Analysis of Related Factors Influencing the Efficacy of Extracorporeal Shockwave in the Treatment of Fracture Nonunion: A Prospective Study in Shanghai, China

Abstract

Background: Extracorporeal shockwave is recommended as the first choice for the treatment of fracture nonunion, However, some patients with fracture nonunion have poor response to extracorporeal shockwave therapy. The present study aimed to investigate related factors which may affect the clinical efficacy of extracorporeal shockwave on fracture nonunion. Methods: Ultrasound examination was applied to observe nonunion gap, local blood supply, hardness of callus and hematoma formation before and after extracorporeal shockwave therapy. The patient's condition was followed up for 12 months after extracorporeal shockwave therapy. Four correlations and regression analysis methods were applied to analyze the factors which were correlated the clinical efficacy of extracorporeal shockwave. Receiver-operating characteristic analysis revealed that the cut-off of the fracture nonunion gap was 4.200 mm and the cut-off of the hardness of callus/impulse energy was 2.555. Single factor linear correlation analysis, multi-factor linear regression analysis, single-factor logistic regression analysis were applied. Results: The four ultrasound signs were significantly correlated with extracorporeal shockwave therapy: nonunion gap (r = -0.723; OR = 3.074), local blood supply (r = 0.611; OR = 0.191), hardness of callus/impulse energy (r = -0.510; OR = 19.942), and hematoma formation (r = 0.722; OR = 0.015). Conclusions: Nonunion gap larger than 4.200 mm and hardness of callus/impulse energy larger than 2.555 are risk factors of extracorporeal shockwave therapy outcome, and good local blood supply and effective hematoma formation induced by extracorporeal shockwave therapy are protective factors. By analyzing the related factors of extracorporeal shockwave therapy on fracture nonunion, clinicians may screen out the patients with fracture nonunion who are not suitable for extracorporeal shockwave therapy, and reduce the risk of fracture nonunion.

Quantifying Road Transport Resilience to Emergencies: Evidence from China

“…In the two waves of the epidemic, the improvement of the resilience of road transportation in Hunan Province has brought enlightenment. In particular, precise and differentiated epidemic prevention and control measures are recommended, which can be confirmed and supported by other relevant studies [59]. On the one hand, scientific tracking, rapid traceability, and directional closed management are needed [64].…”

“…The finding that there is regional heterogeneity [11,12] in road transport resilience under the same external disturbance is consistent with the results of previous research. This result may be related to the differences in epidemic prevention and control measures, travel willingness, and travel demand of residents, which have been analyzed in existing studies [58][59][60]. Specifically, the resilience of road transport in Beijing and Hunan is higher than that in Shanghai and Xinjiang.…”

“…The heterogeneity of road transport resilience in different provinces/cities during the epidemic has brought enlightenment. Specifically, it is recommended to accurately "close the city" [59] and fully mobilize social forces [65]. On the one hand, it is necessary to seal and control accurately to avoid unnecessary isolation and blockade.…”