of patients, including 65 cases of SB and 86 cases of ILBM also accepted ESWT with the same density, but they wererandomly divided into two groups, ESWT by ultrasonic orientation andESWT resorted to tenderness point and local anatomy symbol (control group). The energy density, times and the interval stage of ESWT were same in each group. The statistic of every part of this study was made, precisely and felicitously.Results: First, the mitotic activity of periosteal osteoblasts increased significantly, compared with a control group (P<0.05) after 1 week, 2 weeks and 4 week when experemental group being performed to ESW, then the periosteal ossification effect was intensified. ESW accelerated cellular proliferation and differentiation obviously, and the form and structure of the periosteal osteoblast and hMSCs changed, cytochemical staining results show that the expression of alkaline phosphatese, osteocalcin and collagen I improved with the interval stage of ESW, andthe difference is obvious. Second, 69 cases of ANFH were followed up for 1 year after ESWT. The necrosis range occupied were measured by MRI, and averaged from 49.9%(before ESWT), to 19.6%(3 months), to 6.8%(6 months), and to 5.6%(12 months) respectively. The Harris hip score average from 47.2 points before ESWT, to 77.9 after ESWT for 3 months, to 90.2 points after ESWT for 6 months, and to 92.2 points after ESWT for 12 months respectively, the difference was significant between ESWT group and self-control group(P<0.01). No collapse of the femoral...