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УЖМБС 2019, 4(6): 9–15
https://doi.org/10.26693/jmbs04.06.009
Medicine. Reviews

Modern Physical Methods of Stimulating the Bone Tissue Healing Processes

Vares Y. E., Shtybel N. V.
Abstract

Restoring the integrity and volume of bone loss has been a major medical problem for decades. Today, all methods focused on solving this problem can be divided into two groups: biological and physical. Among physical stimulation therapies are the following: low–intensity pulsating ultrasonic vibrations, extracorporeal shock–wave therapy, low–level laser therapy, electrical stimulation, and magnetotherapy. In preclinical trials, all of them have demonstrated potential ability to enhance the bone healing. Despite this, physical stimulation therapies in the context of bone healing are poorly described. The purpose of the study was to determine the feasibility of the clinical application of physical stimulation therapies to enhance bone healing, particularly in the maxillofacial area. Material and methods. This research was performed in the PubMed, Elsevier, and Google Scholar databases using a combination of keywords ‘bone healing’ and ‘electrical stimulation’, ‘low–intensity pulsating ultrasonic vibrations’, ‘extracorporeal shock–wave therapy’, ‘magnetotherapy’, ‘low–level laser therapy’ and their synonyms respectively. Publications had to meet the following inclusion criteria: systematic reviews, meta–analyzes and original studies focused on bone healing enhancement using physical stimulation therapies, published between 2010 and 2019. Exclusion criteria were: the impact on bone healing was secondary; clinical cases; physical methods were positioned as additional in treatment; studies were published by Ukrainian authors. Thus, 50 publications were selected that met these criteria. The results of the published studies were systematized and presented in the form of proposed literature review in a logical sequence: the essence of the method, its biological mechanism and the effectiveness of its application. Conclusion. The presence of a variety of physiotherapeutic methods used to enhance bone healing processes and the constant searching for ways to improve them for more effect indicates the urgent need to solve this challenge in the most optimal way. Contradictory results of clinical studies, insufficient number of controlled studies and, as a consequence, lack of evidence base, today call into question the feasibility of clinical application of such physical stimulation therapies as electrical stimulation, low–intensity pulsating ultrasonic vibrations, low–intensity laser therapy and magnetotherapy. A major disadvantage of the above methods is the large number of sessions required to achieve the effect. In the other hand, extracorporeal shock–wave therapy shows to be the only common physical stimulation therapy that has evidenced its effectiveness. In addition, the flexibility of using this method allows to extend the indications for its application, in particular in the maxillofacial area.

Keywords: bone healing, MFA, physiotherapy, extracorporeal shock–wave therapy

Full text: PDF (Ukr) 273K

References
  1. Stewart S, Bryant SJ, Ahn J, Hankenson KD. Bone Regeneration. Translational Regenerative Medicine, 2015: 313–33. https://doi.org/10.1016/b978–0–12–410396–2.00024–4
  2. Cook JJ, Summers NJ, Cook EA. Healing in the new millennium: bone stimulators: an overview of where we’ve been and where we may be heading. Clinics in podiatric medicine and surgery. 2015; 32(1): 45–59. https://www.ncbi.nlm.nih.gov/pubmed/25440417. https://doi.org/10.1016/j.cpm.2014.09.003
  3. Buza JA 3rd, Einhorn T. Bone healing in 2016. Clin Cases Miner Bone Metab. 2016 May–Aug; 13(2): 101–5. https://www.ncbi.nlm.nih.gov/pubmed/27920804. https://www.ncbi.nlm.nih.gov/pmc/articles/5119705. https://doi.org/10.11138/ccmbm/2016.13.2.101
  4. Massari L, Benazzo F, Falez F, Perugia D, Pietrogrande L, Setti S, et al. Biophysical stimulation of bone and cartilage: state of the art and future perspectives. Int Orthop. 2019; 43(3): 539–51. https://www.ncbi.nlm.nih.gov/pubmed/30645684. https://www.ncbi.nlm.nih.gov/pmc/articles/6399199. https://doi.org/10.1007/s00264–018–4274–3
  5. Schandelmaier S, Kaushal A, Lytvyn L, Heels–Ansdell D, Siemieniuk RA, Agoritsas T. Low intensity pulsed ultrasound for bone healing: systematic review of randomized controlled trials. BMJ. 2017; 22; 356: j656. https://www.ncbi.nlm.nih.gov/pubmed/28348110. https://www.ncbi.nlm.nih.gov/pmc/articles/5484179. https://doi.org/10.1136/bmj.j656
  6. Arimoto S, Hasegawa T, Takeda D, Tateishi C, Akashi M, Furudoi S, et al. Effect of low–intensity pulsed ultrasound after intraoral vertical ramus osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019; Mar15. pii: S2212–4403(19)30399–2. https://doi.org/10.1016/j.oooo.2019.03.009
  7. Leighton R, Watson JT, Giannoudis P, Papakostidis C, Harrison A, Steen RG. Healing of fracture nonunions treated with low–intensity pulsed ultrasound (LIPUS): A systematic review and meta–analysis. Injury. 2017Jul; 48(7): 1339–47. https://www.ncbi.nlm.nih.gov/pubmed/28532896. https://doi.org/10.1016/j.injury.2017.05.016
  8. Poolman RW, Agoritsas T, Siemieniuk RA, Harris IA, Schipper IB, Mollon B, et al. Low intensity pulsed ultrasound (LIPUS) for bone healing: a clinical practice guideline. BMJ. 2017 Feb 21; 356: j576. https://www.ncbi.nlm.nih.gov/pubmed/28228381. https://doi.org/10.1136/bmj.j576
  9. Lou S, Lv H, Li Z, Zhang L, Tang P. The effects of low–intensity pulsed ultrasound on fresh fracture: A meta–analysis. Medicine (Baltimore). 2017 Sep; 96(39): e8181. https://www.ncbi.nlm.nih.gov/pubmed/28953676. https://www.ncbi.nlm.nih.gov/pmc/articles/5626319. https://doi.org/10.1097/MD.0000000000008181
  10. Ebrahim S, Mollon B, Bance S, Busse JW, Bhandari M. Low–intensity pulsed ultrasonography versus electrical stimulation for fracture healing: a systematic review and network meta–analysis. Canadian journal of surgery. Journal canadien de chirurgie. 2014; 57(3): E105–18. https://www.ncbi.nlm.nih.gov/pubmed/24869616. https://www.ncbi.nlm.nih.gov/pmc/articles/4035413. https://doi.org/10.1503/cjs.010113
  11. Hannemann PF, Mommers EH, Schots JP, Brink PR, Poeze M. The effects of low–intensity pulsed ultrasound and pulsed electromagnetic fields bone growth stimulation in acute fractures: a systematic review and meta–analysis of randomized controlled trials. Arch Orthop Trauma Surg. 2014; 134: 1093–106. https://www.ncbi.nlm.nih.gov/pubmed/24895156. https://doi.org/10.1007/s00402–014–2014–8
  12. Mittermayr R, Antonic V, Hartinger J, Kaufmann H, Redl H, Téot L, et al. Extracorporeal shock wave therapy (ESWT) for wound healing: technology, mechanisms, and clinical efficacy. Wound Repair Regen. 2012 Jul–Aug; 20(4): 456–65. https://www.ncbi.nlm.nih.gov/pubmed/22642362. https://doi.org/10.1111/j.1524–475X.2012.00796.x
  13. Romeo P, Lavanga V, Pagani D, Sansone V. Extracorporeal shock wave therapy in musculoskeletal disorders: a review. Med Princ Pract. 2014; 23(1): 7–13. https://www.ncbi.nlm.nih.gov/pubmed/24217134. https://www.ncbi.nlm.nih.gov/pmc/articles/5586835. https://doi.org/10.1159/000355472
  14. Cheng JH, Wang CJ. Biological mechanism of shockwave in bone. Int J Surg. 2015 Dec; 24(PtB): 143–6. https://www.ncbi.nlm.nih.gov/pubmed/26118613. https://doi.org/10.1016/j.ijsu.2015.06.059
  15. Ioppolo F, Rompe JD, Furia JP, Cacchio A. Clinical application of shock wave therapy (SWT) in musculoskeletal disorders. Eur J Phys Rehabil Med. 2014 Apr; 50(2): 217–30. https://www.ncbi.nlm.nih.gov/pubmed/24667365
  16. Saggini R, Di Stefano A, Saggini A, Bellomo RG. Clinical application of shock wave therapy in musculoskeletal disorders: Рart І. J Biol Regul Homeost Agents. 2015 Jul–Sep; 29(3): 533–45. https://www.ncbi.nlm.nih.gov/pubmed/26403392
  17. Zhang X, Yan X, Wang C, Tang T, Chai Y. The dose–effect relationship in extracorporeal shock wave therapy: the optimal parameter for extracorporeal shock wave therapy. J Surg Res. 2014 Jan; 186(1): 484–92. https://www.ncbi.nlm.nih.gov/pubmed/24035231. https://doi.org/10.1016/j.jss.2013.08.013
  18. Hausdorf J, Sievers B, Schmitt–Sody M, Jansson V, Maier M, Mayer–Wagner S. Stimulation of bone growth factor synthesis in human osteoblasts and fibroblasts after extracorporeal shock wave application. Arch Orthop Trauma Surg. 2011 Mar; 131(3): 303–9. https://www.ncbi.nlm.nih.gov/pubmed/20730589. https://doi.org/10.1007/s00402–010–1166–4
  19. Yin TC, Wang CJ, Yang KD, Wang FS, Sun YC. Shockwaves enhance the osteogenetic gene expression in marrow stromal cells from hips with osteonecrosis. Chang Gung Med J. 2011 Jul–Aug; 34(4): 367–74. https://www.ncbi.nlm.nih.gov/pubmed/21880191
  20. Pfaff JA, Boelck B, Bloch W, Nentwig GH. Growth Factors in Bone Marrow Blood of the Mandible With Application of Extracorporeal Shock Wave Therapy. Implant Dent. 2016 Oct; 25(5): 606–12. https://www.ncbi.nlm.nih.gov/pubmed/27504532. https://doi.org/10.1097/ID.0000000000000452
  21. Huang HM, Li XL, Tu SQ, Chen XF, Lu CC, Jiang LH. Effects of Roughly Focused Extracorporeal Shock Waves Therapy on the Expressions of Bone Morphogenetic Protein‑2 and Osteoprotegerin in Osteoporotic Fracture in Rats. Chin Med J. 2016; 129(21): 2567‑75. https://www.ncbi.nlm.nih.gov/pubmed/27779163. https://www.ncbi.nlm.nih.gov/pmc/articles/5125335. https://doi.org/10.4103/0366–6999.192776
  22. Korakakis V, Whiteley R, Tzavara A, Malliaropoulos N. The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient–rated pain reduction. Br J Sports Med. 2018 Mar; 52(6): 387–407. https://www.ncbi.nlm.nih.gov/pubmed/28954794. https://doi.org/10.1136/bjsports–2016–097347
  23. Sansone V, Romeo P, Lavanga V. Extracorporeal Shock Wave Therapy Is Effective in the Treatment of Bone Marrow Edema of the Medial Compartment of the Knee: A Comparative Study. Med Princ Pract. 2017; 26(1): 23–29. https://www.ncbi.nlm.nih.gov/pubmed/27784022. https://www.ncbi.nlm.nih.gov/pmc/articles/5588340. https://doi.org/10.1159/000452836
  24. Schaden W, Mittermayr R, Haffner N, Smolen D, Gerdesmeyer L, Wang CJ. Extracorporeal shockwave therapy (ESWT) – First choice treatment of fracture non–unions? Int J Surg. 2015 Dec; 24(PtB): 179–83. https://www.ncbi.nlm.nih.gov/pubmed/26454164. https://doi.org/10.1016/j.ijsu.2015.10.003
  25. Kuo SJ, Su IC, Wang CJ, Ko JY. Extracorporeal shockwave therapy (ESWT) in the treatment of atrophic non–unions of femoral shaft fractures. Int J Surg. 2015; 24(PtB): 131–4. https://www.ncbi.nlm.nih.gov/pubmed/26166737. https://doi.org/10.1016/j.ijsu.2015.06.075
  26. Cai Z, Falkensammer F, Andrukhov O, Chen J, Mittermayr R, Rausch–Fan X. Effects of Shock Waves on Expression of IL–6, IL–8, MCP–1, and TNF–α Expression by Human Periodontal Ligament Fibroblasts: An In Vitro Study. Med Sci Monit. 2016 Mar 20; 22: 914–21. https://www.ncbi.nlm.nih.gov/pubmed/26994898. https://www.ncbi.nlm.nih.gov/pmc/articles/4805137. https://doi.org/10.12659/msm.897507
  27. Inanmaz ME, Uslu M, Isik C, Kaya E, Tas T, Bayram R. Extracorporeal shockwave increases the effectiveness of systemic antibiotic treatment in implant–related chronic osteomyelitis: experimental study in a rat model. J Orthop Res. 2014 Jun; 32(6): 752–6. https://www.ncbi.nlm.nih.gov/pubmed/24676969. https://doi.org/10.1002/jor.22604
  28. Kim YH, Bang JI, Son HJ, Kim Y, Kim JH, Bae H, et al. Protective effects of extracorporeal shockwave on rat chondrocytes and temporomandibular joint osteoarthritis; preclinical evaluation with in vivo99mTc–HDP SPECT and ex vivo micro–CT. Osteoarthritis Cartilage. 2019 Jul 16. pii: S1063–4584(19)31139–2. https://www.ncbi.nlm.nih.gov/pubmed/31323297. https://doi.org/10.1016/j.joca.2019.07.008
  29. Iryanov YM. Infuence of laser irradiation low intensity on reparative osteogenesis and angiogenesis under transosseous osteosynthesis. J Lasers Med Sci. 2016; 7(3): 134–8. https://doi.org/10.15171/jlms.2016.23
  30. Foulad A, Ghasri P, Garg R, Wong B. Stabilization of costal cartilage graft warping using infrared laser irirradiation in a porcine model. Arch Facial Plast Surg. 2010; 12(6): 405–11. https://www.ncbi.nlm.nih.gov/pubmed/21079118. https://www.ncbi.nlm.nih.gov/pmc/articles/4127305. https://doi.org/10.1001/archfacial.2010.93
  31. Wang YH, Wu JY, Kong SC, Chiang MH, Ho ML, Yeh ML, et al. Low power laser irradiation and human adipose–derived stem cell treatments promote bone regeneration in critical–sized calvarial defects in rats. PLoS One. 2018 Apr 5; 13(4): e0195337. https://www.ncbi.nlm.nih.gov/pubmed/29621288. https://www.ncbi.nlm.nih.gov/pmc/articles/5886537. https://doi.org/10.1371/journal.pone.0195337
  32. Bayat M, Virdi A, Rezaei F, Chien S. Comparison of the in vitro effects of low–level laser therapy and low–intensity pulsed ultrasound therapy on bony cells and stem cells. Prog Biophys Mol Biol. 2018 Mar; 133: 36–48. https://www.ncbi.nlm.nih.gov/pubmed/29126668. https://doi.org/10.1016/j.pbiomolbio.2017.11.001
  33. Weber JBB, Camilotti RS, Jasper J, Casagrande LCO, Maito FLDM. Effect of low–level laser therapy on tissue repair after dental extraction in rats administered zoledronic acid and dexamethasone. J Biomed Opt. 2017 May 1; 22(5): 58001. https://www.ncbi.nlm.nih.gov/pubmed/28500856. https://doi.org/10.1117/1.JBO.22.5.058001
  34. Baek WY, Byun IH, Yun IS, Kim JY, Roh TS, Lew DH, et al. The effect of light–emitting diode (590/830 nm)–based low–level laser therapy on posttraumatic edema of facial bone fracture patients. J Craniomaxillofac Surg. 2017 Nov; 45(11): 1875–7. https://www.ncbi.nlm.nih.gov/pubmed/28986000. https://doi.org/10.1016/j.jcms.2017.08.02
  35. Kahraman SA, Cetiner S, Strauss RA. The Effects of Transcutaneous and Intraoral Low–Level Laser Therapy After Extraction of Lower Third Molars: A Randomized Single Blind, Placebo Controlled Dual–Center Study. Photomedicine and Laser Surgery. 2016; 35(8): 401–7. https://www.ncbi.nlm.nih.gov/pubmed/28294694. https://doi.org/10.1089/pho.2016.4252
  36. Pouremadi N, Motaghi A, Safdari R, Zarean P, Rashad A, Zarean P, et al. Clinical Outcomes of Low–level Laser Therapy in Management of Advanced Implant Surgery Complications: A Comparative Clinical Study. J Contemp Dent Pract. 2019 Jan 1; 20(1): 78–82.
  37. Torkzaban P, Kasraei S, Torabi S, Farhadian M Low–level laser therapy with 940 nm diode laser on stability of dental implants: a randomized controlled clinical trial. Lasers Med Sci. 2018 Feb; 33(2): 287–93. https://www.ncbi.nlm.nih.gov/pubmed/29082462. https://doi.org/10.1007/s10103–017–2365–9
  38. Bayat M, Virdi A, Jalalifirouzkouhi R, Rezaei F. Comparison of effects of LLLT and LIPUS on fracture healing in animal models and patients: A systematic review. Prog Biophys Mol Biol. 2018 Jan; 132: 3–22. https://www.ncbi.nlm.nih.gov/pubmed/28688752. https://doi.org/10.1016/j.pbiomolbio.2017.07.004
  39. Bhavsar MB, Han Z, DeCoster T, Leppik L, Costa Oliveira KM, Barker JH. Electrical stimulation–based bone fracture treatment, if it works so well why do not more surgeons use it? Eur J Trauma Emerg Surg. 2019 Apr 6. https://www.ncbi.nlm.nih.gov/pubmed/30955053. https://doi.org/10.1007/s00068–019–01127–z
  40. Griffin M, Bayat A. Electrical stimulation in bone healing: critical analysis by evaluating levels of evidence. Eplasty. 2011; 11: e34. https://www.ncbi.nlm.nih.gov/pubmed/21847434. https://www.ncbi.nlm.nih.gov/pmc/articles/3145421
  41. Piazzolla A, Solarino G, Bizzoca D, Garofalo N, Dicuonzo F, Setti S. et al. Capacitive Coupling Electric Fields In The Treatment Of Vertebral Compression Fractures. Meat Sci. 2016 Jan; 111: 122–9. https://doi.org/10.1016/J.Meatsci.2015.09.003
  42. Aleem IS, Aleem I, Evaniew N, Busse JW, Yaszemski M, Agarwal A, et al. Efficacy of Electrical Stimulators for Bone Healing: A Meta–Analysis of Randomized Sham–Controlled Trials. Scientific Reports. 2016; 6: 31724. https://www.ncbi.nlm.nih.gov/pubmed/27539550. https://www.ncbi.nlm.nih.gov/pmc/articles/4990885. https://doi.org/10.1038/srep31724
  43. Wang Y, Qin QH. A theoretical study of bone remodelling under PEMF at cellular level. Comput Methods Biomech Biomed Engin. 2012; 15(8): 885–97. https://www.ncbi.nlm.nih.gov/pubmed/21604221. https://doi.org/10.1080/10255842.2011.565752
  44. Daish C, Blanchard R, Fox K, Pivonka P, Pirogova E. The Application of Pulsed Electromagnetic Fields (PEMFs) for Bone Fracture Repair: Past and Perspective Findings. Ann Biomed Eng. 2018 Apr; 46(4): 525–42. https://www.ncbi.nlm.nih.gov/pubmed/29356996. https://doi.org/10.1007/s10439–018–1982–1
  45. Naito Y, Yamada S, Jinno Y, Arai K, Galli S, Ichikawa T, et al. Bone–Forming Effect of a Static Magnetic Field in Rabbit Femurs. Int J Periodontics Restorative Dent. 2019 Mar/Apr; 39(2): 259–64. https://doi.org/10.11607/prd.3220
  46. Wang T, Yang L, Jiang J, Liu Y, Fan Z, Zhong C, et al. Pulsed electromagnetic fields: promising treatment for osteoporosis. Osteoporos Int. 2019 Feb; 30(2): 267–76. https://doi.org/10.1007/s00198–018–04822–6
  47. Zhou J, Wang JQ, Ge BF. Different electromagnetic field wave forms have different effects on proliferation, differentiation and mineralization of osteoblasts in vitro. Bioelectromagnetics. 2014; 35(1): 30–8. https://www.ncbi.nlm.nih.gov/pubmed/23775573. https://doi.org/10.1002/bem.21794
  48. Vincenzi F, Targa M, Corciulo C, Gessi S, Merighi S, Setti S, et al. Pulsed electromagnetic fields increased the anti–inflammatory effect of A₂A and A₃ adenosine receptors in human T/C–28a2 chondrocytes and hFOB 1.19 osteoblasts. PLoS One. 2013 May 31; 8(5): e65561. https://www.ncbi.nlm.nih.gov/pubmed/23741498. https://www.ncbi.nlm.nih.gov/pmc/articles/3669296. https://doi.org/10.1371/journal.pone.0065561
  49. Mohajerani H, Tabeie F, Vossoughi F, Jafari E, Assadi M. Effect of pulsed electromagnetic field on mandibular fracture healing: A randomized control trial, (RCT). J Stomatol Oral Maxillofac Surg. 2019 Mar 2. pii: S2468–7855(19)30067–9. https://www.ncbi.nlm.nih.gov/pubmed/30836195. https://doi.org/10.1016/j.jormas.2019.02.022
  50. de Girolamo L, Stanco D, Galliera E, Viganò M, Colombini A, Setti S, et al. Low frequency pulsed electromagnetic field affects proliferation, tissue–specific gene expression, and cytokines release of human tendon cells. Cell Biochem Biophys. 2013; 66: 697–708. https://www.ncbi.nlm.nih.gov/pubmed/23345006. https://doi.org/10.1007/s12013–013–9514–y
  51. Rosso F, Bonasia DE, Marmotti A, Cottino U, Rossi R. Mechanical Stimulation (Pulsed Electromagnetic Fields "PEMF" and Extracorporeal Shock Wave Therapy "ESWT") and Tendon Regeneration: A Possible Alternative. Front Aging Neurosci. 2015 Nov 9; 7: 211. https://www.ncbi.nlm.nih.gov/pubmed/26617513. https://www.ncbi.nlm.nih.gov/pmc/articles/4637423. https://doi.org/10.3389/fnagi.2015.00211