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Extra-corporeal shock wave therapy in tendon healing

This paper is available in a repository.
This paper is available in a repository.

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Abstract

Objectives: A rat model was designed to investigate the effect of low-energy extra-corporeal shock wave therapy (ESWT) (500 shock waves at 14 kV) on the healing potential of tendon injuries that may accompany fractures. Methods: The study included 48 rats for histopathologic (n=28) and biochemical (n=20) studies. The right Achilles tendons of all rats were cut and then sutured using the modified Kessler method. For histopathologic examination, ESWT was administered to the injured tendons under the guidance of fluoroscopy in 14 rats, while the remaining 14 rats remained as controls following sham operation. On the other hand, for biochemical studies 20 rats were divided into four equal groups where two groups received ESWT. On the postoperative third and ninth days, rats (one study with one control group, respectively) were sacrificed to measure the hydroxyproline levels. Results: Histopathologic examination in the second week showed highly cellular granulation tissue with more vas-cularization and massive inflammatory infiltration in ESWT-administered rats. There were many multinuclear giant cells. On the third week, the healing in the ESWT group was considerably better than that of the controls. In addition, the irregularity of the fibrils, intensity of lym-phocyte and histiocyte infiltration were less and there was a reduction in the number of giant cells. Hydroxyproline levels were found to be high in the study groups. Conclusion: Histopathological findings and increased hydroxyproline levels suggest that ESWT may facilitate tendon healing. Amaç: Düflük enerjili ekstrakorporeal flok dalgas› tedavi-sinin (ESWT) k›r›klara efllik edebilen tendon dokular›n-daki zedelenmelerin iyileflmesine etkileri s›çanlar üzerin-de araflt›r›ld›. Çal›flma plan›: Histopatolojik tetkik için 28 s›çan kulla-n›ld›. S›çanlar›n sa¤ aflil tendonlar› kesilerek modifiye Kessler yöntemi ile sütüre edildi. Aflil tendonlar›na skopi kontrolünde 14 kV gücünde 500 flok dalgas› uyguland›. Cerrahi onar›m yap›lan ve ESWT uygulanmayan 14 s›çan kontrol grubuna al›nd›. Biyokimya çal›flmas› için de 20 s›-çan beflerli dört gruba ayr›ld›. S›çanlar›n aflil tendonlar› kesilip sütüre edilerek birinci ve ikinci gruba 14 kV gü-cünde 500 flok dalgas› uyguland›. Birinci grup üçüncü günde ikinci grup dokuzuncu günde öldürülerek hidrok-siprolin düzeyleri ölçüldü. Üçüncü ve dördüncü grup kontrol grubunu oluflturdu. Sonuçlar: Histolojik incelemede, ESWT uygulanan grupta ikinci haftada granülasyon dokusu belirgin olarak daha selüler, daha vaskülarize ve yo¤un iltihabi infiltras-yon içermekteydi ve çok say›da multinükleer dev hücre vard›. Üçüncü haftada ESWT grubunda iyileflmenin kont-rol grubuna göre daha iyi ve düzenli oldu¤u, fibrillerde düzensizli¤in, yo¤un lenfosit ve histiosit infiltrasyonunun azald›¤› ve çok daha az say›da multinükleer dev hücre içerdi¤i görüldü. Deney grubunda hidroksiprolin düzeyle-rinin yükseldi¤i görüldü. Ç›kar›mlar: Deney grubundaki histopatolojik bulgular ve artm›fl hidroksiprolin düzeyleri ESWT uygulamas›n›n tendon iyileflmesini h›zland›rd›¤›n› gösterdi. Anahtar sözcükler: Aflil tendonu/yaralanma; kollajen/biyosen-tez; lithotripsi; s›çan; tendon yaralanmalar›/tedavi.