Abstract
BackgroundLow-intensity pulsed ultrasound (LIPUS) has been widely accepted in promoting the fracture healing process. However, there have been limited clinical trials focused on the efficacy of LIPUS during distraction osteogenesis (DO) by the technique of lengthening over the nail procedure. The purpose of the current study was to evaluate the efficacy of LIPUS during DO.MethodsWe retrospectively evaluated 30 patients (60 segments) who underwent simultaneous bilateral tibial lengthening over the nail. The patients were grouped into the LIPUS group and the control group based on LIPUS stimulation. The two patient groups were compared for demographic data (sex, age at operation, preoperative height, BMI, and smoking history), qualitative assessments of the callus (callus shape and type), external fixation index, and four cortical healing indexes.ResultsFifteen patients (30 segments) were classified as the LIPUS group, and another 15 patients (30 segments) were classified as the control group. No significant differences were found in the assessed demographic data between the groups. LIPUS stimulated a more cylindrical, more homogenous, and denser type of callus formation at the end of the distraction phase. The two groups exhibited equivalent outcomes in terms of external fixation index (p = 0.579). However, significant differences were found in healing indexes of the anterior and medial cortices (p < 0.001 and p = 0.002, respectively). The healing indexes of those cortices in the LIPUS group (mean of 36.6 days/cm and 32.5 days/cm, respectively) reflected their significantly faster healing compared to the control group (mean HI of 57.5 days/cm and 44.2 days/cm, respectively). There were no LIPUS-related complications.ConclusionsLIPUS is a noninvasive and effective adjuvant therapy to enhance callus maturation during DO. It enhances callus consolidation and may have a positive effect on the appropriate callus shape and type.
Highlights
Low-intensity pulsed ultrasound (LIPUS) has been widely accepted in promoting the fracture healing process
There have been several in vivo studies evaluating the efficacy of LIPUS on callus maturation during distraction osteogenesis (DO) [18,19,20,21,22,23], there have been limited clinical trials focused on the efficacy of LIPUS during DO [24,25,26]
The Healing index (HI) of those cortices in the LIPUS group reflected their significantly faster healing compared to the control group
Summary
Low-intensity pulsed ultrasound (LIPUS) has been widely accepted in promoting the fracture healing process. There have been limited clinical trials focused on the efficacy of LIPUS during distraction osteogenesis (DO) by the technique of lengthening over the nail procedure. The consolidation of regenerated callus during DO can be affected by various factors including host factors (age and underlying disease), local factors To reduce these complications and burdens on the patient, several techniques have been employed to enhance callus maturation. Low-intensity pulsed ultrasound (LIPUS), which has been widely accepted for promoting the fracture healing process [13,14,15,16,17], may be another option for adjuvant therapy to accelerate consolidation of the regenerated callus. This clinical investigation was performed to evaluate the efficacy of LIPUS during DO under the hypothesis that LIPUS would enhance callus maturation
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