冲击波治疗骨肌疾病课件

1、让疼痛远离我和我的家人冲击波治疗仪第1页，共51页。手柄表面，高能流密度surface, high ED0,35 mJ/mm2深度，低能流密度depth, low ED 探头Transmitter在组织中传播spreads in the tissueED: 能流密度ED: energy flux density有效治疗范围Radial Extension第2页，共51页。绝对禁忌症ABSOLUTE CONTRAINDICATIONS妊娠Pregnancy血栓症thrombosis血凝固紊乱（血友病）coagulation disorders (haemophilia)肿瘤疾病tumour di

2、seases 急性炎症acute inflammation目标治疗区脓肿pus focus in the target area第3页，共51页。相对禁忌症RELATIVE CONTRAINDICATIONS抗凝血剂使用者，特别是苯丙香豆素（维生素K拮抗剂） use of anticoagulants, especially marcumar (vitamin k antagonist)有多发性神经病的糖尿病 polyneuropathy in case of diabetes mellitus可的松治疗结束六周后才能使用体外冲击波治疗 cortisone therapy up to 6 we

3、eks before first ESWT treatment风湿性疾病 rheumatic disease第4页，共51页。肿胀swelling变红reddening血肿haematomas瘀点petechiae灼伤般疼痛感pain like sunburn治疗初期病情恶化first worsening副作用SIDE EFFECTS第5页，共51页。冲击波治疗的益处Benefits of Shock Wave Treatment 几次治疗后，疼痛即得到缓解/减轻 pain relief/ reduction after a few treating sessions 治疗依从性好 the c

4、ompliance is very good 治疗后病人能直接感受到第一疗效 the patients can feel first effects directly after the treatment 能治疗复杂症状及相关适应症 treatment of complex symptoms/ indications possible第6页，共51页。治疗结缔组织 treatment of connective tissue活化淋巴系统 activation of lymphatic system大面积治疗 treatment of large areas possible作用于神经系统（门

5、控制、疼痛记忆） effects on the nervous system (gate control, pain memory?)冲击波治疗的益处Benefits of Shock Wave Treatment第7页，共51页。经典适应症CLASSIC INDICATIONS第8页，共51页。经典适应症Classic Indications Calcific tendonitis/ shoulder pain钙化性肌腱炎/肩痛Achillodynia 跟腱痛Plantar fasciitis 足底筋膜炎Ulnar humeral epicondylitis肱骨内上踝炎Tibial stre

6、ss syndrome胫骨压力症候群Radial humeral epicondylitis肱骨外上髁炎Trochanteric tendonitis转子肌腱炎Patellar tendonitis髌腱炎第9页，共51页。治疗方法 PROTOCOL 查找主要痛点和其他痛点look for the main and other pain points 与病人密切交谈close dialogue with the patient 生物反馈biofeedback 2000次发散式冲击波 radial shocks 2000 多数学派的治疗方法protocol of the most studies

7、传统派old school新派：联合疗法，治疗扳机点 new: combined therapy, trigger points第10页，共51页。治疗方法PROTOCOL治疗间隔：5-7天 interval5 7days治疗次数：3-5次 sessions3 5最晚在第5次治疗后进入休息期 break latest after 5th session第11页，共51页。钙化肌腱炎/肩痛Calcific tendonitis/Shoulder pain前期超声或X线定位/决定治疗区域与深度Preliminary ultrasound orx-ray localization/ determin

8、ation of penetration depth and treatment area在皮肤上标记出治疗区域Marking of therapeutic window on the skin在90%的例子中，旋转套的冈上肌腱感染，需要治疗。In approx. 90% of the casesthe supraspinatus tendon of the rotator cuff is affected and has to be treated 第12页，共51页。钙化肌腱炎/肩痛Calcific tendonitis/Shoulder pain第13页，共51页。钙化肌腱炎/肩痛Cal

9、cific tendonitis/Shoulder pain第14页，共51页。钙化肌腱炎/肩痛Calcific tendonitis/Shoulder pain第15页，共51页。钙化肌腱炎/肩痛Calcific tendonitis/Shoulder pain第16页，共51页。肱骨内上髁炎Radial humeral epicondylitis DD第17页，共51页。Ulnar humeral epicondylitis 肱骨内上髁炎Sessions 治疗次数Energy 能级(bar)Pulses/session 每次治疗使用脉冲数Freq 频率(Hz)Transmitter 探头T

10、endon insertion (painful spot) 腱附着端1. Pain points 痛点5 81.8 4.01500 300012 15R15Adjacent upper arm and forearm muscles邻近的上臂与前臂的肌肉2. Muscles 肌肉1.8 3.02000 300015 21D20-STreatment interval: 5 - 7 days 治疗间隔：5 - 7 天Supine patient positioning Flexion of elbow joint approx. 30 to 40 degree, supination posi

11、tion. R-SW (R15) application at the tendon insertion. 病人仰卧位 肘关节弯曲大约30-40度，手心向上。R-SW(R15)应用于腱附着端。Supine patient positioning Extension of elbow joint, supination position. Smoothing of forearm muscles with D20-S.病人仰卧位 肘关节外展，手心向上。用D20-S按摩前臂肌肉。 肱骨内上髁炎Ulnar humeral epicondylitis仅使用发散性冲击波疗法Only radial sho

12、ck wave therapy 第18页，共51页。肱骨内上髁炎Ulnar humeral epicondylitis病人仰卧位-肘关节外展。用V-ACTOR按摩邻近肌肉。Supine patient positioning Extension of elbow joint. Smoothing of surrounding muscles with the V-ACTOR。第19页，共51页。Preliminary ultrasound/x-ray for localization,determination of penetrationdepth 前期超声或X线定位，确定治疗深度Marki

13、ng of therapy region 标记治疗区域转子肌腱炎Trochanteric Tendonitis ESWT New Treatment Guide第20页，共51页。转子肌腱炎Trochanteric Tendonitis DD第21页，共51页。Patellar tendonitis (Jumpers Knee) 髌骨肌腱炎（跳跃膝）Preliminary ultrasound/x-ray for localization,determination of penetrationdepth 前期超声或x线定位，确定治疗深度Marking of therapy region 标记

14、治疗区域第22页，共51页。髌骨肌腱炎（跳跃膝）Patellar tendonitis (Jumpers Knee)第23页，共51页。Patellar tendonitis 髌骨肌腱炎Sessions 治疗次数Energy 能级(bar)Pulses/session 每次治疗使用脉冲数Freq 频率(Hz)Transmitter 探头Patella, tibial tendon insertion 髌骨、胫骨腱附着端1. Pain points 痛点6 82.8 3.52000 300015 21R15, DI15Adjacent muscles 相邻肌肉2. Muscles 肌肉2.0 3

15、.52000 400021D20-S, D35-STreatment interval: 5 - 7 days 治疗间隔：5 - 7 天Supine patient positioning with the knee on a half roll. Fixation of patellar zone with a cuff. R-SW (R15) application at the patella (tip, basis) and tibial tendon insertion.病人仰卧位，膝盖置于半圆柱形物上。用一条绷带固定髌骨区。R-SW(R15)应用于髌骨（尖部、底部）及胫骨腱附着端。

16、Supine patient positioning with the knee on a half roll. Fixation of paellar zone with a cuff. Smoothing of adjacent muscles with D20.病人仰卧位，膝盖置于半圆柱形物上。用一条绷带固定髌骨区。用D20按摩相邻肌肉。髌骨肌腱炎Patellar tendonitis (Jumpers Knee) 仅使用发散式冲击波疗法Only radial shock wave therapy 第24页，共51页。 Preliminary ultrasound/ x-ray 前期超声

17、/X线定位 Marking of therapy region 标记治疗区域胫骨压力综合征（胫骨疲劳性骨膜炎）Tibial stress syndrome (Shin splint) ESWT New Treatment Guide第25页，共51页。Tibial stress syndrome 胫骨压力综合征Sessions 治疗次数Energy 能级(bar)Pulses/session 每次治疗使用脉冲数Freq 频率(Hz)Transmitter 探头Medial, inner edge of shin bone 胫骨内缘1. Pain points 痛点6 82.8 3.52000

18、300015 21R15, DI15Adjacent muscles 相邻肌肉2. Muscles 肌肉2.0 3.52000 400021D20-S, D35-STreatment interval: 5 - 7 days 治疗间隔：5 - 7 天Supine patient positioning with knee on a half roll. R-SW application.病人仰卧位，膝盖置于半圆柱形物上。使用R-SW。胫骨压力综合征（胫骨疲劳性骨膜炎） Tibial stress syndrome (Shin splint)仅使用发散式冲击波疗法Only radial shoc

19、k wave therapy 第26页，共51页。跟腱痛AchillodyniaPreliminary ultrasound / x-ray 前期超声/x线定位Marking of therapy region 标记治疗区域第27页，共51页。跟腱痛Achillodynia第28页，共51页。跟腱痛Achillodynia第29页，共51页。足底筋膜炎Plantar fasciitisPreliminary ultrasound/ x-ray 前期超声/x线定位Localization of pain points withbio-feedback 根据人体生物反馈定位痛点Marking of

20、 therapy region 标记治疗区域第30页，共51页。足底筋膜炎，跟骨骨刺Plantar fasciitis, Heel Spur第31页，共51页。足底筋膜炎，跟骨骨刺Plantar fasciitis, Heel Spur第32页，共51页。足底筋膜炎，跟骨骨刺Plantar fasciitis, Heel Spur第33页，共51页。研究Studies第34页，共51页。Improvement %改善度RSW发散式冲击波2 month2个月55.26 month6个月72.912 month12个月84.02000次冲击波，治疗3次，一周一次2000, 3 sessions,

21、1/ week跟骨骨刺Heel Spur第35页，共51页。Improvement %改善度Verum冲击波治疗组Control对照组1 week1周73284 weeks4周634852 weeks52周81发散式冲击波，2000次，治疗3次，1周1次RSW, 2000, 3 sessions, 1/ week肱骨外上髁炎HER第36页，共51页。%Pain free 无疼痛感Improvement有明显改善Unchanged无变化Worse恶化4 weeks 4周25.7 54.314.25.73 month 3个月5014.330.710.76 month 6个月59.325.914.8

22、012 month 12个月80.319.2RSW, 5 sessions, 1/ weekCalcium deposit % 钙沉积Gone钙化消失Disintegration分解No Change无变化4 weeks 4周17.620.961.53 month 3个月44.86.948.36 month 6个月65.34.430.412 month 12个月7525RSW, 2000, 3 sessions, 1/ week 发散式冲击波，2000次，治疗3次，1周1次肩袖钙化性肌腱炎Calcific Tendinitis of Rotator Cuff第37页，共51页。After 1

23、year1年之后反馈Recalcification再钙化5 %OP骨质疏松5 %Resorption骨吸收90 %钙化性肌腱炎，聚焦式冲击波Tendinosis Calcarea, FSW第38页，共51页。Follow up追踪观察Verum 冲击波治疗组Placebo安慰剂组Mid中期75.4 % good 良好52.3 %Long term长期80.7 %40.9 %夹挤综合症，聚焦式冲击波Impingement Syndrome, FSW第39页，共51页。1 yearfollow up1年后反馈Achillodynia跟腱痛Patella tip syndrome髌骨尖综合征Tibi

24、alis anterior syndrome胫前综合征Pain free 疼痛消失60 %40 %58.8 %Improvement 有改善12.5 %24.4 %17.7 %No change 无明显变化27.5 %35.6 %23.5 %发散式冲击波，治疗5次，1周1次RSW, 5 sessions, 1/ week疼痛治疗Sports-Induced Diseases第40页，共51页。肌筋膜疼痛综合症Myofascial pain syndrome扳机点治疗Trigger point treatment第41页，共51页。肌筋膜疼痛综合征Myofascial pain syndrome

25、可用RSWT成功治愈的骨科适应症 Orthopaedic indications which can be treated successfully with RSWT 上位及低位颈部综合征Upper and lower Cervical-Syndrome肩周痛Periarticular shoulder pain前臂屈伸肌腱炎Tendomyosis in the extensor and flexor region of the forearm 上踝病变Epicondylopathy背痛Dorsalgia (Back pain)臀肌痛Glutealgia第42页，共51页。 内收肌疼痛Pai

26、n in the adductor muscles 股屈伸肌痉挛Shortenings in the femoral flexor and extensor muscles 小腿筋膜间室综合征Peroneal compartment syndrome胫前综合征Tibial anterior syndrome 胫骨压力综合征（胫骨疲劳性骨膜综合征）Tibial stress syndrome (Shin splint)伴有/不伴有跟腱痛的小腿肌肉萎缩Shortening of the calf muscle with and without Achillodynia 跖骨痛Metatarsalg

27、ia肌筋膜疼痛综合征Myofascial pain syndrome可用RSWT成功治愈的骨科适应症 Orthopaedic indications which can be treated successfully with RSWT第43页，共51页。肌筋膜疼痛综合征Myofascial pain syndrome治疗长度Length of treatment取决于肌肉刺激的持续范围和时间Depending on the extent and duration of the muscle irritation早期疼痛可经过1-2次治疗成功治愈。Early stage complaints

28、can be treated successfully with 1 - 2 treatments sessions 多数案例中，痛点的缓解/解除需要4-8次治疗（一周12次治疗）In most cases several treatment sessions (4 - 8) are required to release/eliminate the pain points (1 -2 treatments / week).建议尽早采用扳机点治疗It is recommended to start trigger point treatment at the most possible ear

29、ly stage第44页，共51页。肌筋膜疼痛综合征Myofascial pain syndrome 冲击波治疗的优点Benefits of shock wave therapy 促进组织再生Strong regenerative effect on the tissue可深入组织治疗，而不伤皮肤Penetrate deep inside the tissue without harming the skin 因此冲击波操作方便，易于重复治疗。可被大多数患者接受。Therefore shock wave therapy can be easily repeated and is well tolerated by most patients.第45页，共51页。 超声波扫描术Sonography 给病人提供最安全的治疗方案 Gives the patients the most possible treatment safety 可识别不可采用ESWT治疗的结构改变（例如肿瘤） Structural modifications which must not be treated with RSW