The Effect Of Metaphyseal Shock Wave Application On The Longitudinal Growth Of Femur: A Rat Model

Öz

There is an idea that extracorporeal shock wave therapy (ESWT) induces increased blood flow and stimulates the physiological process of bone growth on physis. Also, recent studies have shown that ESWT promotes growth plate chondrogenesis and longitudinal bone growth in rabbits. The aim of the study was to investigate the longitudinal growth of femur bone on a rat model after ESWT application on distal metaphyseal region. The present study used the Multimed 2001- ELMED lithotripter designed for urinary stone treatment on thirty immature rats with unclosed physes. Rats were divided into 3 groups consisting of 10 rats in each group. The age of the rats was ranged from 4 to 6 weeks. To the first group, single dose 0.3 mJ/mm2, 1000 shock wave; to the second group single dose 0.7 mJ/mm2, 1000 shock wave; and to the third group 3 doses (1 session weekly period) 0.3mJ/mm2, 1000 shock wave were applied on the right distal femur metaphyseal region under ketamine anesthesia. The left femurs of the same animals were accepted as controls. Radiological measurements were made digitally with the NetCAD 4.0 engineering program. Metaphyseal shock wave application did not affect the longitudinal bone growth in the early stage (p>0.05 in all 3 groups). These results indicate that ESWT applied to the distal metaphysis of the femur had no effect on early longitudinal bone growth based on radiological measurements in rats. Still there is need to further histologic and radiologic studies in this area

Anahtar Kelimeler

• Metaphysis
• shock wave therapy
• longitudinal bone growth
• rat model.

Metafizyal Şok Dalga Uygulamasının Femurun Longitudinal Büyümesi Üzerindeki Etkisi: Rat Modeli

Öz

Ekstrakorporeal şok dalga tedavisinin (ESWT) artan kan akışını indüklediği ve fizyolojik kemik büyüme sürecini uyardığı düşüncesi oluşmuştur. Ayrıca, son çalışmalar ESWT'nin büyüme plağında kondrogenezi ve tavşanlarda longitudinal kemik büyümesini arttırdığını göstermiştir. Bu çalışmanın amacı, rat modelinde distal metafizyal bölgeye ESWT uygulaması sonrası femur kemiğinin longitudinal büyümesini araştırmaktır. Bu çalışmada, fizisleri kapanmamış otuz immatür rat için üriner taş tedavisi için tasarlanmış Multimed 2001- ELMED litotriptör cihazı kullanıldı. Ratlar her grupta 10’ar denek olmak üzere 3 gruba ayrıldı. Ratların yaşı 4 ile 6 hafta arasında değişmekteydi. Birinci gruba tek doz 0.3 mJ/mm2, 1000 şok dalgası; ikinci gruba tek doz 0.7 mJ/mm2, 1000 şok dalgası; üçüncü gruba ise 3 doz (haftalık periyotlarla 1 seans) 0.3 mJ/mm2, 1000 şok dalgası ketamin anestezisi altında sağ distal femur metafizyal bölgesine uygulandı. Ratların sol femurları kontrol olarak kabul edildi. Radyolojik ölçümler NetCAD 4.0 mühendislik programı ile dijital olarak yapıldı. Metafizyal şok dalgası uygulaması erken dönemde longitudinal kemik büyümesini etkilemedi (3 grupta da p>0.05). Bu sonuçlar, femurun distal metafizine uygulanan ESWT'nin ratlarda radyolojik ölçümlere dayalı olarak erken dönemde longitudinal kemik büyümesi üzerinde etkisi olmadığını göstermektedir. Yine de bu alanda daha ileri histolojik ve radyolojik çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Anahtar kelimeler: Metafiz
• şok dalga tedavisi
• longitudinal kemik büyümesi
• rat modeli

Kaynakça

1. 1. Stoller M. General Urology. 12th eds; Prentice Hall International inc. pp.299-307. 1990.
2. 2. Chaussy C, Brendel W and Schmieid E. Extracorporally induced destruction of kidney stones by shock wave. Lancet 1980; (2) 12-65.
3. 3. Haupt G, Haupt A, Ekkernkamp A, Gerety B and Chvapıl M. Influence of shock wave on fractures healing. Urology. 1992;39:529-532.
4. 4. Forriol F, Solchaga L, Mreno JL and Canadel J. The effect of shock waves on mature and healing cortical bone. Int Orthop 1994;(18) 325-329.
5. 5. Haupt G. Review article. Use of extracorporal shock waves in the treatment of pseudoarthrosis, tendinopathy and other orthopaedic disease. J Urol 1997;158, 4-11.
6. 6. Dahmen GP, Franke R, Gonchars V, Poppe K, Lendrodt St, Lichtenberger S, Jost S, Montigel J, Nam VC and Dahmen G. Dıe bahandlung knohennaher Weıhteilschmerrzen mit extracorporaler Stosswellentherepie (ESWT) indikation, technik und bisherige Ergebnisse, edited by Ch. Chaussy, F. Eisenberger, D. Jocham, D. Wilbert, Die stoswelle – Forschung und Klinik. Tübingen, Attempo Verlag. pp.174-186. 1995.
7. 7. Yel M, Kapıcıoglu S. Is a new method Shock Waves (ESWL) in Orthopaedic Artropl. Artros Surg 1996;12, 78-80.
8. 8. Sukul DMKSK, Johannes EJ, Pierik EG, Van Eijck GJ. and Kirstelijn MJE. The effect of high energy shock waves focused on cortical bone: an in vitro study. J Surg Res 1993; 54, 46-51.

9. 9. Schleberger R. First clinical applications of shock waves in orthopaedics.in: Meeting of Austrian Society of Bone and mineral Research II. Vienna. 1996.
10. 10. Tosun N, Yücel M and Brenner H. Orthopaedic usage of Extracorporeal Shock wave lithotripsy (ESWL). Acta Orthop Traum Turc 1997; (31)339-342.
11. 11. Valchanou VD and Michailov P. High energy shock waves in the treatment of delayed and nonunion fractures. Int Orthop (SICOT), 1991;(15) 181-184.
12. 12. Bürger RA, Withzsch U, Haist J, Karnovsky V, Ahlers J and Hohenfellner R. Extracorporeal shock wave therapy of pseudo-arthrosis. Urology 1992;(147) 48 ff
13. 13. Graff J, Richter K, Pastor J. Effects of high energy shock waves on bony tissue. Urol Res 1988; 16, 252 ff.
14. 14. Gündes H. The effects of Shock Waves with High Energy on immature cortical bone and periost ( in vivo study), (Postgraduate study), Orthopaedic Department in The School of Medicine, Marmara University of Istanbul, Turkey 1994.
15. 15. Yaemann LD, Jerome CH P, Mc Cullough DL. Effect of shock waves on the structure and growth of the immature rat epiphysis. J Urol 1989; (141) 670-674.
16. 16. van der Jagt OP, Waarsing JH, Kops N, Schaden W, Jahr H, Verhaar JA, Weinans H. Unfocused extracorporeal shock waves induce anabolic effects in osteoporotic rats. J Orthop Res. 2013 May;31(5):768-75.
17. 17. McClure SR, Van Sickle D, White MR. Effects of extracorporeal shock wave therapy on bone. Vet Surg. 2004 Jan-Feb;33(1):40-8.
18. 18. Fleis JL (1981) Statistical methods for rates and proportions. John Wiley&Sons, New York. Pp.250-255.
19. 19. Farese A, Pozzi M, Patussi V, Ballerini G, Arena U, Surrenti C. Piezzoelectric extracorporeal shock wave litotripsy in 93 patients with gallstones. J Gastroenterol 1993 (25) 251-255.
20. 20. Ilharreborde B, Raquillet C, Morel E, Fitoussi F, Bensahel H, Penneçot GF, Mazda K. Long-term prognosis of Salter-Harris type 2 injuries of the distal femoral physis. J Pediatr Orthop B. 2006 Nov;15(6):433-8.
21. 21. Hasler CC, Krieg AH. Current concepts of leg lengthening. J Child Orthop. 2012 Jun;6(2):89-104.
22. 22. Schelberger R., Senge T. Non-invasive treatment of long bone pseudarthrosis by shock waves (ESWL). Arch Orthop Traum Surg 1992;(111) 224-227.
23. 23. Lv F, Li Z, Jing Y, Sun L, Li Z, Duan H. The effects and underlying mechanism of extracorporeal shockwave therapy on fracture healing. Front Endocrinol (Lausanne). 2023 May 24;14:1188297.
24. 24. Catalano MG, Marano F, Rinella L, de Girolamo L, Bosco O, Fortunati N, Berta L, Frairia R. Extracorporeal shockwaves (ESWs) enhance the osteogenic medium-induced differentiation of adipose-derived stem cells into osteoblast-like cells. J Tissue Eng Regen Med. 2017 Feb;11(2):390-399.
25. 25. Ramesh S, Zaman F, Sävendahl L, Madhuri V. Radial shockwave treatment promotes chondrogenesis in human growth plate and longitudinal bone growth in rabbits. Bone. 2022 Jan;154:116186.
26. 26. Giusti G, Penteado FT, Santos JB, Alves MT, Faloppa F. Effect of shock waves upon the growth plate in rabbits. Acta Ortopédica Brasileira. 2005;13:31-4.
27. 27. Wang CJ, Wang FS, Yang KD. Biological effects of extracorporeal shockwave in bone healing: a study in rabbits. Arch Orthop Trauma Surg. 2008 Aug;128(8):879-84.
28. 28. Van der Jagt OP, Piscaer TM, Schaden W, Li J, Kops N, Jahr H, Van der Linden JC, Waarsing JH, Verhaar JA, de Jong M, Weinans H. Unfocused extracorporeal shock waves induce anabolic effects in rat bone. JBJS. 2011 Jan 5;93(1):38-48
29. 29. Hsu SL, Chou WY, Hsu CC, Ko JY, Jhan SW, Wang CJ, Lee MS, Hsu TC, Cheng JH. Shockwave Therapy Modulates the Expression of BMP2 for Prevention of Bone and Cartilage Loss in the Lower Limbs of Postmenopausal Osteoporosis Rat Model. Biomedicines. 2020 Dec 15;8(12):614.
30. 30. Shi L, Gao F, Sun W, Wang B, Guo W, Cheng L, Li Z, Wang W. Short-term effects of extracorporeal shock wave therapy on bone mineral density in postmenopausal osteoporotic patients. Osteoporosis International. 2017 Oct;28:2945-53