低能超声波加速骨折愈合————蒋业斌1, 张志勇1,2,刘军3

摘要：骨折愈合是一个高度复杂的再生过程。它需要一 系列在空间和时间上来说都是高度关联的相互作用。这 些相互作用涉及到为骨骼的自然修复和完整痊愈所必需 的许多不同类型的细胞，蛋白质和基因表达。超声波对 康复全过程中的不同的阶段都有影响。这些阶段包括信 号传导、基因表达、血流组织改建和重造，以及骨痂的 机械力学特性。的确，依照很多实验室和临床上针对检 查超声波对骨折愈合的影响所进行的研究表明，研究人 员已提出了诸多直接或间接的生物机制来解释超声波加 速骨折愈合的功效。很多双盲安慰剂对照的临床研究和 众多的科学实验数据都显示了超声波对骨折愈合过程中 的三个主要阶段即炎症、康复和组织改建都有积极的影 响。超声波能增强并加快血管再造，软骨生成和骨生成 等生物过程。越来越多的科学和临床数据也展示了超声 波对于延迟愈合和不愈合的病例具有非常好的疗效。因 为超声波治疗从各方面来看都是比较经济的，总的医疗 费用和所需的康复时间都会明显减少,所以病人从中能 得到很大的效益。

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Low intensity ultrasound effects over osteopenic female rats bones————Daniela Cristina Leite De Carvalho, Alberto Cliquet Jr

SUMMARY： Several studies have already shown the beneficial effects of low intensity pulsed ultrasound on osteogenesis in fracture cases. However, few reports have related the ultrasound action in bone with some injury but without fracture. Thus, we induced a rat osteopenia model by ovariectomy and the proximal third of rat femur was stimulated by ultrasound (200 ms burst of 1.5 MHz sine waves repeated at 1.0 kHz, 30mW/cm2, SATA) for 20 min/day, during 20 days. After the treatment period, the body weight was significantly higher in the non-treated group than the treated one. No significant difference in bone mineral content was detected among the groups (p>0.05). Also, no significant difference was noted in the mechanical properties of the femoral diaphysis. However, histologic investigations showed that the treated femur presented less microarchitectural deterioration than the non-treated group. Moreover, it was demonstrated that the treated group did show recent bone formation which was not there in the non-treated group. These results suggest that the low intensity ultrasound can interfere in a positive way on osteoporosis.

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The Use of Low-Intensity Ultrasound to Accelerate the Healing of Fractures————Clinton Rubin, PHD, Mark Bolander, MD, John P. Ryaby, BS, And Michael Hadjlargyrou, PHD

SUMMARY：
·Double-blind, prospective, placebo-controlled clinical trials demonstrate that healing times of fresh fractures of the radius and tibia are reduced by up to 40% with the use of low-intensity ultrasound.
· Animal studies indicate that low-intensity ultrasound exposure results in stronger and stiffer callus formation and in acceleration of the endochondral ossification process.
· Extensive clinical evidence demonstrates that ultrasound represents a safe, noninvasive method of accelerating the healing of fresh fractures of the tibia, the distal aspect of the radius, the scaphoid, and the metatarsals.
· Clinical studies indicate that ultrasound reduces the confounding effect of smoking and patient age on the fracture-healing process.
· Ultrasound requires a brief, twenty-minute, daily at-home treatment regimen and has no known contraindications.
· The effectiveness of low-intensity ultrasound has also been demonstrated in the clinical treatment of delayed unions and nonunions.

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Ultrasound – an alternative healing method for nonunions?————E. Mayr · V. Frankel · A. Rüter

SUMMARY：
Several years ago, low-intensity pulsed ultrasound (frequency 1.5 MHz; signal burst width 200 ms; signal repetition frequency 1 KHz; intensity 30 mW/cm2) was shown to accelerate fresh fracture healing both clinically and experimentally. On the basis of a prescription use registry, this paper reports on the use of low-intensity pulsed ultrasound in the therapy of 951 delayed unions and 366 nonunions. The overall success rate for delayed unions was 91% (average healing time 129 ± 2.7 days) and for nonunions 86% (average healing time 152 ± 5.3 days). Stratifying the data, it becomes clear that patient medication with calcium channel blockers, nonsteroidal anti-inflammatory drugs, and steroids is a negative predictor for healing nonunions, as well as renal or vascular insufficiency. Patients who were smokers during ultrasound therapy had lower healing rates than those who never smoked. When comparing the patients of our own clinic treated with low-intensity ultrasound under study conditions which demonstrate that if healing was achieved it was an effect of the ultrasound therapy to the worldwide prescription use registry, no difference was seen in healing rate, healing time, or fracture age. Therefore, the results of these two populations support each other. Low-intensity pulsed ultrasound may provide a method of nonoperative treatment of great promise for healing disorders. Determination of ranking of this new method should be done within the near future.

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低强度超声波促进桡骨远端骨折愈合————汤荣光，刘印文，郑昱新，周国林，王鹤歧

摘要：
[目的] 观察低强度脉冲超声对桡骨远端骨折 愈合的促进作用。[方法] 41例桡骨远端骨折患者，随 机分为超声治疗组（21例）和对照组（20例）。超声组 在骨折复位后以短臂石膏固定，每日以低强度脉冲超 声治疗15min；对照组仅作复位和短臂石膏固定。记 录两组患者骨折临床愈合时间和X线片上骨折线处灰度 值的变化。[结果] 超声治疗组的临床愈合时间较对照 组缩短（32.04d ±2.58dVS40.75d ±5.12d,P<0. 01）。超声治疗组骨折愈合前后X 线片上骨折线处灰 度值变化较对照组大。[结论] 低强度脉冲超声可明显 加快桡骨远端骨折的愈合，促进骨折处局部骨的形 成。

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低强度脉冲超声对关节软骨缺损修复影响的初步观察————贾小林 陈丈直 周伟 王智彪

摘要：
[目的]观察低强度脉冲超声对兔膝关节软骨缺 损修复的影响。[方法]于30只兔股骨髁间窝软骨面处 钻孔，术后左后肢膝关节缺损处以低强度脉冲超声辐 照，右后肢予以假照作为对照。分别于术后2周、4周 和8 周处死，作大体及病理组织学观察。 [结果]大体观察和组织学观察均表明治疗组修复 比对照组提前，且修复组织中蛋白多糖含量明显增加。 [结论]低强度脉冲超声能促进关节软骨缺损修复。

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