M. sc.(Biomedical-engineering)-Thesis-Presentation(PPT.)- Effects-of-low-level-laser-therapy-on-human-bone-regeneration
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M. sc.(Biomedical-engineering)-Thesis-Presentation(PPT.)- Effects-of-low-level-laser-therapy-on-human-bone-regeneration



M.sc (Biomedical Engineering) Thesis Presentation: EFFECTS OF LOW LEVEL LASER THERAPY ON HUMAN BONE REGENERATION (ppt.).

M.sc (Biomedical Engineering) Thesis Presentation: EFFECTS OF LOW LEVEL LASER THERAPY ON HUMAN BONE REGENERATION (ppt.).



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M. sc.(Biomedical-engineering)-Thesis-Presentation(PPT.)- Effects-of-low-level-laser-therapy-on-human-bone-regeneration M. sc.(Biomedical-engineering)-Thesis-Presentation(PPT.)- Effects-of-low-level-laser-therapy-on-human-bone-regeneration Presentation Transcript

  • Supervisor:1Chairman,Prof. and 2Course-coordinatorof International Co-operation.Co- Supervisors:Prof. F. H. Sirazee3(Ex. Head of the Department ),Associate Prof. P.C Debenath3( Head of the Department ). 1. Dept. of Medical Radiation Physics, Kreis-krankenhaus Gummersbach Teaching Hospital of the University of Cologne, 51643 Gummersbach, Germany.2. Dept. of Medical Physics and Biomedical Engineering, GonoBishwabidyalay (Gono University), Nayarhat, Savar, Dhaka- 1344, Bangladesh.3. Department of Orthopedic and Traumatology, ShaheedSuhrawardy Medical College Hospital, Dhaka-1207,Bangladesh. 2
  • Contents: 3
  • Introduction:Optimizing the results of fracture treatmentrequires a holistic view of both patients andtreatment.There is a perception, not least among fracturesurgeons themselves, that the mechanical issueshave been over-emphasized in the past. 4
  • Introduction:The principles of AO treatment, drummedinto a generation of orthopedictrainees, were anatomical openreduction, rigid internal fixation and earlyrehabilitation of soft tissues withoutexternal splint. 5
  • Introduction:Now the science is taking another step, further inthe direction from mechanics to biology.If the mechanical environment influences boneregeneration and hence fracture healing, how, ata cellular level, does it do so. 6
  • Introduction:Low level laser acts on biological tissues on cellularlevel.The basic premise is that LLLT stimulates cellactivation processes which in turn, intensifyphysiologic al activities. 7
  • Introduction:Low Level Laser increases - Cellular ion-exchange, Tissue vascularization, Lymphatic circulation, Activates cytokines, Growth factors andnecessary hormonal activities for tissue healingenhancement in the proliferative stage therebyreduction of pain & inflammation. 8
  • Introduction:And increases Fibroblast, Chondrocyte and osteoblast proliferation, Inhibition of osteoclast & Synthesis of bone collagen and bone matrixthat activities & enhances bone regeneration. 9
  • How to Speed upfracture healing ! Although there are no magical ways to fix a bone fracture, but there are ways to help speed up the healing process, and help fracture to heal properly/ faster.  Proper medical management.  Nutritional Support.  BMP/ Osteoblast cell injection  Electrical stimulation.  Magnetic stimulation.  Ultrasound therapy.  Gene-therapy  Low Level Laser therapy. 10
  • Enhancement of Bone Union(Cont.)Among the current procedures of bonefracture union enhancement, low levellaser therapy is superior to others incontrast to-  Patient Compliance,  Length Of Healing Time,  Less-invasive Procedure And Cost-effectiveness. 11
  • Laser mechanism on biologicaltissues can be explained by-1. Physical mechanism2. Bio-chemical mechanismThe primary (physical) mechanisms relateto the interaction between photons andmolecules in the tissue, while thesecondary mechanisms relate to theeffect of the chemical (Bio-chemical)changes induced by primary effects. 12
  • Mechanism of action of LLLT on tissue (cont.): physical- There are two primary forms of physical effects generated by laser irradiation on biological tissues: Photon-absorption (the basis of photobiological action, and generated by all forms of light). Internal conversion & fluorescence of light also generates Speckle formation, which is unique to laser therapy. 13
  • Mechanism of action ofLLLT on tissue (cont.):Biochemical- Bio-chemical action of laser can be explained by“Action of photon with mitochondrial respiratorychain- Cytochromecoxidase enzyme”.  Cytochromecoxidase mediated increase in ATP production.  Cytochromecoxidase mediated singlet-oxygen production.  Cytochromecoxidase mediated Reactive oxygen species (ROS) formation.  Cytochromecoxidase mediated Photodiassociation and Nitric Oxide Production. 14
  • Infrared laser radiation enhances bone regeneration/ formation by two consecutive phases of cellular, intra cellular and tissue modulating cascades of inter- depended process.• 1.Directly by simulation of osteoblast formation, inhibition of osteoclast activities, proliferation/differentiation of fibroblast and enhancement bone growth factors/ modulation of cytokines.• 2. Indirectly by enhancing some specific bone formation modulation, and creating a friendly environment that fascinates bone formation /regeneration. 15
  • Mechanism of action of Laser on Bone union(Direct)-• Studies of bone healing response to infrared light show acceleration of osteoblast formation as well as calcium salt deposition under the influence of infrared light.• Osteoclast Inhibition Prevents Bone Mineral Resorption .• Bone-matrix & collagen synthesis. 16
  • Mechanism of action of Laser on Bone union(Indirect)-• Laser promotes cellular/tissue ion exchange / transport and enhances Bone Mineralization.• Laser therapy increases Nitric Oxide in tissues which increases vascularity, thereby helps in tissue healing and Bone Formation.• Laser therapy increases lymphatic circulation in bone and enhances better tissue healing & regeneration. 17
  • Effects Of Low Level Laser(Ga-al-as, 830nm) On HumanAppendicular Bone FractureByAssessing Parameters:  Objective (Clinical) &  Subjective (Radiological). 18
  • • Duration of study: The duration of this study was two years (from April- 2008 to March- 2010).• Type of study:• Prospective Randomized Case Control study.• Place of study: The study was conducted at ShaheedSuhrawardy Medical College Hospital in the Department of Orthopedics and Traumatology, Sher- E-Bangla Nagor, Dhaka-1207, Bangladesh. 19
  • Materials & Method (Cont.) Materials: sample• The sample was collected randomly from admitted patients with appendicular bone fracture (superior and inferior extremity) at ShaheedSuhrawardy Medical College Hospital in the Department of Orthopedics and Traumatology, Dhaka-1207, Bangladesh.• A total of 40 patients randomly collected; among which 20 were in the Laser group (L1,L2) and 20 were in the control group (C1,C2). 20
  • Materials & Method (Cont.)Materials: MachineBio-Lux MD Ga- Al- As Laser(830 nm) Machine with Probe. 21
  • Materials & Metho(Cont.)Method:Applied laser in the laser therapy groupwas continuous infrared laser with BioLuxMD (Ga-Al-As-830nm).The first session was started on the 5th dayafter surgery/ incidence; based on previousresearch work which proved that laserworks best on the proliferative stage oftissue healing. 22
  • Materials & Method(Cont.) Method:• Procedure: LLLT was irradiated on the fracture- side, performed transcutaneously in pointing method, in 4 anatomical locations at 500 mW; 0.5 centimeter away from fracture line and, two points in each site of line/ day.• Dose and duration: @ 8J/cm2 dose (energy) of total dose 8*4*9 J/cm2 for adult & @ 4 J/cm2 dose (energy) of total dose 4*4*9 J/cm2 for child. 23
  • Materials & Method (Cont.)Method:Treatment Protocol (Cont.)Laser Treatment Protocols used inThis work:• 4- 8 joules /cm2• 4 points/ session• Power-500mw• Point spacing is every 2-4 sq. cm.• Treatment schedule: daily for the first week, followed by alternate day in the second week (9 days total). 24
  • Materials & Method(Cont.) Method (Cont.)• The data’s were routinely processed, by measuring the callus/ new bone formation. The best sets of weekly x-ray images of each patient from each group were selected for this analysis, and data’s are also shown in datasheets and graphs .• Efficacies of treatment were evaluated with pain questionnaire, clinical assessment and serial weekly radiograph assessment starting from 1st week up to 4th week and on the 6th week. 25
  • Materials & Method(Cont.)Method (Cont.)The patients were analyzed by-Clinical Assessment Pain & inflammation level. Stability of fracture side. Movement of fracture side. Immobilization duration. Patient compliance. 26
  • Densitometerused in this Radiological Assessmentwork.  Radiographic Scoring System (by Lane and Sandhu) of fracture site, done weekly.  Densitometer assessment of Callus in the radiograph of fracture site, taken weekly. 27
  • • Clinically the laser group showed better stable fracture site, earlier movement of limb and removal of cast/plaster was performed.• Pain & inflammation also subsided much earlier in the laser group (L1 & L2) than the control group (C1 & C2). 28
  • Observation & Result(Cont.)• Radio-logically, this study compared degree of callus formation, callus density changes by weeks, and assessment of bone/ callus formation/ union, pain & inflammation parameters changes, with and without laser radiation (LLLT) in the post laser therapy period, starting from 1st week up to 4th week and on 6th. 29
  • Observation Patient on & Result (Cont.) LLLT Before starting of treatment.L1-2. Patient Name:Md DalilUddinAge: 95 YearsSex: MaleDiagnosis: FractureLt. Humerus (Shaft)Study group: L1 At 1st week At 2nd week At 3rd week At 4th week At 6th week At 12th week 30
  • Observation & Result(Cont.) C1-1.. Patient Name: Halima Begum Age: 55 Years Sex: Female Diagnosis: Fracture Rt. Shaft of Femur Study group: C1 Patient Name: Ms Halima Begum Week Vs Bone Density: Non-fracture side(Cortex, Medulla) & fracture Side ( Cortex, Medulla). Non-fracture site, Medulla fracture site, Medulla Non-fracture site, Cortex fracture site,Cortex 2.0033 1.7767 1.7567 1.43 1.0167 1.2267 1.8133 1.1667 1.0167 1.0033 1.2867 0.8333 1.14 0.87 1.8233 0.8367 1.1033 0.9267 0.9333 0.5633 31At the end of the 1st week At the end of the 2nd week At the end of the 3rd week At the end of the 4th week At the end of the 6th week
  • Observation & Result(Cont.) L1-1. Patient Name: Ms Anowara Age: 55 Years Sex: Female Diagnosis: Fracture Rt. Shaft of Radius Study group: L1 Patient Name: Ms Anowara Week Vs Bone Density Change: Non-fracture side (Cortex, Medulla) & fracture side ( Cortex, Medulla) Non-fracture site, Medulla fracture site, Medulla Non-fracture site, Cortex fracture site, Cortex 2.0267 0.9067 0.9033 1.2333 0.9667 1.1667 1.1733 1.1767 1.3067 0.78 0.8333 0.88 0.88 0.9033 1.39 0.8367 1.0933 1.0967 0.8967 0.5633 32At the end of the 1st week At the end of the 2nd week At the end of the 3rd week At the end of the 4th week At the end of the 6th week
  • • The result of this study reveals a better bone healing after irradiation with 830nm diode laser (Ga-Al-As).• This study result also concludes that better bone healing after irradiation with Ga-Al- As, 830nm diode laser in human model as an adjunctive to regular fracture management that accelerates bone union significantly and enhances patient compliances. 33
  • This study has demonstrated the potential of low level laser therapy in the treatment of –“ Enhancement Of Human Bone Fracture Union”. 34
  • FutureRecommendations(Cont.)A large multi- centric study pointingimportant subjective (i.e. • mechanical, • biochemical and • Histological , as well as objective (clinical) parameters. 35
  • Future Recommendations (Cont.) Including - laser protocol (dose, duration, type of laser & mode of operation), patient selection criteria and procedure of therapy, is highly desirable to make this non- invasive method of bone stimulation applicable in medical science. 36