Human autologous mesenchymal stem cells with extracorporeal shock wave therapy for nonunion of long bones

Zhai, Ling; Ma, Xinlong; Jiang, Chuan; Zhang, Bo; Liu, Shui-Tao; Xing, Gengyan

doi:10.4103/0019-5413.189602

Cited by 15 publications

(8 citation statements)

References 41 publications

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“…In 22 of the cases, pulsed electromagmetic field (PMEF) therapy was also applied without achieving significantly increased healing rates [38]. Zhai et al reported that significantly higher union rates of long-bone non-unions were obtained when applying autologous mesenchymal stem cells additionally to fESWT [39]. To the best knowledge of the authors, the present study describes the combination of fESWT, a biophysical procedure, with nail dynamization for the first time.…”

Section: Discussionmentioning

confidence: 91%

Addition of shock wave therapy to nail dynamization increases the chance of long-bone non-union healing

et al. 2022

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Background Long-bone non-unions after intramedullary nailing can be treated by nail dynamization or focused high-energy extracorporal shock wave therapy (fESWT). The objective of this study was to assess the effect of the combination therapy of nail dynamization and fESWT on long-bone non-unions. Materials and methods 49 patients with long-bone non-unions (femur and tibia) after nailing were treated with nail dynamization (group D, n = 15), fESWT (group S, n = 17) or nail dynamization in addition to fESWT (group DS, n = 17). Patients were followed up for 6 months retrospectively. Furthermore, age, sex, Non-Union Scoring System (NUSS) score, time intervals from primary and last surgery until intervention and smoking status were analysed for their correlations to bone union. Results Union rates were 60% for group D, 64.7% for group S and 88.2% for group DS, with a significant difference between group D and DS (p = 0.024). Successful treatment was correlated with high age (OR 1.131; 95% CI 1.009–1.268; p = 0.034), female gender (OR 0.009; 95% CI 0.000–0.89; p = 0.039), low NUSS score (OR 0.839; 95% CI 0.717–0.081; p = 0.028) and negative smoking status (OR 86.018; 95% CI 3.051–2425.038; p = 0.009). Conclusions Data from the present study indicate that the combination therapy of nail dynamization and fESWT leads to a higher union rate than dynamization or fESWT alone. Level of evidence Level 3.

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Section: Discussionmentioning

confidence: 91%

Addition of shock wave therapy to nail dynamization increases the chance of long-bone non-union healing

et al. 2022

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“…Our review included two randomized controlled trials (RCTs) [ 28 , 34 ], one non-randomized controlled trial [ 35 ], and 20 observational studies (14 retrospective [ 5 , 9 , 25 , 26 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ] and six prospective [ 11 , 46 , 47 , 48 , 49 , 50 ]). Together, the included papers reported a total of 1838 cases of delayed union or nonunion ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…The average Downs and Black score for the 23 included studies was 15.2 (range 8–26), which is at the low end of the fair range. Only one study scored within the excellent range [ 28 ], and only two scored within the good range [ 33 , 34 ]. Ten papers had fair scores [ 5 , 26 , 36 , 37 , 38 , 39 , 43 , 46 , 48 , 49 ].…”

Section: Resultsmentioning

confidence: 99%

Extracorporeal Shockwave Therapy in the Treatment of Nonunion in Long Bones: A Systematic Review and Meta-Analysis

Sansone

Ravier

Pascale

et al. 2022

JCM

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Background: Nonunion is one of the most challenging problems in the field of orthopedics. The aim of this study was to perform a systematic review of the literature to evaluate the effectiveness of extracorporeal shockwave therapy (ESWT) in the treatment of nonunion in long bones. Methods: We conducted a search of three databases (PubMed, Scopus, and Web of Science) and found 646 total publications, of which 23 met our inclusion criteria. Results: Out of 1200 total long bone nonunions, 876 (73%) healed after being treated with ESWT. Hypertrophic cases achieved 3-fold higher healing rates when compared to oligotrophic or atrophic cases (p = 0.003). Metatarsal bones were the most receptive to ESWT, achieving a healing rate of 90%, followed by tibiae (75.54%), femurs (66.9%) and humeri (63.9%). Short periods between injury and treatment lead to higher healing rates (p < 0.02). Conversely, 6 months of follow-up after the treatment appears to be too brief to evaluate the full healing potential of the treatment; several studies showed that healing rates continued to increase at follow-ups beyond 6 months after the last ESWT treatment (p < 0.01). Conclusions: ESWT is a promising approach for treating nonunions. At present, a wide range of treatment protocols are used, and more research is needed to determine which protocols are the most effective.

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“…In clinical work, a fracture with no signs of healing over 6 months is usually defined as fracture nonunion [ 20 ], and there have been a large number of studies and articles on healing fracture nonunion. Studies have shown that ESW can promote bone formation, induce angiogenesis, ease pain, and stimulate callus growth, as well as a variety of biological effects [ 21 – 23 ].…”

Section: Discussionmentioning

confidence: 99%

The analgesic efficacy of extracorporeal shock wave combined with percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar compression fractures in postmenopausal women

et al. 2021

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Background To explore the analgesic efficacy of extracorporeal shock wave (ESW) combined with percutaneous vertebroplasty (PVP) after reduction in overextension position in the treatment of osteoporotic thoracolumbar compression fractures in postmenopausal women. Methods The data of postmenopausal women with osteoporotic thoracolumbar compression fracture admitted in our department from January 2017 to October 2019 were analyzed retrospectively. They were divided into groups of unipedicular percutaneous kyphoplasty (U-PKP n = 21), bipedicular PKP (B-PKP n = 20), and ESW combined with PVP after reduction in overextension position (EP-PVP n = 18). The improvement of pain and vertebral height in three groups was compared. Results Postoperative compression rate and Cobb angle of vertebral fractures in the three groups were all lower than those before surgery, and the differences between pre-operation and post-operation were statistically significant (P < 0.05). The visual analog scale (VAS) and Oswestry dysfunction index (ODI) scores of the three groups decreased significantly after the operation (P < 0.05). The ODI scores of the EP-PVP group in the third months after the operation were significantly improved compared with the other two groups, and the difference was statistically significant (P < 0.05). Conclusions In our small-sample study, all three treatment schemes can treat osteoporotic compression fracture of thoracolumbar vertebrae in postmenopausal women, relieve pain, and improve quality of life. ESW combined with PVP after reduction in overextension position could achieve a good vertebral reduction rate and improve kyphosis, and may reduce the application of analgesic drugs.

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Human autologous mesenchymal stem cells with extracorporeal shock wave therapy for nonunion of long bones

Cited by 15 publications

References 41 publications

Addition of shock wave therapy to nail dynamization increases the chance of long-bone non-union healing

Addition of shock wave therapy to nail dynamization increases the chance of long-bone non-union healing

Extracorporeal Shockwave Therapy in the Treatment of Nonunion in Long Bones: A Systematic Review and Meta-Analysis

The analgesic efficacy of extracorporeal shock wave combined with percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar compression fractures in postmenopausal women

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