Addition of shock wave therapy to nail dynamization increases the chance of long-bone non-union healing

Background Long-bone non-unions after intramedullary nailing can be treated by nail dynamization or focused high-energy extracorporal shock wave therapy (fESWT). The objective of this study was to assess the effect of the combination therapy of nail dynamization and fESWT on long-bone non-unions. Materials and methods 49 patients with long-bone non-unions (femur and tibia) after nailing were treated with nail dynamization (group D, n = 15), fESWT (group S, n = 17) or nail dynamization in addition to fESWT (group DS, n = 17). Patients were followed up for 6 months retrospectively. Furthermore, age, sex, Non-Union Scoring System (NUSS) score, time intervals from primary and last surgery until intervention and smoking status were analysed for their correlations to bone union. Results Union rates were 60% for group D, 64.7% for group S and 88.2% for group DS, with a significant difference between group D and DS (p = 0.024). Successful treatment was correlated with high age (OR 1.131; 95% CI 1.009–1.268; p = 0.034), female gender (OR 0.009; 95% CI 0.000–0.89; p = 0.039), low NUSS score (OR 0.839; 95% CI 0.717–0.081; p = 0.028) and negative smoking status (OR 86.018; 95% CI 3.051–2425.038; p = 0.009). Conclusions Data from the present study indicate that the combination therapy of nail dynamization and fESWT leads to a higher union rate than dynamization or fESWT alone. Level of evidence Level 3.

Ultrasound-Guided Stellate Ganglion Block Combined with Extracorporeal Shock Wave Therapy on Postherpetic Neuralgia

Objectives. To evaluate the effect of ultrasound-guided stellate ganglion block combined with extracorporeal shock wave therapy (ESWT) on postherpetic neuralgia. Methods. Thirty-six patients with craniofacial postherpetic neuralgia, whose skin lesions were healed and natural course more than 1 month, were selected for the study and then randomly divided into 3 groups: the ultrasound-guided stellate ganglion block group (group A, n = 12), the extracorporeal shock wave therapy group (group B, n = 12), and the combined treatment group (group C, n = 12). Each group received basic drug treatment. The Visual Analogue Scale (VAS) and the Pain Disability Index (PDI) were used to evaluate the clinical effects of the 3 groups of patients before treatment, after twice treatments, after treatment for four times, and after treatment for six times. Results. The VAS and PDI were significantly declined in each group after the treatment ( P < 0.05 ), and the declination in group C was more obvious than the other two groups ( P < 0.05 ). After treatment for six times, the VAS score of group A, group B, and group C was 3.1 ± 1.2, 3.3 ± 1.3, and 1.9 ± 0.7, respectively. After treatment for six times, the PDI of group A, group B, and group C was 11.7 ± 8.4, 12.3 ± 7.8, and 4.6 ± 3.2, respectively. Three patients developed skin bruising and slight swelling, which were relieved by themselves. Conclusions. Ultrasound-guided stellate ganglion block combined with shock wave therapy could significantly improve the pain symptoms of patients with postherpetic neuralgia, which is a safe and effective treatment for postherpetic neuralgia.

Dynamics of the mandible bone tissue condition after the dental implantation and shockwave therapy

Background. The problem of restoration the integrity of the dentition after tooth loss remains one of the most problematic dental issues. Мodern dental technologies open a promising direction in its solution, in particular - the method of dental implantation. Objective. The aim of our work was to study the changes that occur in the bone tissue of the mandible after implantation of titanium foam and to determine the effect of shock wave therapy (SWT) on its structure restoration. Methods. The study was performed on 15 adult rabbits aged 6-7 months, weighing 2.5-3 kg. The animals from the experimental groups were implanted with titanium pin, 3 mm long. The pin was implanted under combined anesthesia bilaterally into the body of the mandible. One day after the operation, the animals received SWT 500 pulses with a frequency of 5 Hz and a maximum pressure at the wavefront of 1.2 Bar per implantation site using the device Storz Medical Master Plus MP 100. The animals were removed from the experiment on 15-th day, after which the mandible was disarticulated and radiographically performed. The obtained results were statistically significant. The differences at p<0.05 were considered significant. Results. The results showed that the bone tissue of the jaws during implantation undergoes traumatic injury, the results of which, two weeks after surgery on radiographs we can clearly see a violation of the bone tissue structure and a significant increase in its density. Using the SWT method, we obtained a positive dynamics of bone density after titanium pin implantation and slight Rh-changes in bone structure compared with normal. Conclusion. Аfter implantation with titanium pin the bone density of the rabbit lower jaw body is significantly reduced, X-ray shows the heterogeneity of bone structure, areas of sclerosis are expressed. Shock wave therapy helps to restore the quality of bone tissue, this is confirmed by the fact that the density indicators are close to the norm and X-ray shows some separate small areas of restructuring of bone tissue heterogeneity, mainly due to merging the pattern of the bone trabeculae of the bone cancellous part.

Extracorporeal Shock Wave Therapy Combined with Complex Decongestive Therapy in Patients with Breast Cancer-Related Lymphedema: A Systemic Review and Meta-Analysis

Breast cancer-related lymphedema (BCRL) is one of the most significant complications seen after surgery. Several studies demonstrated that extracorporeal shock wave therapy (ESWT), in addition to conventional complex decongestive therapy (CDT), had a positive effect on BCRL in various aspects. The systematic review and meta-analysis aim to explore the effectiveness of ESWT with or without CDT on BRCL patients. We searched PubMed, Embase, PEDro, Cochrane Library Databases, and Google Scholar for eligible articles and used PRISMA2020 for paper selection. Included studies were assessed by the PEDro score, Modified Jadad scale, STROBE assessment, and GRADE framework for the risk of bias evaluation. The primary outcomes were the volume of lymphedema and arm circumference. Secondary outcome measures were skin thickness, shoulder joint range of motion (ROM), and an impact on quality-of-life questionnaire. Studies were meta-analyzed with the mean difference (MD). Eight studies were included in the systemic review and four in the meta-analysis. In summary, we found that adjunctive ESWT may significantly improve the volume of lymphedema (MD = −76.44; 95% CI: −93.21, −59.68; p < 0.00001), skin thickness (MD = −1.65; 95% CI: −3.27, −0.02; p = 0.05), and shoulder ROM (MD = 7.03; 95% CI: 4.42, 9.64; p < 0.00001). The evidence level was very low upon GRADE appraisal. ESWT combined with CDT could significantly improve the volume of lymphedema, skin thickness, and shoulder ROM in patients with BCRL. There is not enough evidence to support the use of ESWT as a replacement for CDT. This study was registered with PROSPERO: CRD42021277110.

IMPROVING THE EFFECTIVENESS OF CONSERVATIVE TREATMENT OF ERECTILE DYSFUNCTION IN PATIENTS WITH PEYRONIE'S DISEASE USING THE "BTL 6000" SHOCK WAVE THERAPY APPARATUS AND THE "TIVORTIN" DRUG

Исследовалось эффективность комплексной терапии эректильной дисфункции у пациентов с болезнью Пейрони, с применением препарата "Тивортин", который является субстратом для NO-синтазы - фермента, который катализирует синтез оксида азота в эндотелиоцитах, тем самым вызывая стабилизацию скорости кровотока в артериях полового члена, а также способствует восстановлению морфологической структуры, измененной белочной оболочки; и аппарата ударно-волновой терапий "БТЛ 6000", предназначенный для дезинтеграции бляшек в стадии кальцификации, которая купирует болевые ощущения в 91% случаев и уменьшает деформацию полового члена в 31% случаев, путем ударно-волновой терапии, и улучшения микроциркуляции в кавернозных телах полового члена, тем самым повышает эффективность лечения эректильной дисфункции у больных с болезнью Пейрони. The effectiveness of complex therapy of erectile dysfunction in patients with Peyronie's disease was studied with the use of the drug "Tivortin", which is a substrate for NO-synthase, an enzyme that catalyzes the synthesis of nitric oxide in endotheliocytes, thereby causing stabilization of the blood flow rate in the arteries of the penis, and also contributes to the restoration of the morphological structure, the altered protein envelope; and the shock wave therapy apparatus "BTL 6000", designed for the disintegration of plaques in the calcification stage, which relieves pain in 91% of cases and reduces the deformation of the penis in 31% of cases, by shock wave therapy, and improves microcirculation in the cavernous bodies of the penis, thereby increasing the effectiveness of treatment of erectile dysfunction in patients with Peyronie's disease.

Effect of Botulinum Toxin Injection and Extracorporeal Shock Wave Therapy on Nerve Regeneration in Rats with Experimentally Induced Sciatic Nerve Injury

This study was designed to compare the roles of botulinum neurotoxin A (BoNT/A) and extracorporeal shock wave therapy (ESWT) in promoting the functional recovery and regeneration of injured peripheral nerves. A total of 45 six-week-old rats with sciatic nerve injury were randomly divided into two experimental groups and one control group. The experimental groups received a single session of intranerve BoNT/A or ESWT immediately after a nerve-crushing injury. The control group was not exposed to any treatment. Differentiation of Schwann cells and axonal sprouting were observed through immunofluorescence staining, ELISA, real-time PCR, and Western blot at 3, 6, and 10 weeks post-nerve injury. For clinical assessment, serial sciatic functional index analysis and electrophysiological studies were performed. A higher expression of GFAP and S100β was detected in injured nerves treated with BoNT/A or ESWT. The levels of GAP43, ATF3, and NF200 associated with axonal regeneration in the experimental groups were also significantly higher than in the control group. The motor functional improvement occurred after 7 weeks of clinical observation following BoNT/A and ESWT. Compared with the control group, the amplitude of the compound muscle action potential in the experimental groups was significantly higher from 6 to 10 weeks. Collectively, these findings indicate that BoNT/A and ESWT similarly induced the activation of Schwann cells with the axonal regeneration of and functional improvement in the injured nerve.

About the possibility of using physiotherapy in the practice of a surgeon. Literature review

Physiotherapy is a field of medicine based on the study and application of natural and artificially created natural factors on the human body. Physical factors can have both local and systemic effects on the patient’s body. In the postoperative period, physiotherapy helps to solve the most important problems, such as accelerating the processes of tissue regeneration and reducing the risk of infection in the area of surgery. Physical factors, activating fibroblasts, accelerate the synthesis of collagen fibers and increase the regenerative capacity of damaged tissues. In addition, due to bacteriostatic and bactericidal action, microorganisms are destroyed and the risk of postoperative infectious complications is reduced. Understanding the key features of all stages of the wound process allows you to rationally affect the wound. The use of an integrated approach based on drug therapy and the use of physiotherapy procedures significantly increases the effectiveness of treatment and helps the patient to return to their usual level of life as soon as possible. This article is a review of the literature on the most commonly used methods of physiotherapy in the postoperative period. Based on the analysis of publications, the article presents the features and principle of operation of such techniques as electrophoresis, phonophoresis, magnetotherapy, ozone therapy, electrical stimulation, cryotherapy, shock wave therapy, galvanization, darsonvalization, as well as therapy based on the effects of ultraviolet radiation, laser, ultrasound, microcurrents. Examples of physiotherapeutic procedures that should be used at various stages of the wound process, depending on the impact, are given. It is the use of various methods of influence in combination with each other that helps to achieve the maximum effect of treatment in the postoperative period.