The effects of LIPUS on soft-tissue healing: a review of literature
LIPUS 对软组织愈合的影响：文献综述
Anil Khanna†, Richard T. C. Nelmes, Nikolaos Gougoulias, Nicola Maffulli*, and Jim Gray*
Department of Trauma and Orthopaedic Surgery, Keele University School of Medicine, Thornburrow Drive, Hartshill Stoke on Trent ST4 7QB Staffs, UK and Health Protection Agency, Virus Reference Department, London
基尔大学医学院创伤和整形外科系，英国，Hartshill Stoke 的 Thornburrow Drive，Trent ST4 7QB 员工，英国卫生署，病毒参考部门，伦敦
Introduction: Ultrasound is widely used for imaging purposes and as an adjunct to physiotherapy. Low-intensity pulsed ultrasound (LIPUS), having removed the thermal component found at higher intensities, is used to improve bone healing. However, its potential role in soft-tissue healing is still under investigation.
简介：超声被广泛用于成像目的以及作为物理治疗的辅助手段。低强度脉冲超声 （LIPUS）去除了较高强度的热成分，可用于改善骨愈合。但是，其在软组织愈合 中的潜在作用仍在研究中。
Material and methods: We searched on Medline using the keywords: lowintensity pulsed ultrasound, LIPUS and LIPUS and soft-tissue healing. Thirty-two suitable articles were identifified.
材料和方法：我们在 Medline 上搜索了以下关键词：低强度脉冲超声，LIPUS 和 LIPUS 以及软组织愈合，确定了三十二篇合适的文章。
Results: Research, mainly pre-clinical, so far has shown encouraging result, with LIPUS able to promote healing in various soft tissues such as cartilage, intervertebral disc, etc. The effect on the bone-tendon junction, however, is primarily on bone. The role of LIPUS in treating tendinopathies is questionable. Adequately powered human studies with standardisation of intensities and dosages of LIPUS for each target tissue are needed.
结果：到目前为止，主要是临床前研究已经显示出令人鼓舞的结果，LIPUS 能够促 进各种软组织（例如软骨，椎间盘等）的愈合。然而，对骨-腱连接的影响主要是对骨的影响。LIPUS 在治疗肌腱病中的作用值得怀疑。 需要对每个目标组织的 LIPUS 强度和剂量进行标准化的充分动力的人体研究。
Keywords: low intensity pulsed ultrasound/soft tissue healing
关键词：低强度脉冲超声/软组织愈合
Introduction 简介
Ultrasound is widely used for imaging purposes and as an adjunct to physiotherapy. Low-intensity pulsed ultrasound (LIPUS), having removed the thermal component found at higher intensities, is used to improve bone healing. However, its potential role in soft-tissue healing is still under investigation.
超声广泛用于成像目的和作为物理治疗的辅助手段。低强度 脉冲超声（LIPUS）去除了较高强度的热成分，可用于改善骨 愈合。但是，其在软组织愈合中的潜在作用仍在研究中。
Ultrasound is widely used as an imaging modality1 at intensities of 0.05–0.5 W/cm2 . At intensities of 0.2–100 W/cm2 , the surgical and therapeutic benefits of ultrasound have also been explored.1 In orthopaedic practice, intensities of 0.1 W/cm2 have been shown to improve bone healing.1,2
超声被广泛用作强度为 1.5 – 0.5 W/cm2.在强度为 0.2 – 100 W / cm2的情况下，还探 讨了超声的手术和治疗益处。在1英寸骨科实践表明，0.1 W/cm2的强度促进骨骼愈合。
For the management of ligament, muscle and tendon injuries high-intensity (.0.1 W/cm2) continuous ultrasound has been used therapeutically for .50 years.3,4 However, studies on the effects of therapeutic ultrasound in muscle and joint healing have been contradictory. Generally, there seem to be insufficient evidence to support the clinical use of ultrasound at these doses.5 Following the success of ultrasonic waves applied at low intensity (0.1 W/cm2 ), in a constant frequency (1–1.5 MHz) and in a pulsatile manner (LIPUS) on osteoid tissue, the potential benefit in soft-tissue healing is being investigated.6–9
为了处理韧带，肌肉和腱损伤，使用了高强度（.0.1 W / cm2）连续超声在治疗上已有50年的历史。 然而，关于治疗性超声波对肌 肉和关节愈合的影响的研究却是矛盾的。通常，似乎没有足够 的证据支持以这些剂量进行超声的临床使用。在以恒定频率 （ 0.1 W / cm2）施加低强度的超声波成功之后（ 1 – 1.5 MHz）并以脉冲方式（LIPUS）对类骨组织进行研究，正在 研究其在软组织愈合中的潜在益处。
We thus review the currently available literature on the role of LIPUS in soft-tissue healing, investigating its effect both at cellular and tissue level, and summarising the evidence available so far.
因此，我们回顾了有关 LIPUS 在软组织愈合中的作用的现有文献，研究其在细胞和组 织上的作用 级别，并总结到目前为止可用的证据。
Methods 方法
For the purposes of this review, scientific articles were identified on Medline using the primary keywords: low-intensity pulsed ultrasound, LIPUS, tendon, soft tissue and healing. We also used the keywords: LIPUS and tendon, LIPUS and tendon healing, LIPUS and soft tissue, LIPUS and soft-tissue healing, low-intensity pulsed ultrasound and tendon, low-intensity pulsed ultrasound and tendon healing, low-intensity pulsed ultrasound and soft tissue and low-intensity pulsed ultrasound and soft-tissue healing. Additional publications were identified searching manually the references sections of each of the articles identified using the above-mentioned keywords.
为了进行此综述，在 Medline 上使用以下主要关键词识别了 科学文章：低强度脉冲超声，LIPUS，肌腱，软组织和愈合。 我们还使用了以下关键字：LIPUS 和肌腱，LIPUS 和肌腱愈合， LIPUS 和软组织，LIPUS 和软组织愈合，低强度脉冲超声和肌 腱，低强度脉冲超声和肌腱愈合，低强度脉冲超声和软组织 低强度脉冲超声和软组织愈合。手动搜索使用上述关键字标 识的每篇文章的参考部分，从而确定其他出版物。
Exclusion criteria: Publications in language other than English, articles not discussing the subject matter, studies where low-intensity ultrasound was used continuously and studies where intensity of ultrasound was .0.1 W/cm2 were excluded. Also, studies where primary action of LIPUS was on osteoid tissue [e.g. bone-tendon junction (BTJ)] were excluded to specifically focus on the effect of LIPUS in soft-tissue healing.
排除标准：除英语以外的其他语言的出版物，未讨论主题的文章， 连续使用低强度超声的研究以及超声强度为.0.1 W / cm2 的研究被 排除。此外，排除了 LIPUS 对类骨组织起主要作用的研究（例如， 骨腱连接（BTJ）），以专门关注 LIPUS 在软组织愈合中的作用。
We thus identified 32 articles fulfilling the inclusion criteria.
因此，我们确定了 32 篇符合纳入标准的文章。
Biophysics of ultrasound therapy 超声疗法的生物物理学
Ultrasound, an acoustic radiation, is a form of mechanical energy that can be transmitted into the body as a high-frequency pressure wave. The acoustic energy generated from ultrasound is produced from a piezoelectric crystal within a transducer, which emits high-frequency acoustic pressure waves (1–12 MHz) transmitted through body tissues by molecular vibrations and collisions.10 The micromechanical strains produced by these pressure waves in body tissues can result in biochemical events at the cellular level.11 This ultrasonic energy can be divided into two categories: high-intensity ultrasound with peak intensities from 5000 to 15 000 W/cm2 , and low-intensity ultrasound with intensities of 0.5–3000 mW/cm2 . This low-intensity ultrasound is used in physical therapy, whereas the high intensities are used in treating tumours by selectively heating tissue and causing necrosis.
超声波是一种声辐射，是一种机械能，可以作为高频压力波 传输到体内。超声波产生的声能是由换能器中的压电晶体产 生的，该换能器通过分子振动和碰撞发出通过身体组织传输 的高频声压波（1 – 12 MHz）。这些压力产生的微机械应 变人体组织中的超声波可导致细胞水平的生化事件。分为两类：峰值强度为 5000 至 15000 W / cm2 的高强度超声 和强度为 0.5 – 3000 mW / cm2 的低强度超声。这种低强度 超声用于物理治疗，而高强度超声通过选择性地加热组织并 引起坏死来治疗肿瘤。