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Analysis of therapeutic effect of high focused extracorporeal shock wave comprehensive therapy on femoral head bone marrow edema syndrome

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Original Article | Vol 3 | Issue 2 |  July-December 2023 | page: 35-40 | Ruimeng Duan, Leilei Zhang, Haonan Ling, Jie Guan, Huisheng Shi, Dawei Liang, Xiantao Chen

DOI: https://doi.org/10.13107/jrs.2023.v03.i02.99

Author: Ruimeng Duan [1], Leilei Zhang [1], Haonan Ling [1], Jie Guan [1], Huisheng Shi [1], Dawei Liang [1], Xiantao Chen [1]

[1] Department of Femoral Head Necrosis, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang, Henan, China.

Address of Correspondence
Dr. Xiantao Chen,
Department of Femoral Head Necrosis, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), No. 82 Qiming South Road, Luoyang, Henan Province 471000, China.
E-mail: luoyangzhenggu@163.com

Abstract

Purpose: This study explored the clinical therapeutic effect of high-focused extracorporeal shock wave therapy (HF-ESWT) combined with exercise rehabilitation and drug therapy on femoral head bone marrow edema syndrome (BMES).
Materials and Methods: This study systematically reviewed and analyzed the clinical data of 43 patients with femoral head bone marrow edema who were treated in our hospital from January 2017 to June 2022. Twenty-three patients received HF-ESWT comprehensive treatment. Twenty patients received general treatment including medication and exercise rehabilitation treatment. The treatment methods for Group B patients were the same as Group A, except for not receiving shock wave therapy. Changes in visual analog scale (VAS), Harris score of the hip, and the edema area of region of interest area (ROIA) on hip magnetic resonance imaging (MRI) were analyzed before and after treatment.
Results: Our research found that patients receiving HF-ESWT had significantly reduced VAS compared with general treatment at 1, 2, and 3 months (P < 0.05). We found that HF-ESWT comprehensive treatment had significantly improved hip Harris score compared with general treatment at 2 and 3 months (P < 0.05). HF-ESWT comprehensive treatment had significantly reduced edema area of ROIA on hip MRI compared with general treatment at 1, 2, and 3 months (P < 0.05). In addition, the healing rate was significantly higher in the HF-ESWT
comprehensive treatment group compared with general treatment group (P < 0.05). One of the patients in the group treated with shockwaves developed hip pain that worsened after treatment, three patients developed local skin ecchymosis, and the other patients had no adverse events.
Conclusion: HF-ESWT comprehensive treatment significantly reduced hip pain symptoms, quickly shortened the time for femoral head edema to dissipate, and significantly improved hip function for affected limbs with bone marrow edema syndrome. HF-ESWT comprehensive treatment may be an effective therapeutic strategy for HF-BMES.
Keywords: Extracorporeal shock wave therapy, Bone marrow edema syndrome, Traditional Chinese medicine, Osteonecrosis of the femoral head

References:

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How to Cite this article: Duan R, Zhang L, Ling H, Guan J, Shi H, Liang D, Chen X | Analysis of therapeutic effect of high focused extracorporeal shock wave comprehensive therapy on femoral head bone marrow edema syndrome | Journal of Regenerative Science | Jul-Dec 2023; 3(2): 35-40.

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A novel treatment method for ankylosing spondylitis combined with sacroiliac joint bone marrow edema

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Original Article | Vol 3 | Issue 2 |  July-December 2023 | page: 41-46 | Leilei Zhang, Xuanye Zhu, Haonan Ling, Wanyi Zhang, Ying Zhang, Youwen Liu, Xiantao Chen

DOI: https://doi.org/10.13107/jrs.2023.v03.i02.101

Author: Leilei Zhang [1], Xuanye Zhu [2], Haonan Ling [1], Wanyi Zhang [1], Ying Zhang [1], Youwen Liu [1], Xiantao Chen [1]

[1] Center of hip Surgery, Henan Luoyang Orthopedic-Traumatological Hospital, Orthopedic Hospital of Henan Province, Luoyang, China.
[2] Henan University of Traditional Chinese Medicine, zhengzhou, China.

Address of Correspondence
Dr. Center of Hip Surgery, Henan Luoyang Orthopedic-Traumatological Hospital, Orthopedic Hospital of Henan Province, No. 82, South Qiming Road, 471002, Luoyang, China.
E-mail: luoyangzhenggu@139.com

Abstract

Objective: To investigate whether high-energy extracorporeal shock wave therapy (ESWT) combined with conventional oral medicine as a potential novel therapeutic approach for the treatment of ankylosing spondylitis (AS)combined with sacroiliac joint bone marrow edema.
Materials & Methods: 40 patients were divided into two groups and were treated with or without ESWT in combination with conventional oral medicine. A visual analog scale (VAS) score of spinal pain, as well as indicators of spinal mobility, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) scores, inflammatory index (C-reactive protein, blood cell sedimentation rate), and other indicators were compared between the two groups. The Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system was used to evaluate pain and structural damage in the sacroiliac joint.
Results: (1) After one month of treatment (T1), VAS, BASDAI, BASFI, and SPARCC scores were lower in both groups than at the start of treatment (T0) (P < 0.05), with greater decreases observed in the treatment group (P < 0.05). (2) Also, at T1, indicators of spinal mobility for the two groups were improved (P < 0.05). (3) ESR and C-reactive protein levels for the two groups decreased significantly at T1 versus T0 (P < 0.05).
Conclusion: ESWT combined with oral medication can significantly relieve pain and improve clinical functional symptoms for patients with AS. It can also reduce sacroiliac joint bone marrow edema and control the inflammatory reaction in the sacroiliac joint, which represents a novel, effective, reliable, and safe clinical treatment therapeutic method.
Keywords: Ankylosing spondylitis, Sacroiliac joint, extracorporeal shock wave therapy, oral medicine.

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How to Cite this article: Zhang L, Zhu X, Ling H, Zhang W, Zhang Y, Liu Y, Chen X | A novel treatment method for ankylosing spondylitis combined with sacroiliac joint bone marrow edema | Journal of Regenerative Science | Jul-Dec 2023; 3(2): 41-46.

 

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Clinical Study on Appropriate Energy of Extracorporeal Shock Wave for Rotator Cuff Non-calcific Tendinopathy Treatment

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Original Article | Vol 3 | Issue 2 |  July-December 2023 | page: 47-51 | Jin Xi, Li Jie, Li Jin, Luo Hao, Zhang Liheng

DOI: https://doi.org/10.13107/jrs.2023.v03.i02.103

Author: Jin Xi [1], Li Jie [2], Li Jin [2], Luo Hao [2], Zhang Liheng [2]

[1] Graduate Union of Changchun University of Chinese Medicine, Changchun China.
[2] Department of Sports medicine and joint surgery Jilin Provincial People’s Hospital, Changchun, China.

Address of Correspondence
Dr. Zhang Liheng,
Department of Sports medicine and joint surgery Jilin Provincial People’s Hospital, Changchun, China.
E-mail: 1987174487@qq.com

Abstract

Objective: This study aims to investigate the short-term clinical efficacy of extracorporeal shock waves with different energy levels on rotator cuff non-calcific tendinopathy.
Materials and Methods: A total of 139 patients with rotator cuff rotator non-calcific tendinopathy were randomly divided into eight groups based on the different energy levels of the Dornier Aries smart focus shock wave therapy device: Level 5, 2000 shocks (0.062 mJ/mm2), Level 6, 2000 shocks (0.084 mJ/mm2), Level 7, 2000 shocks (0.096 mJ/mm2), Level 8, 2000 shocks (0.117 mJ/mm2), Level 5, 3000 shocks (0.062 mJ/mm2), Level 6, 3000 shocks (0.084 mJ/mm2), Level 7, 3000 shocks (0.096 mJ/mm2), and Level 8, 3000 shocks (0.117 mJ/mm2). Each
group received shock wave treatment corresponding to the respective energy level and shock count. The visual analogue scale (VAS) and Constant-Murley score (CMS) were compared before and 1, 2, and 4 weeks after treatment to determine the short-term efficacy.
Results: The VAS scores of all groups significantly decreased at 1, 2, and 4 weeks after treatment compared to before treatment. The VAS score of the Level 7, 2000 shocks (0.096 mJ/mm2) group was significantly lower than the other groups (P < 0.05). The CMS scores of all groups significantly increased at 1, 2, and 4 weeks after treatment compared to before treatment. The CMS score of the Level 7, 2000 shocks (0.096 mJ/mm2) group was significantly higher than the other groups (P < 0.05). There was significant statistical difference in the effective rate among the eight groups (P > 0.05). No serious adverse reactions were observed in any group before or after the treatment.
Conclusion: Extracorporeal shock wave therapy for rotator cuff rotator non-calcific tendinopathy can alleviate shoulder joint pain, improve shoulder joint function, and enhance patients quality of life with good efficacy. The optimal therapeutic effect was observed at an energy level of 0.096 mJ/mm2 and 2000 shocks.
Keywords: Rotator cuff injury, Rotator cuff non-calcific tendinopathy, Extracorporeal shock wave therapy

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How to Cite this article: Xi J, Jie L, Jin L, Hao L, Liheng Z | Clinical Study on Appropriate Energy of Extracorporeal Shock Wave for Rotator Cuff Non-calcific Tendinopathy Treatment. | Journal of Regenerative Science | Jul-Dec 2023; 3(2): 47-51.

 

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Comparison of Radial Pressure Waves and Focused Extracorporeal Shock Waves in Treatment of Osteoarthritis of the Knee

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Original Article | Vol 3 | Issue 2 |  July-December 2023 | page: 62-66 | Xichun Sun, Suoli Cheng, Xianghua Xiong, Zhengcheng Wang

DOI: https://doi.org/10.13107/jrs.2023.v03.i02.109

Author: Xichun Sun [1], Suoli Cheng [1], Xianghua Xiong [2], Zhengcheng Wang [1]

[1] Department of Orthopedics, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China,
[2] Department of Orthopedics, People’s Hospital of Liangping District, Chongqing, China.

Address of Correspondence

Dr. Suoli Cheng,
Department of Orthopedics, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China.
E-mail: chengsuoli@126.com

Abstract

Objective: The aim of this study is to investigate and compare the clinical efficacy of radial pressure waves and focused external shock wave therapy for knee osteoarthritis (KOA).
Materials and Methods: From October 2020, 90 patients aged 45–65 years old with Kellgren and Lawrence classification (K-L) stage I and II of KOA were selected in our hospital or randomly assigned to 3 groups with 30 cases in each group. One group was treated with antiinflamatory medication. The other two groups received one course of treatment (once a week, 4 times in total) performed by using radial focused shock
waves respectively, and follow-up was conducted by telephone and outpatient review 3, 6, and 9 months after the treatment. Visual Analog Scale (VAS) and Western Ontario McMaster Osteoarthritis Index (WOMAC) osteoarthritis score were used before and after treatment.
Results: (1) VAS, WOMAC, and evaluation indexes of both treated groups were better than those of the control group (oral drug group); (3) The score of the radial group was significantly different from that of the focused group (P > 0.05).
Conclusion: (1) Focused and radial pressure waves (RPW) have good clinical therapeutic effect on early KOA (2) Comparison of long-term effect: focused shock waves are more significant than radial (3) Radial pressure waves area good indication in relatively young patients, short course of disease (within 1 year), and K-L stage I an II. (4) In older patients, with more than a year of symptoms and K-L stages II and III, focal waves are more effective than radial waves. (5) Patients with acute onset and night pain or accompanied by obvious effusion can first take nonsteroidal
drugs orally continuously for a week, and the treatment effect is better. During treatment, the drugs can be continued or stopped according to the specific conditions. When synovial edema and effusion of the joint decreased, the conventional parameters were used for treatment.
Keywords: Knee osteoarthritis, Extracorporeal shock wave therapy, Radial Pressure Waves

References:

1. Sharma L. Osteoarthritis of the knee. N Engl J Med 2021;384:51-9.
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How to Cite this article: Sun X, Cheng S, Xiong X, Wang Z | Comparison of Radial Pressure Waves and Focused Extracorporeal Shock Waves in Treatment of Osteoarthritis of the Knee. | Journal of Regenerative Science | Jul-Dec 2023; 3(2): 62-66.

 

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Clinical Study on the Treatment of Long Bone Fracture Non-union with Extracorporeal Shock Wave Therapy Combined with Platelet-rich Plasma

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Original Article | Vol 3 | Issue 2 | July-December 2023 | page: 67-72 | RongDa Xu, JiaHui Li, ZhenCun Cai, Zhi Li, ZhiHao Liang, YuanLong Li, Lin Shen, HongLiang Tu, HongYu Zhou, Han Sun, Pei Li

DOI: https://doi.org/10.13107/jrs.2023.v03.i02.111

Author: RongDa Xu [1], JiaHui Li [1], ZhenCun Cai [1], Zhi Li [2], ZhiHao Liang [2], YuanLong Li [3], Lin Shen [4], HongLiang Tu [5], HongYu Zhou [6], Han Sun [7], Pei Li [1]

[1] Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, China,
[2] Department of Orthopedics Surgery, Centro Hospitalar Conde de São Januário, Rua do Almirante Costa Cabral, Macau, China,
[3] Department of Orthopedics Surgery, Guangdong General Hospital, Yuexiu District, Guangzhou, China,
[4] Department of Hand Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, China,
[5] Department of Orthopedics Surgery, 242 Hospital Affiliated to Shenyang Medical College, Huanggu District, China,
[6] Department of Orthopedics Surgery, Shenyang Orthopedic Hospital, Dadong District, Shenyang, China,
[7] Department of Orthopedics Surgery, Liaoyang County Central Hospital, Liaoyang, China.

Address of Correspondence

Dr. Pei Li,
Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, China.
E-mail: peili4421@gmail.com

Abstract

Objective: The objective of the study was to evaluate of the therapeutic efficacy of extracorporeal shock wave therapy (ESWT) combined with platelet-rich plasma (PRP) injection in patients with long bone fracture non-union.
Material and Methods: A total of 36 patients identified with long bone fracture non-union treated from September 2020 to September 2023 were enrolled into this study. Employing a random number table method, they were randomly divided into three groups, with 12 cases in each group. Based on the treatment modality, the groups were categorized as the ESWT group, PRP group, and combination ESWT + PRP group. Routine radiographs and musculoskeletal ultrasound were obtained before treatment and at 3-, 6-, and 9-month post-treatment intervals to observe for bone callus formation and assess fracture line imaging scores with the aim to evaluate the treatment efficacy of each group.
Results: With the extension of treatment time, the bone callus and fracture line imaging scores of the three groups gradually increased (P < 0.05). At 3-, 6-, and 9-month post-treatment, the scores of the ESWT combined with the PRP group were significantly better than those of the singular ESWT group and PRP group, and the differences were statistically significant (P < 0.05).
Conclusion: Therapy with singular ESWT, singular PRP, and combination ESWT + PRP has demonstrated effective improvement in fracture healing for patients with long bone fracture non-union. The synergistic effects of combination therapy were more significant, surpassing the efficacy of singular ESWT or PRP applications. The combined use of ESWT and PRP represents a safe and promising alternative treatment for long-bone fracture non-union, making it a compelling choice in the context of fracture healing.
Keywords: Extracorporeal shock wave therapy, Platelet-rich plasma, Non-union of fracture.

References:

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18. Sun L, Zhang N, Tu H, Li P. The application value of musculoskeletal ultrasound in long tubular bone fractures and nonunion shock wave therapy. Chin J Med Ultrasound 2019;16:827-31.

 

How to Cite this article: Xu R, Li J, Cai Z, Li Z, Liang Z, Li Y, Shen L, Tu H, Zhou H, Sun H, Li P | Clinical Study on the Treatment of Long Bone Fracture Non-union with Extracorporeal Shock Wave Therapy Combined with Platelet-rich Plasma. | Journal of Regenerative Science | Jul-Dec 2023; 3(2): 67-72.

 

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Very Low and Low-energetic Extracorporeal Shock Wave Treatment of Spasticity in Children and Adults – A Systematic Review

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Systematic Review | Volume 2 | Issue 1 | JRS Jan – Jun 2022 | Page 03-08 | Karsten Knobloch, Henning Lohse-Busch, Andreas Gohritz, Tomas Nedelka

DOI: 10.13107/jrs.2022.v02.i01.33

Author: Karsten Knobloch [1], Henning Lohse-Busch [2], Andreas Gohritz [3], Tomas Nedelk [4,5]

[1] Department of Sports Medicine, SportPraxis Prof. Knobloch, Hannover, Germany.

[2] Zentrum für Bewegungsstörungen, Rheintalklinik Bad Krozingen, Germany.

[3] Department of Neurology, Universitätsspital Basel, Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Suisse.

[4] Department of Neurology, Charles University in Prague, 2nd Faculty of Medicine, Prague, Czech Republic.

[5] Department of Neurology, Czech Technical University, Faculty of Biomedical Engineering, Kladno, Czech Republic.

Address of Correspondence
Prof. Dr. Karsten Knobloch,
SportPraxis Prof. Knobloch, Heiligerstr. 3, D-30159 Hannover, Germany.
E-mail: professor.knobloch@sportpraxis-knobloch.de

Abstract

Introduction: This systemic review aims to assess the modes and treatment parameters of radial and focused extracorporeal shockwave therapy (ESWT) in spasticity based on the technologies and energy levels involved.
Materials and Methods: 1086 patients from 31 randomized-controlled trials (RCT) or cohort studies are included. 300 children were studied in seven studies (3 RCTs) with two radial and four focused electromagnetic ESWT devices and 14 studies with 443 patients using focused ESWT (electrohydraulic 46 patients, electromagnetic 367 patients, and piezoelectric 30 patients).
Results: In electromagnetic focused ESWT 8 RCTs (n = 323 patients) and three cohort studies (n = 44) used either very low-energetic (0.03–0.05 mJ/mm2) with 1500–2000 shots and 4–5 Hz with 3–5 focused sessions, or low-energetic 0.07–0.12 mJ/mm2 with 1500–2000 shots with 4–5 Hz and 1–3 sessions. The 64 children in the five electromagnetic focused trials were treated with very low-energetic 0.03 mJ/mm2, 1500 shots, and three sessions. 17 studies (n = 687) were using radial technologies with 7 RCTs (n = 349) and ten cohort studies (n = 338). Among the 17 trials, four studies (1 RCT, 3 cohort studies) included 236 children treated with either very low-energetic 0.6–1 bar (two trials) or low-energetic 1.5–3 bar with 5–10 Hz. Energy-wise three radial studies were very low-energetic 0.6–1 bar and 14 studies applied low-energetic radial pressures 1.5–3 bar. Notably, the frequency was mainly 4–8 Hz in the radial studies.
Conclusion: Both, radial and focused very low- to low-energetic ESWT improve function and reduce spasticity significantly. Adverse effects were not noted with the applied very low- to low-energetic device parameters neither among children nor in adults.

Keywords: Spasticity, Extracorporeal shock wave therapy, Extracorporeal shockwave therapy, Children.

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How to Cite this article: Knobloch K, Lohse-Busch H, Gohritz A, Nedelka T | Very Low and Low-energetic Extracorporeal Shock Wave Treatment of Spasticity in Children and Adults–A Systematic Review. | Journal of Regenerative Science | Jan – Jun 2022; 2(1): 03-08.

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