Klinische Studie zur Behandlung häufiger Erkrankungen des Bewegungsappartes des Pferdes mittels fokussierter extrakorporaler Stoßwellentherapie (ESWT)

Urhahne, Petra Focussed Extracorporeal Shock Wave Therapy (ESWT)
for treatment of common diseases in equine orthopaedics In the
present study the results of focussed extracorporeal shock wave
therapy on 65 treated horses with the following four diseases are
represented: navicular disease, chronic proximal suspensory
ligament desmitis, chronic proximal sesamoiditis and bone spavin.
Only horses which had shown lameness over a period of at least two
months were included in the study. The focus of this study was to
assess the influence of focussed extracorporeal shock wave therapy
on the clinical symptoms and on radiological und ultrasonographic
findings as well as to determine if treatment could restore full
athletic function during the time of observation. The focussed
shock waves were produced using a conventional veterinary shock
wave generator based on the electrohydraulic principle. Treatments
were conducted two to four times in intervals of three to four
weeks. For each treatment of horses with navicular disease 2000
impulses were applied, for the treatment of the other diseases 1500
impulses were applied with a maximum energy flux density of 0,15
mJ/mm². No other treatments were allowed during the time of
observation. After each shock wave treatment the horses had two
days of rest before a controlled exercise program was started.
Clinical examinations to document treatment success were conducted
at least four times. The first examination was conducted shortly
after the first shock wave application (until two moths later), the
second one three months after the beginning of treatment, the next
one half a year after commencement of treatment, and the last
clinical examination was carried out up to thirty months after the
first treatment. Within the framework of these clinical
examinations x-rays and ultrasound pictures were taken too. A
significant initial improvement of lameness was observed in all
four orthopaedic diseases, shown by an improvement in the lameness
of at minimum one lameness-degree in 78 % to 100 % of the treated
horses in the first two months after therapy started. After three
months 50 % (six horses) of the twelve horses with navicular
disease, 77 % (26 horses) of the 34 patients with chronic proximal
suspensory ligament desmitis, 70 % (seven horses) of the ten horses
with chronic proximal sesamoiditis and 44 % (four horses) of the
nine spavin diagnosed horses were free of lameness. The examination
of the patients half a year after the first treatment 33 % (four
horses) of the navicular disease horses, 79 % (27 horses) with
proximal suspensory ligament desmitis, 70 % (seven horses) with
sesamoiditis and 33 % of the spavin diagnosed horses were free of
lameness. Six to thirty months after the first ESWT-treatment 42 %
(five horses) of the horses with navicular disease, 79 % of the
patients with chronic proximal suspensory ligament desmitis, 60 %
(six horses) of the horses with chronic proximal sesamoiditis and
33 % (three horses) of the spavin-diagnosed horses were still
sound. No relevant side effects were noticed in treated horses. The
sonographic examination of the thirty-four horses with chronic
proximal suspensory ligament desmitis showed a complete restoration
in function in 77 % of all treated patients after a maximum of six
months after begin of ESWT. When pre- and post-treatment x-rays
were compared to one another no significant changes were seen. The
results of this study were compared to the results of other,
previously conducted studies in which shock wave therapy was
utilised in horses suffering from the same orthopaedic diseases as
occurred in this study, as well as to results of conventional
treatments of the named diseases. Although the studies yielded
varying results, all studies were able to show a significant
improvement of lameness after shock wave therapy. The results of
the present study demonstrate that focussed extracorporeal shock
wave therapy seems to be an effective treatment in the four
described chronic orthopaedic diseases of the horse with no
considerable side effects, and especially effective for the
treatment of chronic proximal suspensory ligament desmitis und
chronic proximal sesamoiditis.