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Extrakorporale Stoßwellentherapie bei Knochenheilungsstörungen

Evidenzbasierte Therapie – Literaturübersicht und eigene Ergebnisse

Extracorporeal shock wave therapy for bony non-union

Evidence-based therapy – Review of the literature and personal results

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Die extrakorporale Stoßwellentherapie (ESWT) wird zunehmend zur Behandlung von Knochen- und Weichteilpathologien eingesetzt. Tierexperimentell wurde die osteogene Potenz der ESWT eindeutig nachgewiesen. Als molekulare Wirkmechanismen werden Zellmembranhyperpolarisierung und Radikalbildung diskutiert, gefolgt von Knochenvorläuferzellstimulation und Wachstumsfaktorexpression. Auch klinisch gibt es deutliche Hinweise auf eine Wirksamkeit der ESWT bei Pseudarthrosen. Es wurden Heilungsraten von 41–89% angegeben, wobei jedoch nur Studien vom Evidenzgrad IV ohne Kontrollgruppe vorliegen. In 601 eigenen prospektiv behandelten Patienten wurde eine Konsolidierungsrate von 83% erreicht. Bisher fehlt ein echter Wirksamkeitsnachweis. Bis dieser durch eine randomisierte und kontrollierte Studie erfolgt ist, muss die Anwendung der ESWT – auch aufgrund der geringen Risiken und Nebenwirkungen und der günstigen Kosten-Nutzen-Relation – auf Basis der besten verfügbaren Evidenz empfohlen werden. Die wissenschaftliche Datenlage zur ESWT ist deutlich fundierter als für die meisten anderen konservativen und operativen Therapieverfahren.

Abstract

Extracorporeal shock wave therapy (ESWT) is applied increasingly in the treatment of bone and soft tissue pathologies. Animal studies have yielded a broad scientific basis supporting the efficacy of ESWT in bone stimulation and also demonstrated its osteogenic potency. Discussion of molecular mechanisms of action has concentrated mainly on cell membrane hyperpolarization and radical production, followed by stimulation of osteoprogenitor cells and expression of growth factors. Clinical studies also indicate that ESWT is effective in the treatment of non-union and healing rates of 41–89% have been observed, but only on the basis of level IV evidence derived from uncontrolled studies. Among 601 patients prospectively treated for non-union, we achieved a consolidation rate of 83%. However, real evidence of its efficacy is still lacking. Until a randomized controlled study provides this ESWT must be recommended on the basis of the best available evidence – not least because of its low-level risks and side effects and positive cost-benefit ratio. More scientific data is available on ESWT than on most other conservative and operative treatment options for patients with bony non-union.

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  1. Abteilung für Unfall- und Wiederherstellungschirurgie, BG-Unfallklinik, Prof.-Küntscher-Straße 8, 82418 , Murnau, Deutschland

    H. Gollwitzer

  2. Abteilung für Orthopädie, BG-Unfallklinik, Murnau, Deutschland

    H. Brandner

  3. Klinik für Orthopädie und Sportorthopädie der Technischen Universität München, München, Deutschland

    T. Gloeck

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Gollwitzer, H., Brandner, H. & Gloeck, T. Extrakorporale Stoßwellentherapie bei Knochenheilungsstörungen. Trauma Berufskrankh 8, 142–152 (2006). https://doi.org/10.1007/s10039-006-1158-3

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