Zafer ORHAN, Murat ALPER, Ferda ŞENEL, Necati YILMAZ, Ümit SAYAR

Ekstrakorporeal şok dalgası tedavisinin sıçanlarda kırık iyileşmesi üzerine etkileri

Amaç: Tibia diafizlerinde kırık oluşturulduktan sonra Kirschner teliyle intramedüller tespit yapılan sıçanlarda, düşük enerjili şok dalgasının kırık iyileşmesi üzerine etkileri radyolojik, histolojik ve sintigrafik olarak incelendi. Çalışma planı: Ortalama ağırlıklar 200 gr (180-220 gr) olan üç aylık (2.5-4 ay) Wistar-albino tipi sıçanlardan dört ve alt haftalık gruplar oluşturuldu. Tüm sıçanlarda parmakla bastırarak skopi kontrolunda sağ tibia diafizlerinde transvers kırık oluşturuldu ve kırıklar intramedüller olarak K-teliyle tespit edildi. Birinci (çalışma) ve ikinci (kontrol) gruplarda 14'er adet, üçüncü (çalışma) ve dördüncü (kontrol) gruplarda beşer sıçan yer aldı. Kırık sonrası deney gruplarındaki sı çanlara 0, 5, 9, 14 ve 19. günlerde 14 kV gücünde 200'er şok dalgası uygulandı. Sıçanlarda dördüncü ve altıncı haftalarda radyolojik inceleme yapıldı. Birinci ve ikinci grup dördüncü haftada öldürülerek histolojik olarak incelendi. Üçüncü ve dördüncü gruplar altıncı haftada osteoblastik aktivite açısından sintigrafik olarak incelendi ve sonrasında histolojik tetkik için anesteziyle öldürüldü. Sonuçlar: Radyolojik skorlar dört ve altıncı haftalarda deney grubunda anlamlı derecede daha yüksekti (sırasıyla p=0.002 ve p=0.011); histolojik olarak ESWT grubunda daha yüksek oranda kemiksel kaynama saptandı. (sırasıyla p=0.027 ve p=0.001). Sintigrafi çalışmasında statik çalışmada 10 dakikalık sayımda kontrol grubuna göre daha yüksek değerler elde edildi (p=0.039). Çıkarımlar: Çalışmamızda elde edilen radyolojik, histolojik ve sintigrafik veriler ESWT uygulamasının kırık iyileşmesini hızlandırdığını gösterdi.

Anahtar Kelimeler:

Kırık iyileşmesi, Tibia kırıkları, Sıçanlar, Hastalık modelleri, hayvan, Kemik yenilenmesi, Litotripsi

The effect of extracorporeal shockwave treatment on the healing of experimental rat tibial fractures

Objectives: We performed radiologic, histologic, and scintigraphic studies to evaluate the effect of extracorporeal shock-wave lithotripsy (ESWL) on the healing of experimental rat tibial fractures. Methods: Wistar albino rats aged 2.5 to 4 months (mean age 3 months) and with a mean weight of 200 g (range 180 to 220 g) were assigned to four- and six-week groups. A transverse fracture in the right tibial diaphyses was induced manually followed by intramedullary fixation with the use of a Kirschner wire. Each of the two (study and control) four-week and six-week groups consisted of 14 rats and five rats, respectively. Following fracture induction and fixation, four- and six-week study groups were administered ESWL at 200 shock waves (14 kV) to the fracture line on day 0, 5, 9, 14, and 19. The rats were radiologically examined in the forth and sixth weeks. The first two groups of rats were sacrificed at the end of four weeks for histologic examination. The remaining two groups underwent scintigraphic examination for osteoblastic activity at the end of six weeks and were then sacrificed for histologic examination. Results: Radiological scores were significantly higher in the study rats in the forth and sixth weeks (p=0.002 and p=0.011, respectively); similarly, significantly higher extent of bone healing was observed in the ESWT groups (p=0.027 and p=0.001, respectively). The 10-minute static scintigraphic counting resulted in higher values in the shock wave administered rats (p=0.039). Conclusion: Radiologic, histologic, and scintigraphic results of our study showed that ESWT treatment increased the rate of clinical bone healing.

Keywords:

Fracture Healing, Tibial Fractures, Rats, Disease Models, Animal, Bone Regeneration, Lithotripsy,

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1.Chaussey C, Eisenberg F, Wanner K, Forssman F, Hepp W, Schmiedt E, et al. The use of shock waves for the destruction of renal calculi without direct contact. Urol Res 1976;4:175.
2. Paterson DC, Carter RF, Maxwell GM, Hillier TM, Ludbrook J, Savage JP. Electrical bone-growth stimulation in an experimental model of delayed union. Lancet 1977;1:1278-81.
3. Bassett CA. The development and application of pulsed electromagnetic fields (PEMFs) for ununited fractures and arthrodeses. Orthop Clin North Am 1984;15:61-87.
4. Duarte LR. The stimulation of bone growth by ultrasound. Arch Orthop Trauma Surg 1983;101:153-9.
5. Dyson M, Brookes M. Stimulation of bone repair by ultrasound. Ultrasound Med Biol 1983;Suppl 2:61-6.
6.Arem AJ, Madden JW. Effects of stress on healing wounds: I. Intermittent noncyclical tension. J Surg Res 1976;20:93-102.
7. van Royen BJ, O'Driscoll SW, Dhert WJ, Salter RB. A comparison of the effects of immobilization and continuous passive motion on surgical wound healing in mature rabbits.Plast Reconstr Surg 1986;78:360-8.
8. Goodship AE, Kenwright J. The influence of induced micromovement upon the healing of experimental tibial fractures.J Bone Joint Surg [Br] 1985;67:650-5.
9. McCormack D, Lane H, McElwain J. The osteogenic potential of extracorporeal shock wave therapy. An in-vivo study. Ir J Med Sci 1996;165:20-2.
10. Kaulesar Sukul DM, Johannes EJ, Pierik EG, van Eijck GJ, Kristelijn MJ. The effect of high energy shock waves focused on cortical bone: an in vitro study. J Surg Res 1993;54:46-51.
11. Rompe JD, Eysel P, Hopf C, Vogel J, Kullmer K. Extracorporeal shockwave treatment of delayed bone healing. A critical assessment. Unfallchirurg 1997;100:845-9. [Abstract]
12.Vogel J, Hopf C, Eysel P, Rompe JD. Application of extracorporeal shock-waves in the treatment of pseudarthrosis of the lower extremity. Preliminary results. Arch Orthop Trauma Surg 1997;116:480-3.
13. White AA 3rd, Panjabi MM, Southwick WO. Effects of compression and cyclical loading on fracture healing--a quantitative biomechanical study. J Biomech 1977;10:233-9.
14. Haupt G, Haupt A, Ekkernkamp A, Gerety B, Chvapil M. Influence of shock waves on fracture healing. Urology 1992;39:529-32.
15. Allen HL, Wase A, Bear WT. Indomethacin and aspirin:effect of nonsteroidal anti-inflammatory agents on the rate of fracture repair in the rat. Acta Orthop Scand 1980;51:595-600.
16. Lane JM, Sandhu HS. Current approaches to experimental bone grafting. Orthop Clin North Am 1987;18:213-25.
17. Cornell CN, Lane JM. Newest factors in fracture healing. Clin Orthop 1992;(277):297-311.
18. Frost HM. The biology of fracture healing. An overview for clinicians. Part II. Clin Orthop 1989;(248):294-309.
19. Chaussy C, Schmiedt E, Jocham D, Brendel W, Forssmann B, Walther V. First clinical experience with extracorporeally induced destruction of kidney stones by shock waves. J Urol 1982;127:417-20.
20.Valchanou VD, Michailov P. High energy shock waves in the treatment of delayed and nonunion of fractures. Int Orthop 1991;15:181-4.