title: The effects of shockwave on bone healing and systemic concentrations of nitric oxide (NO), TGF-beta1, VEGF and BMP-2 in long bone non-unions.
abstract: This study investigated the effects of extracorporeal shockwave treatment (ESWT) on bone healing and the systemic concentrations of nitric oxide (NO), TGF-beta1, VEGF and BMP-2 in long bone non-unions. Forty-two patients with 42 established non-unions of the femur and tibia were enrolled in this study. Each long bone non-union was treated with 6000 impulses of shockwave at 28 kV in a single session. Ten milliliters of peripheral blood were obtained for measurements of serum NO level and osteogenic growth factors including TGF-beta1, VEGF and BMP-2; serum levels of calcium, alkaline phosphatase, calcitonin and parathyroid hormone before treatment and at 1 day, 1, 3 and 6 months after treatment. The evaluations for bone healing included clinical assessments and serial radiographic examinations. At 6 months, bony union was radiographically confirmed in 78.6%, and persistent non-union in 21.4%. Patients with bony union showed significantly higher serum NO level, TGF-beta1, VEGF and BMP-2 at 1 month after treatment as compared to patients with persistent non-union. Shockwave-promoted bone healing was associated with significant increases in serum NO level and osteogenic growth factors. The elevations of systemic concentration of NO level and the osteogenic factors may reflect a local stimulation of shockwave in bone healing in long bone non-unions.
authors.affiliation: Department of Orthopedic Surgery, Chang Gung University College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Taiwan.
authors.forename: Ching-Jen
authors.initials: CJ
authors.lastname: Wang
authors.forename: Kunder D
authors.initials: KD
authors.lastname: Yang
authors.forename: Jih-Yang
authors.initials: JY
authors.lastname: Ko
authors.forename: Chung-Cheng
authors.initials: CC
authors.lastname: Huang
authors.forename: Hsuan-Ying
authors.initials: HY
authors.lastname: Huang
authors.forename: Feng-Sheng
authors.initials: FS
authors.lastname: Wang
mesh_terms: D000328:Adult; D055396:Bone Morphogenetic Protein 2 / Q000378:metabolism*; D001842:Bone and Bones / Q000378:metabolism / Q000528:radiation effects*; D005264:Femoral Fractures / Q000378:metabolism / Q000532:radiotherapy; D017102:Fracture Healing / Q000502:physiology*; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism*; D013978:Tibial Fractures / Q000378:metabolism / Q000532:radiotherapy; D053773:Transforming Growth Factor beta1 / Q000378:metabolism*; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism*
chemical_list: D055396:Bone Morphogenetic Protein 2; D053773:Transforming Growth Factor beta1; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D009569:Nitric Oxide